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Ossato A, Gasperoni L, Del Bono L, Messori A, Damuzzo V. Efficacy of Immune Checkpoint Inhibitors vs. Tyrosine Kinase Inhibitors/Everolimus in Adjuvant Renal Cell Carcinoma: Indirect Comparison of Disease-Free Survival. Cancers (Basel) 2024; 16:557. [PMID: 38339309 PMCID: PMC10854775 DOI: 10.3390/cancers16030557] [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: 12/18/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The proven efficacy of mTOR inhibitors (mTORIs), tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs) in metastatic renal cell carcinoma (RCC) suggests that these agents should be investigated as adjuvant therapy with the aim of eliminating undetectable microscopic residual disease after curative resection. The aim of our study was to compare the efficacy of these treatments using an innovative method of reconstructing individual patient data. METHODS Nine phase III trials describing adjuvant RCC treatments were selected. The IPDfromKM method was used to reconstruct individual patient data from Kaplan-Meier (KM) curves. The combination treatments were compared with the control arm (placebo) for disease-free survival (DFS). Multi-treatment KM curves were used to summarize the results. Standard statistical tests were performed. These included hazard ratio and likelihood ratio tests for heterogeneity. RESULTS In the overall population, the study showed that two ICIs (nivolumab plus ipilimumab and pembrolizumab) and one TKI (sunitinib) were superior to the placebo, whereas both TKIs and mTORIs were inferior. As we assessed DFS as the primary endpoint for the adjuvant comparison, the overall survival benefit remains unknown. CONCLUSIONS This novel approach to investigating survival has allowed us to conduct all indirect head-to-head comparisons between these agents in a context where no "real" comparative trials have been conducted.
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Affiliation(s)
- Andrea Ossato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padova, Italy;
| | - Lorenzo Gasperoni
- Oncological Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Luna Del Bono
- Azienda Ospedaliera Universitaria Pisana, 56100 Pisa, Italy;
| | - Andrea Messori
- HTA Unit, Regional Health Service, 50139 Florence, Italy
| | - Vera Damuzzo
- Hospital Pharmacy, Vittorio Veneto Hospital, 31029 Vittorio Veneto, Italy
- Italian Society of Clinical Pharmacy and Therapeutics (SIFaCT), 10123 Turin, Italy
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Magerl M, Schiffhorst G, Fanter L, Müller G, Hirche C, Berkemeier F, Aygören E. Patient-level indirect treatment comparison of lanadelumab versus pdC1-INH i.v. in hereditary angioedema patients: PATCH study. Allergy 2024; 79:215-224. [PMID: 37641968 DOI: 10.1111/all.15861] [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: 03/16/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is an autosomal dominant inherited disease in which patients suffer from local attacks primarily affecting skin and gastrointestinal tract, and sometimes even the upper respiratory tract leading to asphyxiation. Since head-to-head trials between authorized treatments are lacking, this study compares efficacy and safety of lanadelumab and intravenous plasma-derived C1-esterase inhibitor (pdC1-INH i.v.) in HAE patients on long-term prophylaxis by means of an indirect treatment comparison. METHODS Efficacy and safety of lanadelumab against pdC1-INH i.v. were analyzed in a fully prespecified indirect comparison based on individual patient data (n = 231) from the HELP and CHANGE clinical trials. Primary and secondary efficacy endpoints were compared using a generalized linear model for count data. Confounding variables were identified a priori via systematic literature research and validated by clinical experts. Adjustment of confounders was implemented using a conditional regression model. RESULTS Lanadelumab showed a statistically significant improvement in reduction of HAE attack rates compared to pdC1-INH i.v. across multiple endpoints: Monthly attack rate of patients treated with lanadelumab was less than half compared to pdC1-INH i.v. (Rate ratio: 0.486; 95% CI: 0.253, 0.932). Monthly rate of laryngeal attacks was found to be five times lower for lanadelumab (Rate ratio: 0.2; 95% CI: 0.044, 0.915) and monthly rate of acute treated HAE attacks among lanadelumab patients was about one third of the attack rate of pdC1-INH i.v. patients (Rate ratio: 0.366; 95% CI: 0.185, 0.727). CONCLUSION This study contributes to current knowledge in the treatment of HAE by indicating a statistically significant reduction of HAE attacks under lanadelumab compared to pdC1-INH i.v.
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Affiliation(s)
- Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | | | - Lena Fanter
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | - Gerrit Müller
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | | | | | - Emel Aygören
- Universitätsklinikum Frankfurt, Frankfurt, Germany
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Oliveira-Maia AJ, Rive B, Morrens J, Godinov Y, Cabrieto J, Perualila N, Mulhern-Haughey S. Indirect adjusted comparison of 6-month clinical outcomes between esketamine nasal spray and other real-world polypharmacy treatment strategies for treatment resistant depression: results from the ICEBERG study. Front Psychiatry 2023; 14:1250987. [PMID: 38025416 PMCID: PMC10669145 DOI: 10.3389/fpsyt.2023.1250987] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background The efficacy of esketamine nasal spray (NS) as a rapid-acting agent for treatment resistant depression (TRD) was demonstrated in comparisons with placebo, when both were given in addition to a newly initiated selective serotonin reuptake inhibitor (SSRI)/serotonin norepinephrine reuptake inhibitor (SNRI). How esketamine NS compares with commonly used real-world (RW) polypharmacy treatment strategies is not known. Method ICEBERG was an adjusted indirect treatment comparison that analysed data from SUSTAIN-2 (NCT02497287; clinicaltrials.gov), a long-term, open-label study of esketamine NS plus SSRI/SNRI, and the European Observational TRD Cohort (EOTC; NCT03373253; clinicaltrials.gov), an observational study of routine clinical practice. Data were compared between patients receiving esketamine NS (SUSTAIN-2) and those from the EOTC treated with polypharmacy treatment strategies, either combination or augmentation. Analyses were adjusted for potential confounders, using rescaled average treatment effect among treated estimates. Threshold analyses were conducted to assess potential impact of unmeasured confounders on the robustness of analyses where esketamine NS was found to be significantly superior. Sensitivity analyses were used to understand the impact of analysis method selection and data handling. Results Esketamine NS treatment resulted in a higher probability of 6-month response (49.7% [95% confidence interval (CI) 45.6-53.9]) and remission (33.6% [95% CI 29.7-37.6]) versus RW polypharmacy (26.8% [95% CI 21.0-32.5] and 19.4%, [95% CI 14.2-24.6], respectively). Relative risk calculations showed esketamine NS was 1.859 (95% CI 1.474-2.345; p < 0.0001) times as likely to result in response and 1.735 (1.297-2.322; p = 0.0002) times as likely to result in remission versus RW polypharmacy at 6 months. Threshold and extensive sensitivity analyses supported that analyses of esketamine NS superiority were robust. Conclusion ICEBERG supports esketamine NS being superior to current RW individualized polypharmacy strategies, including augmentation, with benefits extending beyond acute use, to improved chance of 6-month response and remission. While unobserved confounding factors may certainly impact results of an indirect comparison, threshold analysis supported a low likelihood of this affecting the conclusions.To view an animated summary of this publication, please click on the Supplementary video.
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Affiliation(s)
- Albino J. Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
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Oliveira-Maia AJ, Morrens J, Rive B, Godinov Y, Cabrieto J, Perualila N, Barbreau S, Mulhern-Haughey S. ICEBERG study: an indirect adjusted comparison estimating the long-term benefit of esketamine nasal spray when compared with routine treatment of treatment resistant depression in general psychiatry. Front Psychiatry 2023; 14:1250980. [PMID: 38025433 PMCID: PMC10669153 DOI: 10.3389/fpsyt.2023.1250980] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Treatment resistant depression (TRD) affects 10-30% of patients with major depressive disorder. In 4-week trials, esketamine nasal spray (NS) was efficacious vs. placebo when both were initiated in addition to a new selective serotonin or serotonin norepinephrine reuptake inhibitor. However, comparison with an extended range of real-world treatments (RWT) is lacking. Methods ICEBERG was an adjusted indirect treatment comparison using propensity score-based inverse probability weighting, performed on 6-month response and remission data from patients receiving esketamine NS plus oral antidepressant from the SUSTAIN-2 (NCT02497287; clinicaltrials.gov) study, compared with patients receiving other RWT from the European Observational TRD Cohort (EOTC; NCT03373253; clinicaltrials.gov) study. SUSTAIN-2 was a long-term open-label study of esketamine NS, while the EOTC was conducted at a time when esketamine NS was not available as RWT. Threshold and sensitivity analyses were conducted to assess how robust the primary analyses were. Results Patients receiving esketamine NS had a higher probability of 6-month response (49.7% [95% confidence interval (CI) 45.6-53.9]) and remission (33.6% [95% CI 29.7-37.6]) vs. patients receiving RWT (26.4% [95% CI 21.5-31.4] and 18.2% [95% CI 13.9-22.5], respectively), according to rescaled average treatment effect among treated estimates. Resulting adjusted odds ratios (OR) and relative risk (RR) favoured esketamine NS over RWT for 6-month response (OR 2.756 [95% CI 2.034-3.733], p < 0.0001; RR 1.882 [95% CI 1.534-2.310], p < 0.0001) and remission (OR 2.276 [95% CI 1.621-3.196], p < 0.0001; RR 1.847 [95% CI 1.418-2.406], p < 0.0001). Threshold analyses suggested that differences between the two studies were robust, and results were consistent across extensive sensitivity analyses. Conclusion ICEBERG supports that, at 6 months, esketamine NS has a substantial and significant benefit over RWT for patients with TRD. While results may be affected by unobserved confounding factors, threshold analyses suggested these were unlikely to impact the study conclusions.To view an animated summary of this publication, please click on the Supplementary video.
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Affiliation(s)
- Albino J. Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
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Osorio J, Maccioni S, Sharma R, Patel L, Spin P, Natale A. QDOT MICRO™ versus THERMOCOOL ® SMARTTOUCH™ and THERMOCOOL SMARTTOUCH ® Surround Flow in radiofrequency ablation of paroxysmal atrial fibrillation. J Comp Eff Res 2023; 12:e230005. [PMID: 37584396 PMCID: PMC10690395 DOI: 10.57264/cer-2023-0005] [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: 01/17/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Aim: The objective of this study was to indirectly compare QDOT MICRO™ (QDOT), Thermocool® SmartTouch™ (ST) and Thermocool® SmartTouch® Surround Flow (STSF) to treat paroxysmal atrial fibrillation. Methods: Differences in baseline characteristics between study cohorts were reduced by reweighting patients using inverse probability of treatment weighting. The primary outcome was procedure time. Secondary outcomes were fluoroscopy time, clinical success at 12 months, and rhythm monitoring-adjusted recurrence. Results: QDOT was associated with significantly faster mean procedure and fluoroscopy time, and significant improvement in the rate of recurrence compared with pooled ST/STSF. No difference was observed for clinical success at 12 months. Conclusion: QDOT was associated with greater efficiency, greater effectiveness in rhythm monitoring-adjusted recurrence and similar effectiveness in clinical success at 12 months compared with pooled ST/STSF.
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Affiliation(s)
- Jose Osorio
- Medical Director Electrophysiology, Electrophysiology - Cardiovascular Group, HCA Florida Miami, Miami, FL 33133, USA
| | - Sonia Maccioni
- Johnson & Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, CA 92618, USA
| | - Reecha Sharma
- Johnson & Johnson Medical Devices, Clinical Research, Irvine, CA 92618, USA
| | | | - Paul Spin
- EVERSANA, Burlington, ON, L7N 3H8, Canada
| | - Andrea Natale
- Executive Medical Director, Texas Cardiac Arrhythmia Research, St. David's Medical Center, Austin, TX 78705, USA
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Gebbia V, Valerio MR, Martorana F, Sanò MV, Vigneri P. Letter to the Editor: statistics and clinical perception of patients' reported outcomes for palbociclib and abemaciclib: a sliding doors story. J Comp Eff Res 2023; 12:e220212. [PMID: 37114420 PMCID: PMC10402907 DOI: 10.57264/cer-2022-0212] [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: 12/18/2022] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Vittorio Gebbia
- Kore University of Enna, Enna, 94100, Italy
- Medical Oncology Units, La Maddalena Clinic for Cancer, Palermo, 90100, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinico P. Giaccone, University of Palermo, Palermo, 90100, Italy
| | - Federica Martorana
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, 95100Italy
- Department of Clinical & Experimental Medicine, University of Catania, Catania - Italy, & Center of Experimental Oncology & Hematology AOU, Policlinico ‘G. Rodolico – San Marco’, Catania, 95100, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, 95100Italy
| | - Paolo Vigneri
- Department of Clinical & Experimental Medicine, University of Catania, Catania - Italy, & Center of Experimental Oncology & Hematology AOU, Policlinico ‘G. Rodolico – San Marco’, Catania, 95100, Italy
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Law EH, Cameron C. Letter in Reply: indirect comparison of quality-of-life scores between patients with advanced breast cancer receiving palbociclib and abemaciclib in combination with fulvestrant. J Comp Eff Res 2023; 12:e230009. [PMID: 37114409 PMCID: PMC10402903 DOI: 10.57264/cer-2023-0009] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Ernest H Law
- Director, Value & Evidence, Pfizer, New York, NY 10017, USA
| | - Chris Cameron
- Chief Scientific Officer, Global Value & Evidence, EVERSANA, Sydney, Nova Scotia, B1P 1C6, Canada
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Signorovitch J, Diels J, Van Sanden S, Schubert A, Hassan F, Thilakarathne P, Ozturk B, Barthelmes N, Reich K. Matching-adjusted indirect comparison (MAIC) results confirmed by head-to-head trials: a case study in psoriasis. J DERMATOL TREAT 2023; 34:2169574. [PMID: 36724798 DOI: 10.1080/09546634.2023.2169574] [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: 02/03/2023]
Abstract
BACKGROUND Head-to-head comparisons through randomized controlled trials (RCTs) provide high-quality evidence to inform healthcare decisions. In their absence, indirect comparisons are often performed; however, evidence is limited on how valid matching-adjusted indirect comparison (MAIC)-based comparative efficacy estimates are vs. RCT-based estimates. OBJECTIVES Compare MAIC and RCT results of guselkumab vs. secukinumab and ixekizumab to provide insight into validity of results generated using MAIC methods. METHODS Previously reported results from MAICs of guselkumab vs. secukinumab and ixekizumab were compared with results from ECLIPSE and IXORA-R RCTs based on risk differences between Psoriasis Area and Severity Index (PASI) 90 response rates. RESULTS Risk difference (95% confidence interval) in PASI 90 response rates at week 48 for guselkumab vs. secukinumab was 14.4% (9.4%; 19.4%) in ECLIPSE and 9.4% (4.7%; 14.0%) in the MAIC. The risk difference at week 24 for guselkumab vs. ixekizumab was 0.0% (-5.4%; 5.4%) in IXORA-R and 0.7% (-5.1%; 6.4%) in the MAIC. CONCLUSIONS Comparative efficacy results were consistent between MAICs and RCTs of guselkumab vs. secukinumab and ixekizumab. This analysis demonstrates that MAIC methods can provide valid relative treatment effect estimates when direct comparisons are lacking, particularly when trials with similar designs and patient populations inform the analysis.
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Affiliation(s)
| | | | | | | | - Fareen Hassan
- Janssen-Cilag Ltd, High Wycombe, Buckinghamshire, UK
| | | | - Bulent Ozturk
- Janssen-Cilag Ltd, High Wycombe, Buckinghamshire, UK
| | | | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Phillippo DM, Dias S, Ades AE, Belger M, Brnabic A, Saure D, Schymura Y, Welton NJ. Validating the Assumptions of Population Adjustment: Application of Multilevel Network Meta-regression to a Network of Treatments for Plaque Psoriasis. Med Decis Making 2023; 43:53-67. [PMID: 35997006 PMCID: PMC9742635 DOI: 10.1177/0272989x221117162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Network meta-analysis (NMA) and indirect comparisons combine aggregate data (AgD) from multiple studies on treatments of interest but may give biased estimates if study populations differ. Population adjustment methods such as multilevel network meta-regression (ML-NMR) aim to reduce bias by adjusting for differences in study populations using individual patient data (IPD) from 1 or more studies under the conditional constancy assumption. A shared effect modifier assumption may also be necessary for identifiability. This article aims to demonstrate how the assumptions made by ML-NMR can be assessed in practice to obtain reliable treatment effect estimates in a target population. METHODS We apply ML-NMR to a network of evidence on treatments for plaque psoriasis with a mix of IPD and AgD trials reporting ordered categorical outcomes. Relative treatment effects are estimated for each trial population and for 3 external target populations represented by a registry and 2 cohort studies. We examine residual heterogeneity and inconsistency and relax the shared effect modifier assumption for each covariate in turn. RESULTS Estimated population-average treatment effects were similar across study populations, as differences in the distributions of effect modifiers were small. Better fit was achieved with ML-NMR than with NMA, and uncertainty was reduced by explaining within- and between-study variation. We found little evidence that the conditional constancy or shared effect modifier assumptions were invalid. CONCLUSIONS ML-NMR extends the NMA framework and addresses issues with previous population adjustment approaches. It coherently synthesizes evidence from IPD and AgD studies in networks of any size while avoiding aggregation bias and noncollapsibility bias, allows for key assumptions to be assessed or relaxed, and can produce estimates relevant to a target population for decision-making. HIGHLIGHTS Multilevel network meta-regression (ML-NMR) extends the network meta-analysis framework to synthesize evidence from networks of studies providing individual patient data or aggregate data while adjusting for differences in effect modifiers between studies (population adjustment). We apply ML-NMR to a network of treatments for plaque psoriasis with ordered categorical outcomes.We demonstrate for the first time how ML-NMR allows key assumptions to be assessed. We check for violations of conditional constancy of relative effects (such as unobserved effect modifiers) through residual heterogeneity and inconsistency and the shared effect modifier assumption by relaxing this for each covariate in turn.Crucially for decision making, population-adjusted treatment effects can be produced in any relevant target population. We produce population-average estimates for 3 external target populations, represented by the PsoBest registry and the PROSPECT and Chiricozzi 2019 cohort studies.
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Affiliation(s)
- David M. Phillippo
- David M. Phillippo, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK; ()
| | - Sofia Dias
- University of Bristol, Bristol, UK,University of York, York, North Yorkshire, UK
| | | | | | - Alan Brnabic
- Eli Lilly Australia Pty. Limited, Sydney, NSW, Australia
| | - Daniel Saure
- Lilly Deutschland GmbH, Bad Homburg, Hessen, Germany
| | - Yves Schymura
- Lilly Deutschland GmbH, Bad Homburg, Hessen, Germany
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Cheng D, Tchetgen ET, Signorovitch J. On the double-robustness and semiparametric efficiency of matching-adjusted indirect comparisons. Res Synth Methods 2022; 14:438-442. [PMID: 36537355 DOI: 10.1002/jrsm.1616] [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: 04/04/2022] [Revised: 09/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Matching-adjusted indirect comparison (MAIC) enables indirect comparisons of interventions across separate studies when individual patient-level data (IPD) are available for only one study. Due to its similarity with propensity score weighting, it has been speculated that MAIC can be combined with outcome regression models in the spirit of augmented inverse probability weighting estimators to improve robustness and efficiency. We show that MAIC enjoys intrinsic double-robustness and semiparametric efficiency properties for estimating the average treatment effect on the treated in the limited IPD setting without explicit augmentation. A connection between MAIC and the method of simulated treatment comparisons is highlighted. These results clarify conditions under which MAIC is consistent and efficient, informing appropriate application and interpretation of MAIC analyses.
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Affiliation(s)
- David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Tchetgen Tchetgen
- Department of Statistics and Data Science, University of Pennsylvania Wharton School, Philadelphia, Pennsylvania, USA
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Wen Y, Jiang T, Wu X, Peng H, Ren S, Zhou C. Front-line treatment for advanced non-small-cell lung cancer and ALK fusion: a network meta-analysis. Ther Adv Med Oncol 2022; 14:17588359221116607. [PMID: 36032351 PMCID: PMC9403455 DOI: 10.1177/17588359221116607] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background: It remains unknown what is the optimal front-line choice for advanced
non-small-cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK)
fusion. Methods: We conducted a systematic review and network meta-analysis of randomized
phase III clinical trials comparing two or more treatments as the front-line
setting for patients with advanced ALK-positive NSCLC. Results: Nine phase III randomized clinical trials with 2367 patients were included.
As to efficacy, lorlatinib had the most favorable progression-free survival
[PFS; surface under the cumulative ranking curve (SUCRA) = 98.4%] in the
first-line setting, with noticeable outcome benefits versus
chemotherapy [hazard ratio (HR): 0.12; 95% confidence interval (CI):
0.08–0.19], crizotinib (HR: 0.28; 95% CI: 0.19–0.41), ceritinib (HR: 0.22;
95% CI: 0.13–0.37), and brigatinib (HR: 0.58; 95% CI: 0.35–0.96), as well as
beneficial trends when compared with alectinib (HR: 0.66; 95% CI: 0.41–1.04)
and ensartinib (HR: 0.62; 95% CI: 0.36–1.08). Meanwhile, alectinib showed
the optimal overall survival (OS; SUCRA = 91.2%), with significant
improvements over chemotherapy (HR: 0.47; 95% CI: 0.30–0.72) and crizotinib
(HR: 0.58; 95% CI: 0.41–0.82). Similarly, brigatinib also displayed
prolonged OS compared with crizotinib after adjustment for crossover by the
marginal structural model (HR: 0.54; 95% CI: 0.31–0.92). In terms of safety,
alectinib had the fewest grade 3–5 adverse events (SUCRA = 98.9%), with
marked advantages versus crizotinib [odds ratio (OR): 0.67;
95% CI: 0.46–0.97], ceritinib (OR: 0.21; 95% CI: 0.10–0.43), brigatinib (OR:
0.37; 95% CI: 0.20–0.69), ensartinib (OR: 0.48; 95% CI: 0.27–0.89), and
lorlatinib (OR: 0.30; 95% CI: 0.16–0.54). Conclusions: Lorlatinib may have advantageous PFS compared with other agents but a greater
risk of severe toxicity. Second-generation inhibitors, including alectinib,
brigatinib, and ensartinib, provide major efficacy with less toxicity and
remain appropriate regimens in the front-line setting.
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Affiliation(s)
- Yaokai Wen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiangrong Wu
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Haoxin Peng
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, No. 507, Zheng Min Road, Shanghai 200433, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, No. 507, Zheng Min Road, Shanghai 200433, China
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Rogliani P, Ora J, Cavalli F, Cazzola M, Calzetta L. Comparing the Efficacy and Safety Profile of Triple Fixed-Dose Combinations in COPD: A Meta-Analysis and IBiS Score. J Clin Med 2022; 11:jcm11154491. [PMID: 35956108 PMCID: PMC9369741 DOI: 10.3390/jcm11154491] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Triple fixed-dose combination (FDC) therapy is recommended in severe chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations and/or symptoms not controlled by dual FDCs. Since no randomized controlled trials (RCTs) have directly compared the different inhaled corticosteroid/long-acting β2-adrenoceptor agonist/long-acting muscarinic antagonist (ICS/LABA/LAMA) FDCs, we performed a meta-analysis to compare the impact of the current available ICS/LABA/LAMA FDCs in COPD. Methods: A meta-analysis was performed by connecting beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide or glycopyrrolate (BDP/FOR/GLY), budesonide (BUD)/GLY/FOR, and fluticasone furoate/umeclidinium bromide/vilanterol (FF/UMEC/VI) FDCs via ICS/LABA or LABA/LAMA FDCs arms. The safety and efficacy profiles were investigated, and the Implemented Bidimensional Surface under the cumulative ranking curve analysis (IBiS) was carried out. Protocol registration: CRD42022301189. Results: Data from 21,809 COPD patients were extracted from the ETHOS, IMPACT, KRONOS, and TRILOGY studies. No significant (p > 0.05) differences were detected across the triple FDCs with respect to the risk of exacerbation, trough forced expiratory volume in the first second (FEV1), transition dyspnea index (TDI), St. George’s Respiratory Questionnaire (SGRQ), risk of serious adverse events (SAEs), cardiovascular (CV) SAEs, pneumonia, and all-cause mortality. According to IBiS score, BDP/FOR/GLY 200/12/25 µg twice daily (BID) was the FDC reporting the best combined efficacy/safety profile (area 41.41%), although FF/UMEC/VI 100/62.5/25 µg once daily (QD) showed the greatest efficacy profile (50.54%). The protection against mortality related to the dose of ICS. Conclusions: All triple FDCs are effective and safe in COPD regardless of the regimen of administration (twice daily vs. once daily), with no relevant difference in the risk of CV SAEs and pneumonia.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (P.R.); (J.O.); (M.C.)
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Josuel Ora
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (P.R.); (J.O.); (M.C.)
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Francesco Cavalli
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (P.R.); (J.O.); (M.C.)
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
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Zhang L, Qian Y, Li J, Cui C, Chen L, Qu S, Lu S. Indirect comparison of sintilimab and other PD-L1 inhibitors for first-line treatment of non-squamous non-small-cell lung cancer. Future Oncol 2022; 18:1896-1905. [PMID: 35311347 DOI: 10.2217/fon-2021-1336] [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: 11/21/2022] Open
Abstract
Objective: To evaluate sintilimab compared with other PD-L1 inhibitors in combination with platinum-based doublet chemotherapy as the first-line treatment of non-squamous non-small-cell lung cancer. Methods: A frequentist meta-analysis was used to compare outcomes, including progression-free survival, overall survival, objective response rate, time to response and safety profile. Results: The sintilimab combination arm had progression-free survival comparable to that of the pembrolizumab combination arm (hazard ratio [HR] = 1.00; 95% CI: 0.71, 1.41), the atezolizumab combination arm (HR: 0.81; 95% CI: 0.59, 1.10), the tislelizumab combination arm (HR: 0.75; 95% CI: 0.48, 1.16), the camrelizumab combination arm (HR: 0.80; 95% CI: 0.54, 1.20) and the nivolumab combination arm (HR: 0.72; 95% CI: 0.51, 1.02). Any grade or grade ≥3 adverse event was comparable between PD-L1 inhibitors. Conclusion: Sintilimab showed a comparable efficacy and safety profile when compared with other PD-L1 inhibitors combined with platinum-based doublet chemotherapy as the first-line treatment of locally advanced or metastatic non-squamous non-small-cell lung cancer.
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Affiliation(s)
- Lei Zhang
- Eli Lilly & Company, Shanghai, 200021, China
| | - Yijiao Qian
- Eli Lilly & Company, Shanghai, 200021, China
| | - Jinnan Li
- Eli Lilly & Company, Shanghai, 200021, China
| | - Chenwei Cui
- Eli Lilly & Company, Shanghai, 200021, China
| | - Lu Chen
- Eli Lilly & Company, Shanghai, 200021, China
| | - Shuli Qu
- Real World Solutions, IQVIA, Shanghai, 200126, China
| | - Shun Lu
- Oncology department, Shanghai Chest Hospital, Shanghai, 20030, China
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Fu X, Liu Y. A systematic review and meta-analysis of indirect comparison between miRNA and ctDNA in diagnosis of epithelial ovarian cancer. Transl Cancer Res 2022; 10:5372-5382. [PMID: 35116384 PMCID: PMC8799085 DOI: 10.21037/tcr-21-2609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/17/2021] [Indexed: 12/13/2022]
Abstract
Background To evaluate the clinical value of microRNA (miR) and circulating tumor RNA (ctDNA) in the diagnosis of epithelial ovarian cancer (EOC) by meta-analysis and indirect comparison based on common reference criteria. Methods The PubMed, EMBASE, MEDLINE, Cochrane Library, Chinese biology medicine (CBM), China national knowledge infrastructure (CNKI), Wanfang, and Chinese Weipu (VIP) databases were searched by computer. The retrieval time limit was from the date of establishment of the database to September 2020. Two researchers independently screened the literature and extracted the basic data according to the inclusion and exclusion criteria formulated in advance, and evaluated the literature quality according to the quality assessment of diagnostic accuracy research (quadas-2). The Meta disc 1.4 and Stata 12.0 software programs were used for meta-analysis to calculate the combined sensitivity, combined specificity, combined positive likelihood ratio, combined negative likelihood ratio and combined diagnostic odds ratio (DOR). The summary receiver operating characteristic (SROC) curve was drawn using Revman 5.3 software, and the stability of the results was evaluated by sensitivity analysis. The publication bias was evaluated by Deek’s funnel asymmetric test. The relative diagnostic odds ratio (RDOR) results of indirect comparison between microRNA and ctDNA were obtained using R software. Results Nineteen articles were included, including a total of 1,351 EOC patients and 1,194 controls. The heterogeneity test showed that there was obvious heterogeneity caused by non-threshold effect. The random effects model was used for meta-analysis of microRNA in the diagnosis of EOC. The results showed that there was no significant difference between microRNA and ctDNA in the accuracy of EOC diagnosis. The asymmetric test of Deek’s funnel chart showed that there was no significant publication bias. Discussion There are some limitations in this study, there is no blind diagnostic test, and the intensity of indirect comparison evidence is lower than that of direct comparison evidence. The accuracy of diagnostic tests and the imperfection of mesh meta-analysis statistical methods. MicroRNA and ctDNA have similar clinical diagnostic value for EOC.
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Affiliation(s)
- Xiaohang Fu
- Department of Postpartum Rehabilitation, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xi'an, China
| | - Yani Liu
- Department of Gynecology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xi'an, China
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Niewada M, Macioch T, Konarska M, Mela A, Goszczyński A, Przekopińska B, Rajkiewicz K, Wysocki P, Krzakowski M. Immune checkpoint inhibitors combined with tyrosine kinase inhibitors or immunotherapy for treatment-naïve metastatic clear-cell renal cell carcinoma-A network meta-analysis. Focus on cabozantinib combined with nivolumab. Front Pharmacol 2022; 13:1063178. [PMID: 36937206 PMCID: PMC10020696 DOI: 10.3389/fphar.2022.1063178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/06/2022] [Accepted: 11/14/2022] [Indexed: 03/06/2023] Open
Abstract
Introduction: The combination of immunotherapy and targeted therapy is currently marking a new era in the treatment of renal cancer. The latest clinical guidelines recommend the use of drug combinations for the first-line treatment of advanced renal cancer. The aim of this review is to compare the efficacy of combined cabozantinib + nivolumab therapy with other immune checkpoint inhibitors combined with tyrosine kinase inhibitors or monoclonal antibodies blocking the CTLA-4 (cytotoxic T cell antigen 4) in the first-line treatment of metastatic clear-cell renal cell carcinoma (RCC). Methodology: A systematic literature search was carried out in the PubMed and EMBASE databases. Randomized controlled trials (RCTs) on therapies recommended by the latest EAU and ESMO guidelines for treatment-naïve metastatic RCC (i.e., lenvatinib + pembrolizumab, axitinib + pembrolizumab and nivolumab + ipilimumab) were searched. A network meta-analysis (NMA) was performed for data synthesis. The methodology of included RCTs was assessed using the Cochrane RoB two tool. The data were analyzed in the overall population as well as in risk subgroups defined according to the International Metastatic Database Consortium (IMDC) i.e., patients with a favorable and intermediate or poor prognoses. The most recent cut-off dates from included studies were analyzed. Results: Four RCTs (CheckMate 9 ER, KEYNOTE-426, CLEAR and CheckMate 214) were included in the review. No studies directly comparing cabozantinib + nivolumab with any of the drug combinations included in this review were available. NMA showed that cabozantinib + nivolumab was superior compared to axitinib + pembrolizumab and nivolumab + ipilimumab in all analyzed comparisons (overall population and IMDC risk subgroups), both in terms of overall survival and progression-free survival (PFS). The advantage of cabozantinib + nivolumab was statistically significant only for PFS when compared to nivolumab + ipilimumab in the overall population. The results for the comparison of cabozantinib + nivolumab with lenvatinib + pembrolizumab showed numerical superiority of lenvatinib + pembrolizumab combination in terms of overall survival, but none of the results were statistically significant. The advantage of lenvatinib + pembrolizumab over cabozantinib + nivolumab in terms of PFS was statistically significant in the overall and favorable prognosis population. Conclusion: Inclusion of the most recent cut-off data from CheckMate 9 ER did not affect the role of the cabozantinib + nivolumab combination for treatment-naïve metastatic RCC. Cabozantinib + nivolumab is an effective therapeutic option for the first-line treatment of advanced renal cancer that is recommended both in the latest European and American guidelines for all IMDC risk groups.
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Affiliation(s)
- Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
- HealthQuest Sp. z.o.o, Warsaw, Poland
| | - Tomasz Macioch
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
- HealthQuest Sp. z.o.o, Warsaw, Poland
| | | | - Aneta Mela
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
- Ipsen Polan Sp. z.o.o, Warsaw, Poland
- *Correspondence: Aneta Mela,
| | | | | | | | - Piotr Wysocki
- Department of Oncology, Jagiellonian University-Collegium Medicum Hospital, Cracow, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Chest Tumors, the Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Ruggiero A, Fabbrocini G, Cinelli E, Megna M. Real world practice indirect comparison between guselkumab and risankizumab: Results from an Italian retrospective study. Dermatol Ther 2021; 35:e15214. [PMID: 34800070 PMCID: PMC9285826 DOI: 10.1111/dth.15214] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/05/2021] [Accepted: 11/16/2021] [Indexed: 12/28/2022]
Abstract
IL‐23‐inhibitors, such as guselkumab and risankizumab, represent the newest class of biologics approved for psoriasis. Phase III trials have shown their efficacy and safety. However, real life data are still scant. to indirectly compare the effectiveness, safety and tolerability of guselkumab and risankizumab in real world practice. An Italian single‐center retrospective cohort study enrolling moderate‐to‐severe psoriasis patients from September 1, 2018 and December 31, 2020 was performed to indirectly compare guselkumab and risankizumab efficacy and safety. Sixty eight patients were included (36 received guselkumab and 32 risankizumab). The groups were comparable for all analyzed characteristics, except for mean psoriasis duration (p < 0.01) which was higher for guselkumab. In guselkumab group, mean PASI reduced from 16.1 ± 6.4 (baseline) 2.1 ± 0.9 (week‐28) (p < 0.001) up to 0.9 ± 0.8 (week‐44) (p < 0.001). In risankizumab group mean PASI decreased from 13.5 ± 4.9 (baseline) 1.9 ± 0.8 (p < 0.001), (week‐28) (p < 0.001) up to 0.9 ± 0.4 (week‐40) (p < 0.001). No significant difference in mean PASI and BSA were observed between the treatments. No cases of serious AEs, injection site reaction, candida, malignancy, cardiovascular events were reported in both groups. Guselkumab and risankizumab showed favorable efficacy and safety profile, being comparable in terms of PASI90 and PASI100 responses as well as in AEs frequency and discontinuation rates.
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Affiliation(s)
- Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Eleonora Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Pratley RE, Catarig A, Lingvay I, Viljoen A, Paine A, Lawson J, Chubb B, Gorst‐Rasmussen A, Miresashvili N. An indirect treatment comparison of the efficacy of semaglutide 1.0 mg versus dulaglutide 3.0 and 4.5 mg. Diabetes Obes Metab 2021; 23:2513-2520. [PMID: 34286894 PMCID: PMC9291551 DOI: 10.1111/dom.14497] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
AIM To compare the effects of semaglutide 1.0 mg versus dulaglutide 3.0 and 4.5 mg on HbA1c and body weight in patients with type 2 diabetes. MATERIALS AND METHODS A Bucher indirect comparison was conducted to compare efficacy outcomes of semaglutide 1.0 mg versus dulaglutide 3.0 and 4.5 mg using published results from the SUSTAIN 7 and AWARD-11 trials. Sensitivity analyses using individual patient data from SUSTAIN 7 and aggregate data from AWARD-11 were conducted to explore the impact of adjustment for cross-trial imbalances in baseline characteristics. RESULTS Semaglutide 1.0 mg significantly reduced HbA1c versus dulaglutide 3.0 mg, with an estimated treatment difference (ETD) of -0.24%-points (95% confidence interval [CI] -0.43, -0.05), with comparable reductions in HbA1c versus dulaglutide 4.5 mg with an ETD of -0.07%-points (95% CI -0.26, 0.12). Semaglutide 1.0 mg significantly reduced body weight versus dulaglutide 3.0 and 4.5 mg with an ETD of -2.65 kg (95% CI -3.57, -1.73) and -1.95 kg (95% CI -2.87, -1.03), respectively. Sensitivity analyses supported the primary analysis findings. CONCLUSIONS This indirect comparison showed significantly greater reductions in HbA1c with semaglutide 1.0 mg versus dulaglutide 3.0 mg and comparable HbA1c reductions versus dulaglutide 4.5 mg. Semaglutide 1.0 mg significantly reduced body weight versus both dulaglutide 3.0 and 4.5 mg. With several glucagon-like peptide-1 receptor agonists available, information regarding their comparative efficacy can be valuable to clinicians.
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Affiliation(s)
| | | | - Ildiko Lingvay
- Department of Internal Medicine/Endocrinology, Department of Clinical Sciences, UT Southwestern Medical CenterUniversity of TexasDallasTexasUSA
| | | | - Abby Paine
- Zedediah Consulting on behalf of DRG Abacus (part of Clarivate)WokinghamUK
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Fazel M, AlRawashdh N, Alamer A, Curiel-Lewandrowski C, Abraham I. Is there still a role for talimogene laherparepvec (T-VEC) in advanced melanoma? An indirect efficacy comparison of T-VEC plus ipilimumab combination therapy versus T-VEC alone as salvage therapy in unresectable metastatic melanoma. Expert Opin Biol Ther 2021; 21:1647-1653. [PMID: 34693839 DOI: 10.1080/14712598.2022.1998450] [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: 10/20/2022]
Abstract
BACKGROUND Talimogene laherparepvec (T-VEC) improves overall survival (OS) in unresectable stage IIIB/C-IV melanoma T-VEC may have synergistic effects with CTLA-4 inhibitors In the absence of a trial comparing T-VEC and ipilimumab (T-VEC + IPI) to T-VEC, we applied a novel indirect comparison method using extrapolated OS curves to estimate OS outcomes in a simulated trial comparing both regimens in stage IIIB/C-IV unresectable melanoma. RESEARCH DESIGN AND METHODS Two trials with extractable OS curves for a T-VEC versus T-VEC + IPI comparison were identified. Outcomes were adjusted for heterogeneity in prognostic factors using a calculated adjustment factor. T-VEC and adjusted/unadjusted T-VEC+IPI curves were plotted with 95% CIs. RESULTS Unadjusted indirect OS comparison of T-VEC versus T-VEC + IPI revealed no significant difference up to 15 months. Extrapolation beyond 15 months showed significant survival benefits for T-VEC + IPI over T-VEC, confirmed in adjusted analyses. The expected OS percentage at 48 months is 32.0% (95% CI = 26.6-37.3) for T-VEC, 60.0% (95% CI = 46.2-69.1) for unadjusted, and 81.1% (95% CI = 72.3-85.9) for adjusted T-VEC + IPI. CONCLUSIONS Our novel indirect comparison suggests that T-VEC + IPI may demonstrate a significantly improved OS versus T-VEC alone. Findings may portend a possible role for the addition of T-VEC to advanced melanoma treatment regimens in select patients as salvage therapy.
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Affiliation(s)
- Mohammad Fazel
- Division of Dermatology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Neda AlRawashdh
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA.,Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Ahmad Alamer
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.,Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Ivo Abraham
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA.,Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Gristina V, Galvano A, Castellana L, Insalaco L, Cusenza S, Graceffa G, Iacono F, Barraco N, Castiglia M, Perez A, Rizzo S, Russo A, Bazan V. Is there any room for PD-1 inhibitors in combination with platinum-based chemotherapy as frontline treatment of extensive-stage small cell lung cancer? A systematic review and meta-analysis with indirect comparisons among subgroups and landmark survival analyses. Ther Adv Med Oncol 2021; 13:17588359211018018. [PMID: 34646363 PMCID: PMC8504650 DOI: 10.1177/17588359211018018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
Background: The addition of PD-L1 inhibitors to platinum-based chemotherapy (CT) has newly received United States Food and Drug Administration (FDA) approval in extensive stage-small cell lung cancer (ES-SCLC). PD-1 agents similarly improved survival rates, even if not yet supported by international regulatory agencies. The current work aims to assess different efficacy and safety profiles among chemoimmunotherapy plus immuno-oncology (CT+IO) approaches according to different immune checkpoint inhibitor (ICI) subtypes. Material & Methods: We included in our meta-analysis six first-line randomised controlled trials (RCTs) comparing the association of single-agent ICI with CT versus CT alone in ES-SCLC. Pooled hazard ratios (HRs) and risk ratios (RRs) for progression-free survival (PFS), overall survival (OS), objective response rates (ORR), 12-month duration of response rate (DORR), disease control rate (DCR), treatment-related adverse events (TRAEs) and discontinuation rates (DRs) were obtained. Moreover, we performed indirect comparisons according to ICI subtypes, also among subgroups and landmark survival analyses. Results: Although no ORR benefit was observed, our results showed how CT+IO significantly improved DORR, resulting in improved PFS and OS with no differences in TRAEs; however, CT+IO led to a significant increase in DR. Interestingly, an Eastern Cooperative Oncology Group performance status (ECOG PS) of 1, the use of cisplatin, and the absence of brain metastases seem to be associated with a survival gain using CT+IO in ES-SCLC. Indirect comparisons suggested a slight advantage in favour of programmed cell death-1 (PD-1) and programmed death ligand 1 (PD-L1) over anti-CTLA-4 agents in terms of efficacy with no additional safety concerns. No further differences were observed between PD-1 and PD-L1 inhibitors among subgroups and landmark survival analyses with benefit trends towards anti-PD-1 in terms of DORR and DR. Conclusion: While confirming a survival advantage of CT+IO in selected patients, these results suggested the association of PD-1 inhibitors with CT as a viable option for novel therapeutic approaches in the frontline management of ES-SCLC. Further trials evaluating anti-CTLA-4 agents should be carefully studied in biomarker-selected patients.
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Affiliation(s)
- Valerio Gristina
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonio Galvano
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Luisa Castellana
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Lavinia Insalaco
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Stefania Cusenza
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppa Graceffa
- Division of General and Oncological Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Federica Iacono
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Nadia Barraco
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marta Castiglia
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Alessandro Perez
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Sergio Rizzo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, via del vespro, n. 129, Palermo, 90127, Italy
| | - Viviana Bazan
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
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Curtis JR, Regueiro M, Yun H, Su C, DiBonaventura M, Lawendy N, Nduaka CI, Koram N, Cappelleri JC, Chan G, Modesto I, Lichtenstein GR. Tofacitinib Treatment Safety in Moderate to Severe Ulcerative Colitis: Comparison of Observational Population Cohort Data From the IBM MarketScan® Administrative Claims Database With Tofacitinib Trial Data. Inflamm Bowel Dis 2021; 27:1394-1408. [PMID: 33324993 PMCID: PMC8376127 DOI: 10.1093/ibd/izaa289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Tofacitinib is an oral, small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). We aimed to estimate the overall incidence of safety events in patients with UC in a real-life population cohort for comparison with the tofacitinib UC clinical trial program. METHODS Clinical trial-like criteria were applied to an IBM MarketScan® claims database population-based cohort (n = 22,967) of patients with UC (October 2010 to September 2015) to identify a UC trial-like cohort treated with tumor necrosis factor inhibitors (TNFi; n = 6366) to compare with the tofacitinib UC clinical trial cohort (n = 1157). RESULTS Incidence rates (events per 100 patient-years; [95% confidence interval]) in the UC trial-like cohort were as follows: serious infections, 3.33 (2.73-4.02); opportunistic infections (OIs; excluding herpes zoster [HZ]), 1.45 (1.06-1.93); HZ, 1.77 (1.34-2.29); malignancies (excluding nonmelanoma skin cancer [NMSC]), 0.63 (0.43-0.90); NMSC, 1.69 (1.35-2.10); major adverse cardiovascular events (MACE), 0.51 (0.31-0.79); pulmonary embolism (PE), 0.54 (0.30-0.89); deep vein thrombosis (DVT), 1.41 (1.00-1.93); and gastrointestinal perforations, 0.31 (0.16-0.54). Compared with the UC trial-like cohort, tofacitinib-treated patients had numerically lower incidence rates for serious infections (1.75 [1.27-2.36]), OIs (excluding HZ; 0.16 [0.04-0.42]), NMSC (0.78 [0.47-1.22]), PE (0.16 [0.04-0.41]), and DVT (0.04 [0.00-0.23]), and a higher rate for HZ (3.57 [2.84-4.43]); rates for malignancies (excluding NMSC), MACE, and gastrointestinal perforations were similar. CONCLUSIONS When acknowledging limitations of comparing claims data with controlled clinical trial data, incidence rates for HZ among TNFi-treated patients in the UC trial-like cohort were lower than in the tofacitinib UC clinical trial cohort; rates for serious infections, OIs, NMSC, PE, and DVT were numerically higher. CLINICALTRIALS.GOV NCT00787202, NCT01465763, NCT01458951, NCT01458574, NCT01470612.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Huifeng Yun
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | - Gary R Lichtenstein
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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21
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Schwarzer G, Efthimiou O, Rücker G. Inconsistent results for Peto odds ratios in multi-arm studies, network meta-analysis and indirect comparisons. Res Synth Methods 2021; 12:849-854. [PMID: 34133079 DOI: 10.1002/jrsm.1503] [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: 12/02/2020] [Revised: 05/11/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022]
Abstract
The Peto odds ratio is a well-known effect measure in meta-analysis of binary outcomes. For pairwise comparisons, the Peto odds ratio estimator can be severely biased in the situation of unbalanced sample sizes in the two treatment groups or large treatment effects. In this publication, we evaluate Peto odds ratio estimators in the setting of multi-arm studies and in network meta-analysis using illustrative examples. We observe that Peto odds ratio estimators in a multi-arm study are inconsistent if the observed event probabilities are different or the sample sizes of treatment groups are unbalanced. The same problem emerges in network meta-analysis including only two-arm studies and translates to indirect comparisons of pairwise meta-analyses. We conclude that the Peto odds ratio should not be used as effect measure in network meta-analysis or indirect comparisons of pairwise meta-analyses.
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Affiliation(s)
- Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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22
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Tie K, Miller C, Zanation AM, Ebert CS. Subcutaneous Versus Sublingual Immunotherapy for Adults with Allergic Rhinitis: A Systematic Review with Meta-Analyses. Laryngoscope 2021; 132:499-508. [PMID: 33929726 DOI: 10.1002/lary.29586] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine whether subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT) better improves patient outcomes and quality of life for adults with allergic rhinitis or rhinoconjunctivitis (AR/C) with or without mild to moderate asthma. METHODS Systematic review methodology was based on the Cochrane Collaboration handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses. Four databases (PubMed, Cochrane Library, EMBASE, and Web of Science) were queried from inception to July 30, 2020. Two independent reviewers screened potentially relevant studies and assessed risk of bias. Outcomes of interest were symptom score (SS), medication score (MS), combined symptom medication score (CSMS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Meta-analyses with an adjusted indirect comparison were conducted in RevMan 5.4.1. RESULTS Seven SCIT versus SLIT randomized controlled trials (RCTs) demonstrated no significant differences for any outcomes, but insufficient data precluded direct meta-analysis. For the adjusted indirect comparison, 46 RCTs over 39 studies were included for SCIT versus placebo (n = 13) and SLIT versus placebo (n = 33). Statistically significant results favoring SCIT were found for SS (standardized mean difference [SMD] = 0.40; 95% confidence interval [CI] = 0.31-0.49), MS (SMD = 0.26; 95% CI = 0.14-0.39), CSMS (SMD = 0.42; 95% CI = 0.17-0.67), and RQLQ (MD = 0.24; 95% CI = 0.04-0.44). Statistically significant results favoring SLIT were found for SS (SMD = 0.42; 95% CI = 0.32-0.53), MS (SMD = 0.40; 95% CI = 0.28-0.53), CSMS (SMD = 0.37; 95% CI = 0.29-0.45), and RQLQ (MD = 0.32; 95% CI = 0.20-0.43). No significant differences were found between SCIT and SLIT for SS (SMD = -0.02; 95% CI = -0.15 to 0.11), MS (SMD = -0.14; 95% CI = -0.31 to 0.03), CSMS (SMD = 0.05; 95% CI = -0.21 to 0.31), or RQLQ (MD = -0.08; 95% CI = -0.31 to 0.15). CONCLUSION SCIT and SLIT are comparably effective treatments for adults with AR/C. More RCTs analyzing SCIT versus SLIT are needed to directly compare the two. Laryngoscope, 2021.
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Affiliation(s)
- Kevin Tie
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Craig Miller
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Charles S Ebert
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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23
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Phillippo DM, Dias S, Ades AE, Welton NJ. Assessing the performance of population adjustment methods for anchored indirect comparisons: A simulation study. Stat Med 2020; 39:4885-4911. [PMID: 33015906 PMCID: PMC8690023 DOI: 10.1002/sim.8759] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Standard network meta-analysis and indirect comparisons combine aggregate data from multiple studies on treatments of interest, assuming that any factors that interact with treatment effects (effect modifiers) are balanced across populations. Population adjustment methods such as multilevel network meta-regression (ML-NMR), matching-adjusted indirect comparison (MAIC), and simulated treatment comparison (STC) relax this assumption using individual patient data from one or more studies, and are becoming increasingly prevalent in health technology appraisals and the applied literature. Motivated by an applied example and two recent reviews of applications, we undertook an extensive simulation study to assess the performance of these methods in a range of scenarios under various failures of assumptions. We investigated the impact of varying sample size, missing effect modifiers, strength of effect modification and validity of the shared effect modifier assumption, validity of extrapolation and varying between-study overlap, and different covariate distributions and correlations. ML-NMR and STC performed similarly, eliminating bias when the requisite assumptions were met. Serious concerns are raised for MAIC, which performed poorly in nearly all simulation scenarios and may even increase bias compared with standard indirect comparisons. All methods incur bias when an effect modifier is missing, highlighting the necessity of careful selection of potential effect modifiers prior to analysis. When all effect modifiers are included, ML-NMR and STC are robust techniques for population adjustment. ML-NMR offers additional advantages over MAIC and STC, including extending to larger treatment networks and producing estimates in any target population, making this an attractive choice in a variety of scenarios.
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Affiliation(s)
- David M. Phillippo
- Bristol Medical School (Population Health Sciences)University of BristolBristolUK
| | - Sofia Dias
- Bristol Medical School (Population Health Sciences)University of BristolBristolUK
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - A. E. Ades
- Bristol Medical School (Population Health Sciences)University of BristolBristolUK
| | - Nicky J. Welton
- Bristol Medical School (Population Health Sciences)University of BristolBristolUK
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24
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Jackson D, Rhodes K, Ouwens M. Alternative weighting schemes when performing matching-adjusted indirect comparisons. Res Synth Methods 2020; 12:333-346. [PMID: 33131206 DOI: 10.1002/jrsm.1466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/17/2020] [Revised: 07/22/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022]
Abstract
Methods for indirect comparisons and network meta-analysis use aggregate level data from multiple studies. A very common, and closely related, scenario is where a company has individual patient data (IPD) from its own trial, but only has published aggregate data from a competitor's trial, and an indirect comparison of the treatments evaluated in these two trials is required. Matching-Adjusted Indirect Comparison (MAIC) has been developed for this situation, where we use the available IPD to adjust for between-trial imbalances in the distributions of observed baseline covariates between the two trials. We extend the current MAIC methodology, where we compute the weights that satisfy the conventional method of moments and result in the largest possible effective sample size (ESS). We show that the approach proposed by Zubizarreta in a previous study can be used for this purpose. We derive a new analytical result that shows why this alternative approach provides a larger ESS than a conventional MAIC. We also derive a new formula for the maximum ESS that can be achieved, even when permitting negative weights, when adjusting for one covariate. This can be used as an easily computed new metric that quantifies the difficulty in adjusting for covariates. What is already known: MAIC is an established way to perform population adjustment in the situation where IPD is available from one trial but only aggregate level data is available from another trial, and an indirect comparison is required. However the effective sample size (ESS) can be small after making the adjustment. What is new: We show that an alternative method can result in a larger ESS. We provide new analytical results showing why this is the case. We derive a new descriptive statistic that is based on maximising the ESS that quantifies the difficulties in adjusting for particular covariates. Potential impact for RSM readers outside the authors' field: Reweighting methods for population adjustment are becoming more commonly used and their implications for research synthesis methodology is now considerable. This paper provides important new links between the theoretical literature, and the more applied research synthesis methodology literature, relating to this topic.
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Affiliation(s)
- Dan Jackson
- Statistical Innovation Group, AstraZeneca, Cambridge, UK
| | - Kirsty Rhodes
- Statistical Innovation Group, AstraZeneca, Cambridge, UK
| | - Mario Ouwens
- Statistical Innovation Group, AstraZeneca, Cambridge, UK
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25
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Lingvay I, Capehorn MS, Catarig AM, Johansen P, Lawson J, Sandberg A, Shaw R, Paine A. Efficacy of Once-Weekly Semaglutide vs Empagliflozin Added to Metformin in Type 2 Diabetes: Patient-Level Meta-analysis. J Clin Endocrinol Metab 2020; 105:5896001. [PMID: 32827435 PMCID: PMC7549924 DOI: 10.1210/clinem/dgaa577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/19/2020] [Indexed: 12/27/2022]
Abstract
CONTEXT No head-to-head trials have directly compared once-weekly (OW) semaglutide, a human glucagon-like peptide-1 analog, with empagliflozin, a sodium-glucose co-transporter-2 inhibitor, in type 2 diabetes (T2D). OBJECTIVE We indirectly compared the efficacy of OW semaglutide 1 mg vs once-daily (OD) empagliflozin 25 mg in patients with T2D inadequately controlled on metformin monotherapy, using individual patient data (IPD) and meta-regression methodology. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS IPD for patients with T2D receiving metformin monotherapy and randomized to OW semaglutide 1 mg (SUSTAIN 2, 3, 8 trials), or to OD empagliflozin 25 mg (PIONEER 2 trial) were included. Meta-regression analyses were adjusted for potential prognostic factors and effect modifiers. MAIN OUTCOME MEASURES The primary efficacy outcomes were change from baseline to end-of-treatment (~1 year) in HbA1c (%-point) and body weight (kg). Responder outcomes and other clinically relevant efficacy measures were analyzed. RESULTS Baseline characteristics were similar between OW semaglutide (n = 995) and empagliflozin (n = 410). Our analyses showed that OW semaglutide significantly reduced mean HbA1c and body weight vs empagliflozin (estimated treatment difference: -0.61%-point [95% confidence interval (CI): -0.72; -0.49] and -1.65 kg [95% CI: -2.22; -1.08], respectively; both P < 0.0001). Complementary analyses supported the robustness of these results. A significantly greater proportion of patients on OW semaglutide vs empagliflozin also achieved HbA1c targets and weight-loss responses. CONCLUSIONS This indirect comparison suggests that OW semaglutide 1 mg provides superior reductions in HbA1c and body weight vs OD empagliflozin 25 mg in patients with T2D when added to metformin monotherapy.
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Affiliation(s)
- Ildiko Lingvay
- University of Texas Southwestern Medical Center at Dallas, Harry Hines Boulevard, Dallas, Texas
| | - Matthew S Capehorn
- Rotherham Institute for Obesity, Clifton Medical Centre, Doncaster Gate, Rotherham, UK
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26
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Aouni J, Gaudel-Dedieu N, Sebastien B. Matching-adjusted indirect comparisons: Application to time-to-event data. Stat Med 2020; 40:566-577. [PMID: 33111986 DOI: 10.1002/sim.8789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 11/05/2022]
Abstract
The Matching-Adjusted Indirect Comparison method (MAIC) is a recent methodology that allows to perform indirect comparisons between two drugs assessed in two different studies, where individual patients data are available in only one of the two studies, the data of the other one being available in an aggregate format only. In this work, we have assessed the properties of the MAIC method and compared, through simulations, several ways of practical implementation of the method. We conclude that it is more efficient to match the treatment arms separately (match the two drugs to compare on one hand, and the control arms on the other hand) and use the Lasso technique to select the covariates for the matching step is better than matching a maximal set of covariates.
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Affiliation(s)
- Jihane Aouni
- Sanofi Research and Development, Chilly-Mazarin, France.,Ividata Group, Levallois-Perret, France
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27
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Gorevic P, Franklin J, Chen J, Sajeev G, Wang JCH, Lin H. Indirect treatment comparison of the efficacy of patisiran and inotersen for hereditary transthyretin-mediated amyloidosis with polyneuropathy. Expert Opin Pharmacother 2020; 22:121-129. [PMID: 32892660 DOI: 10.1080/14656566.2020.1811850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Patisiran and inotersen are two therapies approved for the treatment of hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy, a rapidly progressive disease with a substantial clinical burden. This analysis indirectly compares the efficacy of patisiran and inotersen on neuropathy and quality of life (QOL). METHODS Published results from the NEURO-TTR study of inotersen and individual patient data from the APOLLO study of patisiran were used. Indirect comparisons were conducted for 15-month changes in neuropathy and QOL endpoints: modified Neuropathy Impairment Score +7 (mNIS+7Ionis,), Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) questionnaire, body mass index (BMI), and Polyneuropathy Disability (PND) score. Analyses were conducted under different assumptions about the impact of missing data and to adjust for baseline differences between studies. RESULTS Patisiran showed significantly greater treatment effects than inotersen for mNIS+7Ionis (mean difference: -12.3 [95% confidence interval: -21.4, -3.3]), Norfolk QOL-DN (-11.3 [-19.8, -2.9]), and BMI (1.0 [0.4, 1.7]). The proportion of patients with improvement or no change from baseline on PND score was higher for patisiran-treated patients (odds ratio: 8.9 [4.6, 17.5]). Results were consistent and robust across analyses and methods. CONCLUSIONS Patisiran demonstrated greater treatment effects on neuropathy and QOL than inotersen in patients with hATTR amyloidosis with polyneuropathy.
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Affiliation(s)
- Peter Gorevic
- Department of Medicine- Rheumatology, Mount Sinai Medical Center , New York City, NY, USA
| | | | - Jihong Chen
- Alnylam Pharmaceuticals , Cambridge, MA, USA
| | | | | | - Hollis Lin
- Alnylam Pharmaceuticals , Cambridge, MA, USA
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28
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Phillippo DM, Dias S, Ades AE, Welton NJ. Equivalence of entropy balancing and the method of moments for matching-adjusted indirect comparison. Res Synth Methods 2020; 11:568-572. [PMID: 32395870 PMCID: PMC7384548 DOI: 10.1002/jrsm.1416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/05/2022]
Abstract
Indirect comparisons are used to obtain estimates of relative effectiveness between two treatments that have not been compared in the same randomized controlled trial, but have instead been compared against a common comparator in separate trials. Standard indirect comparisons use only aggregate data, under the assumption that there are no differences in effect‐modifying variables between the trial populations. Population‐adjusted indirect comparisons aim to relax this assumption by using individual patient data (IPD) from one trial to adjust for differences in effect modifiers between populations. At present, the most commonly used approach is matching‐adjusted indirect comparison (MAIC), where weights are estimated that match the covariate distributions of the reweighted IPD to the aggregate trial. MAIC was originally proposed using the method of moments to estimate the weights, but more recently entropy balancing has been proposed as an alternative. Entropy balancing has an additional “optimality” property ensuring that the weights are as uniform as possible, reducing the standard error of the estimates. In this brief method note, we show that MAIC weights are mathematically identical whether estimated using entropy balancing or the method of moments. Importantly, this means that the standard MAIC (based on the method of moments) also enjoys the “optimality” property. Moreover, the additional flexibility of entropy balancing suggests several interesting avenues for further research, such as combining population adjustment via MAIC with adjustments for treatment switching or nonparametric covariate adjustment.
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Affiliation(s)
- David M Phillippo
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Sofia Dias
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK.,Centre for Reviews and Dissemination, University of York, York, UK
| | - A E Ades
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Nicky J Welton
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
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29
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Xiong Q, Wang C, Liu H, Tan Z, Chen C, Li J, Lip GYH, Hong K. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Asians With Nonvalvular Atrial Fibrillation: A Network Meta-Analysis. Clin Appl Thromb Hemost 2020; 25:1076029619885188. [PMID: 31718263 PMCID: PMC7019404 DOI: 10.1177/1076029619885188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There are few head-to-head trials directly comparing non-vitamin K antagonist oral anticoagulants (NOACs) against one other. A network meta-analysis (NMA) was performed to examine the indirect comparisons among NOACs in Asians with nonvalvular atrial fibrillation (NVAF). STATA 15.0 and ADDIS 1.16.8 softwares were used to perform the statistical analysis. Odds ratios with 95% credible intervals were applied to evaluate the end points. The probabilities of treatment rank were used to understand which interventions are more effective and safe, and the total rank probability was 1. In our NMA, the rank probabilities of apixaban in the case of stroke or systemic embolism, death from any cause, major bleeding, and intracranial hemorrhage (ICH) were 0.47, 0.49, 0.42, and 0.51, respectively. For cases of myocardial infarction, the rank probabilities of rivaroxaban were 0.40. This NMA indirectly compares the main efficacy and safety end points among NOACs in Asians with NVAF, and the rank probability analysis showed that apixaban likely performs best in cases of stroke or systemic embolism, death from any cause, and ICH; rivaroxaban may have the best performance for myocardial infarction.
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Affiliation(s)
- Qinmei Xiong
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Cen Wang
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Hualong Liu
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Zhaochong Tan
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Chen Chen
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Juxiang Li
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kui Hong
- Cardiovascular Department, the Second Affiliated Hospital of Nanchang University, Jiangxi, China.,Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
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30
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Swallow E, Patterson-Lomba O, Yin L, Mehta R, Pelletier C, Kao D, Sheffield JK, Stonehouse T, Signorovitch J. Comparative safety and efficacy of ozanimod versus fingolimod for relapsing multiple sclerosis. J Comp Eff Res 2020; 9:275-285. [PMID: 31948278 DOI: 10.2217/cer-2019-0169] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 01/18/2023] Open
Abstract
Aim: Ozanimod and fingolimod are sphingosine 1-phosphate receptor-modulating therapies for relapsing multiple sclerosis. Patients & methods: Comparative effectiveness was assessed by matching adjusted indirect comparisons of safety and efficacy trial outcomes at first-dose cardiac monitoring, 1 year and 2 years. Results: After adjustment, baseline characteristics were similar. Ozanimod was associated with a lower risk of extended first-dose monitoring, conduction abnormalities including atrioventricular block. One-year risks of any adverse event (AE), mean lymphocyte count reductions and abnormal liver enzymes were lower with ozanimod. Two-year risks of AEs leading to discontinuation, any AEs, herpetic infections, bradycardia and abnormal liver enzymes were lower with ozanimod. Analyses of efficacy outcomes were similar. Conclusion: Ozanimod appears to have a favorable benefit-risk profile versus fingolimod.
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Affiliation(s)
- Elyse Swallow
- Analysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA
| | | | - Lei Yin
- Analysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA
| | - Rina Mehta
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - Corey Pelletier
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - David Kao
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - James K Sheffield
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - Tim Stonehouse
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - James Signorovitch
- Analysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA
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31
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Yan K, Balijepalli C, Sharma R, Barakat S, Sun SX, Falcao S, Druyts E, FitzGerald JM. Reslizumab and mepolizumab for moderate-to-severe poorly controlled asthma: an indirect comparison meta-analysis. Immunotherapy 2019; 11:1491-1505. [PMID: 31686556 DOI: 10.2217/imt-2019-0113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: A systematic literature review and network meta-analysis assessed the efficacy and safety of reslizumab 3.0 mg/kg and mepolizumab 100 mg. Materials & methods: Eligible studies evaluated reslizumab and mepolizumab in patients with inadequately-controlled severe eosinophilic asthma. Using a Bayesian network meta-analysis, 95% credible intervals and posterior probabilities were reported. Results: Of 19 indirect efficacy comparisons performed in base-case (Global Initiative for Asthma 4/5 patients with ≥2 exacerbations in the previous year) and overall populations, significant differences favoring reslizumab were observed for severe exacerbations, FEV1 at 4 weeks and eosinophil counts at 4, 16 and 24 weeks, with no other significant differences including risk of adverse events. Conclusion: Indirect comparison of reslizumab and mepolizumab largely showed no significant differences in efficacy or safety.
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Affiliation(s)
- Kevin Yan
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | | | - Rohini Sharma
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | | | - Shawn X Sun
- Teva Branded Pharmaceutical Products R&D Inc., Malvern, PA 19355, USA
| | | | - Eric Druyts
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada.,Institute for Heart & Lung Health, Vancouver, British Columbia, V6Z 1Y6, Canada
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Wu M, Wang Y, Xu Y, Zhu J, Lv C, Sun M, Guo R, Xia Y, Zhang W, Xue C. Indirect comparison between immune checkpoint inhibitors and targeted therapies for the treatment of melanoma. J Cancer 2019; 10:6114-6123. [PMID: 31762821 PMCID: PMC6856565 DOI: 10.7150/jca.32638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/20/2019] [Indexed: 02/07/2023] Open
Abstract
Background: This systematic review and meta-analysis aims to provide comparative and quantitative data about immune checkpoint inhibitor (IMM) and targeted therapy (TAR) in this work. Methods: A literature search was performed with PubMed, Embase, PMC database, and Web of Science databases to identify relevant studies. Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), and odds ratios (ORs) for overall response rate (ORR) were estimated. Results: Eighteen manuscripts were ultimately utilized for indirect comparisons. In general, both TAR and IMM can prolong the PFS either by monotherapy, combination therapy with chemotherapy or adjuvant therapy. BRAF inhibitor monotherapy showed superiority over anti-CTLA-4 in OS (HR: 1.28, 95%CI: 0.93-1.75) and best ORR (OR: 12.57, 95%CI: 6.63-23.82), as well as longer PFS (HR: 1.63, 95%CI: 1.00-2.67) and higher best ORR (OR: 3.29, 95%CI: 1.94-5.55) compared with anti-PD-1. However, MEK inhibitor monotherapy showed no priority. When combined with chemotherapy, anti-CTLA-4 showed marginally advantages over MEK inhibitor in OS (HR: 0.68, 95%CI: 0.44-1.03), however no advantage in PFS (HR: 1.12, 95%CI: 0.76-1.64), or ORR (OR: 1.78, 95%CI: 0.70-4.49). For post-operational melanoma patient, adjuvant TAR and adjuvant IMM showed no difference in OS (HR: 1.14, 95%CI: 0.82-1.58) or PFS (HR: 1.20, 95%CI: 0.79-1.83). Moreover, the high-rate adverse events and underlying diseases should be considered during the application of those agents. Conclusions: For the unresectable late-stage melanoma, IMM may be a better choice for the combined treatment with chemotherapy. If the chemotherapy is not tolerable for patients, BRAFi involved TAR can be considered.
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Affiliation(s)
- Minliang Wu
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yuchong Wang
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yalong Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Ji Zhu
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Chuan Lv
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Mengyan Sun
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Guo
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yu Xia
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Yagudina RI, Kulikov AY, Krylov VA, Solovieva EY, Fedin AI. [Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:60-68. [PMID: 31464291 DOI: 10.17116/jnevro201911907160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/17/2022]
Abstract
AIM To perform a pharmacoeconomic analysis of the most frequently prescribed neuroprotective medicines for treating patients with mild ischemic stroke in the acute and early rehabilitation periods in the Russian Federation. MATERIAL AND METHODS Three medical technologies were compared: ethylmethylhydroxypyridine succinate (mexidol), inosine + nicotinamide + riboflavin + succinic acid (cytoflavin) and a deproteinized hemoderivate of the blood of calves (actovegin). Cost minimization analysis, budget impact analysis and sensitivity analysis were performed based on the indirect comparison results. RESULTS Efficacy analysis shows that mentioned above medicines have the same efficacy: mean difference mexidol is 0,2 (CI min 0,25; max 0,65), cytoflavin - 0,61 (CI min 0,23; max 0,99), actovegin 0,2 (CI min 0,18; max 0,22). The cost minimization analysis for the Russian Federation shows that mexidol therapy is associated with the lowest costs, while savings are observed both in the evaluation of total costs and separate components: intravenous ampoules and tablet forms. The savings in comparison with cytoflavin and actovegin are 231 RUB and 12,872 RUB, respectively. These savings will be enough to treat five patients with ischemic stroke (IS) with mexidol. Moreover, oral mexidol therapy is cheaper than the same dosage forms of cytoflavin and actovegin by 481 RUB and 3,164 RUB, respectively. This is an advantage for the treatment of population at the outpatient stage. Budget impact analysis has shown that the budget for the medicines for treating IS at the current distribution between treatment regimens, is estimated at 1.99 BN RUB. The increase in the proportion of patients receiving mexidol by 10% reduces total costs to 1.75 BN RUB, which is 240 M RUB less than current costs. With these savings 85 thousand patients with IS could be treated. The sensitivity analysis reveals that the result of the cost minimization analysis and the budget impact analysis remain stable when both the amount of the population and the cost of 1 mg of mexidol vary from -10% to + 10%. CONCLUSIONS Mexidol has the same efficacy as alternatives. However mexidol is superior to cytoflavin and actovegin in terms of cost minimization analysis. The savings from one course of alternatives will cover costs of treatment of five patients with IS using mexidol. The increase in the proportion of patients receiving mexidol is associated with savings, which allows us to consider mexidol therapy of mild IS as budget-saving in the Russian Federation.
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Affiliation(s)
- R I Yagudina
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A Yu Kulikov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - V A Krylov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - E Yu Solovieva
- Pirogov Russian National Research Medical University N.I.Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - A I Fedin
- Pirogov Russian National Research Medical University N.I.Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
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Lohan C, Diamantopoulos A, LeReun C, Wright E, Bohm N, Sawyer LM. Tofacitinib for the treatment of moderately to severely active ulcerative colitis: a systematic review, network meta-analysis and economic evaluation. BMJ Open Gastroenterol 2019; 6:e000302. [PMID: 31413856 PMCID: PMC6673763 DOI: 10.1136/bmjgast-2019-000302] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIMS In the UK, treatments for patients with moderately to severely active ulcerative colitis who have an inadequate response to conventional therapies comprise four biological therapies-the tumour necrosis factor inhibitor (TNFi) agents adalimumab, golimumab and infliximab and the anti-integrin vedolizumab-and an orally administered small molecule therapy, tofacitinib. However, there have been few head-to-head studies of these therapies. This study aimed to compare the clinical and cost-effectiveness of tofacitinib with biological therapies. METHODS A systematic literature review was conducted to identify all relevant randomised controlled trial (RCT) evidence. Clinical response, clinical remission and serious infection rates were synthesised using network meta-analysis (NMA). The results were used to compare the cost-effectiveness of tofacitinib and biologics with conventional therapy, using a Markov model, which incorporated lifetime costs and consequences of treatment from a UK National Health Service perspective. Analyses were conducted separately for TNFi-naïve and TNFi-exposed populations. RESULTS Seventeen RCTs were used in the NMAs. There were no statistically significant differences among biological therapies and tofacitinib for either TNFi-naïve or TNFi-exposed patients. In TNFi-naïve patients, all therapies were more efficacious than placebo. In TNFi-exposed patients, only tofacitinib was significantly more efficacious than placebo as induction therapy, and only tofacitinib and vedolizumab were significantly more efficacious than placebo as maintenance therapies. There were no significant differences in serious infection rates among therapies. The incremental cost-effectiveness ratios for tofacitinib versus conventional therapy were £21 338 and £22 816 per quality-adjusted life year (QALY) in the TNFi-naïve and TNFi-exposed populations, respectively. TNFi therapies were dominated or extendedly dominated in both populations. Compared with vedolizumab, tofacitinib was associated with a similar number of QALYs, at a lower cost. CONCLUSION Tofacitinib is an efficacious treatment for moderately to severely active ulcerative colitis and is likely to be a cost-effective use of NHS resources.
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Affiliation(s)
| | | | - Corinne LeReun
- Independent biostatistician, Sainte-Anne, Guadeloupe, France
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35
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Wang J, Peng FC. [Meta-analysis on indirect comparison of Fuzheng Huayu Jiaonang and Anluo Huaxian Wan in treatment of chronic hepatitis B with liver fibrosis]. Zhongguo Zhong Yao Za Zhi 2019; 43:1492-1500. [PMID: 29728042 DOI: 10.19540/j.cnki.cjcmm.2018.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/18/2022]
Abstract
To investigate the efficacy and safety of Fuzheng Huayu Jiaonang (FZ) and Anluo Huaxian Wan (AL) in the treatment of chronic hepatitis B liver fibrosis. Jadad scoring method was adopted to evaluate the quality of literature, Rev Man 5.3 software was used for Meta-analysis, and indirect comparison was carried out by ITC software. The randomized controlled trials (RCTs) were collected for comparing FZ and AL in treatment of chronic hepatitis B with liver fibrosis. With ETV as the common control, they were compared through indirect Meta-analysis (ITC). Finally, 15 articles (10 FZ, 5 AL) involving 1 316 patients were included. According to the indirect comparison, FZ combined with ETV had significant improvements in hyaluronic acid, laminin, procollagen type Ⅲ, and collagen type Ⅳ. AL combined with ETV had significant improvements in laminin, procollagen type Ⅲ, collagen type Ⅳ, but with no difference in hyaluronic acid. The safety of AL was higher than that of FA. The limited evidences in this study showed that Anluo Huaxian Wan had a higher safety than Fuzheng Huayu Jiaonang, but a lower total efficiency. Due to the low quality of the included RCTs, these two medicines shall be comprehensively compared in further high-quality clinical trials.
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Affiliation(s)
- Jing Wang
- Department of Clinical Pharmacy, Pharmacy Department in Shanxi Provincial People's Hospital, Taiyuan 030012, China
| | - Fang-Chen Peng
- Department of Clinical Pharmacy, Pharmacy Department in Shanxi Provincial People's Hospital, Taiyuan 030012, China
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36
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Arts MP, Kuršumović A, Miller LE, Wolfs JF, Perrin JM, Van de Kelft E, Heidecke V. Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis. Medicine (Baltimore) 2019; 98:e14410. [PMID: 30762743 PMCID: PMC6408089 DOI: 10.1097/md.0000000000014410] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Systematic review with network meta-analysis. OBJECTIVE To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD + AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management. SUMMARY OF BACKGROUND DATA Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is unclear. METHODS A systematic review was performed to compare efficacy of LD + AC, LD, and CC for treatment of lumbar disc herniation. Outcomes included leg pain, back pain, disability (each reported on a 0-100 scale), reherniation, and reoperation. Data were analyzed using random effects network meta-analysis. RESULTS This review included 14 comparative studies (8 randomized) involving 3947 patients-11 studies of LD versus CC (3232 patients), 3 studies of LD + AC versus LD (715 patients), and no studies of LD + AC versus CC. LD was more effective than CC in reducing leg pain (mean difference [MD] -10, P < .001) and back pain (MD -7, P < .001). LD + AC was more effective than LD in reducing risk of reherniation (odds ratio 0.38, P < .001) and reoperation (odds ratio 0.33, P < .001). There was indirect evidence that LD + AC was more effective than CC in reducing leg pain (MD -25, P = .003), back pain (MD -20, P = .02), and disability (MD -13, P = .02) although the treatment effect was smaller in randomized trials. CONCLUSIONS Results of a network meta-analysis show LD is more effective than CC in alleviating symptoms of lumbar disc herniation refractory to initial conservative management. Further, LD + AC lowers risk of reherniation and reoperation versus LD and may improve patient symptoms more than CC.
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Affiliation(s)
- Mark P. Arts
- Department of Neurosurgery, Haaglanden Medical Center Westeinde, The Hague, The Netherlands
| | - Adisa Kuršumović
- Department of Neurosurgery, Donauisar Klinikum Deggendorf, Deggendorf, Germany
| | | | - Jasper F.C. Wolfs
- Department of Neurosurgery, Haaglanden Medical Center Westeinde Antoniushove, Leidschendam, The Netherlands
| | - Jason M. Perrin
- Department of Neurosurgery, University Clinic Mannheim, Mannheim, Germany
| | | | - Volkmar Heidecke
- Department of Neurosurgery, Klinikum Augsburg, Augsburg, Germany
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37
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Chen XJ, Chen YZ, Chen DW, Chen YL, Xiang J, Lin YJ, Chen S, Peng JS. The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy: A Systemic Review and Meta-Analysis. J Cancer 2019; 10:789-798. [PMID: 30854084 PMCID: PMC6400796 DOI: 10.7150/jca.28843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y are common reconstruction techniques of distal gastrectomy. Which of these techniques is better has yet to be established. We performed an indirect comparison to evaluate which technique was optimal for preventing reflux symptoms. Methods: The PubMed, Cochrane Collaboration, Embase, ClinicalTrials.gov and Web of Science databases were searched to identify clinical trials that compared at least two of the reconstruction skills among Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y. Data on reflux gastritis, intraoperative blood loss, bile reflux and postoperative hospital stays were extracted from the included clinical trials for meta-analysis using a random-effects model. Results: Twenty-four articles that included 5419 individuals were assessed as eligible for meta-analysis. The indirect comparison suggested that Roux-en-Y reconstruction significantly reduces reflux gastritis, and it tended to rank first and had the highest probability of preventing bile reflux. No significant differences were found in intraoperative blood loss and postoperative hospital stays. Conclusion: This indirect comparison suggested some superiority of Roux-en-Y reconstruction after distal gastrectomy. Further perspective clinical trials are required to provide evidence for the optimal reconstruction skill.
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Affiliation(s)
- Xi-Jie Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Yun-Zhi Chen
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, and Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, 510630, P. R. China
| | - Dong-Wen Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Ying-Liang Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Jun Xiang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Yi-Jia Lin
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Shi Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Jun-Sheng Peng
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
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Langford BE, Ridley CJA, Beale RC, Caseby SCL, Marsh WJ, Richard L. Focused Ultrasound Thalamotomy and Other Interventions for Medication-Refractory Essential Tremor: An Indirect Comparison of Short-Term Impact on Health-Related Quality of Life. Value Health 2018; 21:1168-1175. [PMID: 30314617 DOI: 10.1016/j.jval.2018.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Up to 50% of essential tremor patients are refractory to medication and require alternative treatment to achieve tremor relief. This study aimed to identify and analyze evidence supporting the use of the emerging magnetic resonance-guided focused ultrasound (MRgFUS) compared to alternative stimulatory and ablative interventions for the treatment of medication-refractory essential tremor: radiofrequency thalamotomy, unilateral deep brain stimulation (DBS), and stereotactic radiosurgery. METHODS A systematic literature review was conducted to identify clinical, health-related quality of life (HRQoL), and economic evidence for each intervention. Because of the lack of comparative evidence captured, a feasibility assessment was performed to determine possible comparisons between interventions, and newly established matching-adjusted indirect comparison and simulated treatment comparison techniques were used to conduct a comparison between unilateral DBS aggregate data and MRgFUS individual patient data. RESULTS The systematic literature review identified 1,559 records, and screening yielded 46 relevant articles. The captured studies demonstrated that radiofrequency thalamotomy, DBS, stereotactic radiosurgery, and MRgFUS all exhibit clinical efficacy, with variation in onset and duration of tremor relief, and are each associated with a unique safety profile. The matching-adjusted indirect comparison and simulated treatment comparison results demonstrated no evidence of a difference in efficacy (measured by Clinical Rating Scale for Tremor Total) and HRQoL (measured by Clinical Rating Scale for Tremor Part C) outcomes between MRgFUS and unilateral DBS in the short term (≤12 months). CONCLUSIONS This study provides preliminary evidence that MRgFUS could elicit similar short-term tremor- and HRQoL-related benefits to DBS, the current standard of care, and allowed for the first robust statistical comparison between these interventions.
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Zhang YF, Ke XT, Li BC, Xiang C, Zhao S. [Meta-analysis on indirect comparison of Erigeron breviscapus injection and Breviscapus injection in treatment of acute ischemic stroke]. Zhongguo Zhong Yao Za Zhi 2018; 42:1194-1201. [PMID: 29027438 DOI: 10.19540/j.cnki.cjcmm.20170121.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 11/18/2022]
Abstract
Erigeron breviscapus injection(DZXI) and Breviscapus injection(DZSI) are two popular injections in treatment of acute ischemic stroke in China. Both of them are manufactured from a same herbal medicine, E. breviscapus, but DZXI is an herbal extract(mixture) preparation and DZSI is a pure compound injection. This article was aimed to systemically evaluate and compare their efficacy and safety in treatment of acute ischemic stroke. The randomized controlled trials(RCTs) were collected for comparing DZXI and DZSI with Salvia miltiorrhiza injection(FDI) as the medium, and they were compared with indirect Meta-analysis(ITC). Thirty-nine RCTs with 4 180 patients were included. Meta-analysis results showed that both DZXI and DZSI had better efficacy than FDI in acute ischemic stroke. In the indirect comparison, DZSI had a higher total efficacy than DZXI, with significantly statistical differences[OR=0.634, 95%CI = (0.432,0.928), P<0.000 01], but there was no significant difference in improvement of neurological deficit [MD=-1.19, 95%CI=(-3.57,1.19), P=0.953]. On the safety aspect, adverse reaction rate of DZXI was 1.14%, mainly including head swelling, fever and chills while DZSI had no significant adverse reactions. The limited evidences in this study showed that Breviscapine injection had higher total efficiency and safety than E. breviscapine injection, but due to the low quality of the included RCTs, these two medicines should be comprehensively compared in further high-quality clinical trials.
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Affiliation(s)
- Yu-Fang Zhang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China
| | - Xi-Tong Ke
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China
| | - Bao-Cai Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China
| | - Cheng Xiang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China
| | - Song Zhao
- Department of Geratology, the Second People's Hospital of Yunnan Province, Kunming 650021, China
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Kawalec P, Moćko P. An indirect comparison of ustekinumab and vedolizumab in the therapy of TNF-failure Crohn's disease patients. J Comp Eff Res 2018; 7:101-111. [DOI: 10.2217/cer-2017-0041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Paweł Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Moćko
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
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Papp KA, Yang M, Sundaram M, Jarvis J, Betts KA, Bao Y, Signorovitch JE. Comparison of Adalimumab and Etanercept for the Treatment of Moderate to Severe Psoriasis: An Indirect Comparison Using Individual Patient Data from Randomized Trials. Value Health 2018; 21:1-8. [PMID: 29304933 DOI: 10.1016/j.jval.2017.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/16/2017] [Accepted: 05/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare outcomes between adalimumab and etanercept in the treatment of moderate to severe plaque psoriasis. METHODS Study groups included patients randomized to adalimumab or placebo (REVEAL and CHAMPION trials) and those randomized to etanercept or placebo (M10-114 and M10-315 trials). Week 12 outcomes were compared between patients receiving adalimumab and those receiving etanercept after adjusting for cross-trial differences in patient characteristics using propensity score weighting and after subtracting effects of placebo. Outcomes included proportion of patients achieving 75% or more, 90% or more, and 100% reductions from baseline in the Psoriasis Area and Severity Index (PASI75, PASI90, PASI100, respectively), symptom resolution (pruritus = 0; psoriatic pain = 0), lesion resolution (minimal scores for plaque signs erythema, desquamation, and induration, and by body regions head, upper limbs, trunk, and lower limbs), absence of skin-related quality-of-life impact (Dermatology Life Quality Index [DLQI] = 0), "complete disease control" (patient's global assessment [PtGA] = 0), and adverse events. RESULTS After adjustment, baseline characteristics were balanced among study groups (adalimumab = 875 vs. placebo = 427; etanercept = 260 vs. placebo = 130). Compared with etanercept, adalimumab was associated with significantly better placebo-adjusted outcomes (PASI75: 62.3% vs. 42.6%; PASI90: 35.9% vs. 12.1%; PASI100: 13.1% vs. 4.9%; pruritus: 24.7% vs. 13.0%; psoriatic pain: 27.4% vs. 8.7%; DLQI: 27.7% vs. 11.7%; and PtGA: 16.4% vs. 10.6%; all P < 0.05), except for similar rates of adverse events and head-specific lesion resolution. CONCLUSIONS Compared with etanercept, adalimumab treatment for moderate to severe plaque psoriasis was associated with greater PASI reduction, higher rates of resolution of skin signs and symptoms, and greater improvements in dermatological life quality.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research, and K. Papp Clinical Research, Waterloo, Ontario, Canada
| | - Min Yang
- Analysis Group Inc., Boston, MA, USA.
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Zhang MY, Zhu GQ, Shi KQ, Zheng JN, Cheng Z, Zou ZL, Huang HH, Chen FY, Zheng MH. Systematic review with network meta-analysis: Comparative efficacy of oral nucleos(t)ide analogues for the prevention of chemotherapy-induced hepatitis B virus reactivation. Oncotarget 2017; 7:30642-58. [PMID: 27121321 PMCID: PMC5058707 DOI: 10.18632/oncotarget.8907] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/02/2016] [Indexed: 12/12/2022] Open
Abstract
Objectives Currently, no consensus exists regarding the optimal oral prophylactic regimens for hepatitis B surface antigen seropositive patients undergoing chemotherapy. We aimed to compare the efficacy of oral nucleos(t)ide analogues (NAs), including lamivudine, entecavir, adefovir, telbivudine and tenofovir, for the prevention of chemotherapy-induced hepatitis B virus (HBV) reactivation and its related morbidity and mortality in patients with chronic HBV (CHB) infection. Results Fifty-two eligible articles consisting of 3892 participants were included. For HBV reactivation, prophylactic treatment with NAs were all significantly superior to no prophylaxis, with odds ratio (OR) from 0.00 (95% confidence interval [CI] 0.00~0.04) for the most effective intervention (tenofovir) to 0.10 (95% CI 0.06~0.14) for the least effective intervention (lamivudine). For secondary outcomes, prophylaxis with NAs also significantly outperformed observation. The results suggested that entecavir reduced the risk of HBV related hepatitis (predicted probability, 83%), HBV related death (68%) and all causes of hepatitis (97%) most efficaciously. It ranked second in decreasing all causes of death (34%). Materials and Methods PubMed, Embase and Cochrane Library database were searched for controlled trials up to March 31, 2015. Primary outcome was the incidence of HBV reactivation. Secondary outcomes included the incidence of HBV-related hepatitis and death, all causes of hepatitis and death. Network meta-analysis combined direct and indirect evidence to estimate ORs for the clinical outcomes. A mean ranking and the probability of optimal therapeutic regime was obtained for each treatment based on clinical outcomes. Conclusions Available evidence suggests that prophylatic therapy with tenofovir and entecavir may be the most potent interventions in prevention of HBV reactivation and HBV-related morbidity and mortality for CHB infection patients undergoing chemotherapy.
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Affiliation(s)
- Min-Yue Zhang
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Gui-Qi Zhu
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Ke-Qing Shi
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Ji-Na Zheng
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhang Cheng
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhuo-Lin Zou
- Department of Infection Diseases, the First Hospital of Jiaxing, Jiaxing 314000, China
| | - Hong-Hui Huang
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Fang-Yuan Chen
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Ming-Hua Zheng
- Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
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43
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Zhou YY, Zhu GQ, Wang Y, Zheng JN, Ruan LY, Cheng Z, Hu B, Fu SW, Zheng MH. Systematic review with network meta-analysis: statins and risk of hepatocellular carcinoma. Oncotarget 2017; 7:21753-62. [PMID: 26943041 PMCID: PMC5008320 DOI: 10.18632/oncotarget.7832] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/21/2016] [Indexed: 02/06/2023] Open
Abstract
Objectives Usage of statins is suggested to decrease the incidence of HCC. When it comes to different statin subtypes, the chemopreventive action remains controversial. We aim to compare the usage of different statins and reduction of HCC risk. Methods We searched PubMed, Embase.com and Cochrane Library database up to August 10, 2015. Duplicated or overlapping reports were eliminated. We performed a traditional pair-wise meta-analysis and a Bayesian network meta-analysis to compare different treatments with a random-effects model. Results We reviewed five observational studies enrolling a total of 87127 patients who received at least two different treatment strategies including rosuvastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, cerivastatin, and lovastatin or observation alone. Direct comparisons showed that usage of atorvastatin (OR 0.63, 95%CI 0.45-0.89) and fluvastatin (OR 0.58, 95%CI 0.40-0.85) could significantly cut the risk of liver cancer. The difference of indirect comparisons between the included regimens is not statistically significant. However, usage of all types of statins, such as fluvastatin (RR 0.55, 95%CI 0.26-1.11), atorvastatin (RR 0.59, 95%CI 0.30-1.16), simvastatin (RR 0.69, 95%CI 0.38-1.25), cerivastatin (RR 0.71, 95%CI 0.19-2.70), pravastatin (RR 0.72, 95%CI 0.37-1.45), lovastatin (RR 0.81, 95%CI 0.34-1.96) and rosuvastatin (RR 0.92, 95%CI 0.44-1.80), appeared to be superior to observation alone. Notably, fluvastatin was hierarchically the best when compared with the six other statins. Conclusions Our analyses indicate the superiority of usage of statins in reduction of liver cancer. Available evidence supports that fluvastatin is the most effective strategy for reducing HCC risk compared with other statin interventions.
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Affiliation(s)
- Yao-Yao Zhou
- Department of Cardiology, Jinhua Municipal Hospital, Jinhua 321004, China
| | - Gui-Qi Zhu
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Yue Wang
- Department of Cardiology, Jinhua Municipal Hospital, Jinhua 321004, China
| | - Ji-Na Zheng
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Lu-Yi Ruan
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhang Cheng
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Bin Hu
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
| | - Shen-Wen Fu
- Department of Cardiology, Jinhua Municipal Hospital, Jinhua 321004, China
| | - Ming-Hua Zheng
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
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Donegan S, Welton NJ, Tudur Smith C, D'Alessandro U, Dias S. Network meta-analysis including treatment by covariate interactions: Consistency can vary across covariate values. Res Synth Methods 2017; 8:485-495. [PMID: 28732142 PMCID: PMC5724666 DOI: 10.1002/jrsm.1257] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 06/17/2017] [Accepted: 06/25/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many reviews aim to compare numerous treatments and report results stratified by subgroups (eg, by disease severity). In such cases, a network meta-analysis model including treatment by covariate interactions can estimate the relative effects of all treatment pairings for each subgroup of patients. Two key assumptions underlie such models: consistency of treatment effects and consistency of the regression coefficients for the interactions. Consistency may differ depending on the covariate value at which consistency is assessed. For valid inference, we need to be confident of consistency for the relevant range of covariate values. In this paper, we demonstrate how to assess consistency of treatment effects from direct and indirect evidence at various covariate values. METHODS Consistency is assessed using visual inspection, inconsistency estimates, and probabilities. The method is applied to an individual patient dataset comparing artemisinin combination therapies for treating uncomplicated malaria in children using the covariate age. RESULTS The magnitude of the inconsistency appears to be decreasing with increasing age for each comparison. For one comparison, direct and indirect evidence differ for age 1 (P = .05), and this brings results for age 1 for all comparisons into question. CONCLUSION When fitting models including interactions, the consistency of direct and indirect evidence must be assessed across the range of covariates included in the trials. Clinical inferences are only valid for covariate values for which results are consistent.
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Affiliation(s)
- Sarah Donegan
- Department of BiostatisticsUniversity of LiverpoolWaterhouse BuildingLiverpoolUK
| | - Nicky J. Welton
- School of Social and Community MedicineUniversity of BristolBristolUK
| | - Catrin Tudur Smith
- Department of BiostatisticsUniversity of LiverpoolWaterhouse BuildingLiverpoolUK
| | - Umberto D'Alessandro
- MRC Unit The GambiaSerrekundaThe Gambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Sofia Dias
- School of Social and Community MedicineUniversity of BristolBristolUK
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Zheng JN, Han YJ, Zou TT, Zhou YJ, Sun DQ, Zhong JH, Braddock M, Zheng MH. Comparative efficacy of vasoconstrictor therapies for type 1 hepatorenal syndrome: a network meta-analysis. Expert Rev Gastroenterol Hepatol 2017; 11:1009-1018. [PMID: 28708431 DOI: 10.1080/17474124.2017.1356223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/14/2023]
Abstract
The outcome of a comparative efficacy and safety of vasoconstrictor therapies for treatment of patients with type 1 hepatorenal syndrome (HRS-1) remain inconclusive. Areas covered: We searched literature databases for randomized controlled trials (RCTs) until 31 January 2016, and included ten eligible RCTs. In conclusion, terlipressin was the most efficacious vasoconstrictor drug for HRS-1, but had a higher probability of causing AEs. Norepinephrine was an attractive alternative to terlipressin and associated with less AEs. Expert commentary: To date, most previous traditional meta-analyses included trials with a limited population and compared terlipressin alone or with albumin against no intervention or albumin. Since different HRS types have different diagnoses and show different responses to vasoconstrictors, it may be questionable to combine data from patients with type 1 and type 2 HRS, which has been reported for most previous meta-analyses. Thus, performing a high-quality network meta-analysis of the existing literature is a valuable way to interrogate published data and to draw conclusions which may inform on the best interventional strategy.
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Affiliation(s)
- Ji-Na Zheng
- a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China
| | - Yi-Jing Han
- a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China
| | - Tian-Tian Zou
- a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,c School of the Second Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China
| | - Yu-Jie Zhou
- a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China
| | - Dan-Qin Sun
- d Department of Nephrology , Affiliated Wuxi Second Hospital, Nanjing Medical University , Wuxi , China
| | - Jian-Hong Zhong
- e Department of Hepatobiliary Surgery , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China
| | - Martin Braddock
- f Global Medicines Development , AstraZeneca R&D , Loughborough , United Kingdom
| | - Ming-Hua Zheng
- a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,g Institute of Hepatology , Wenzhou Medical University , Wenzhou , China
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46
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Abstract
Standard methods for indirect comparisons and network meta-analysis are based on aggregate data, with the key assumption that there is no difference between the trials in the distribution of effect-modifying variables. Methods which relax this assumption are becoming increasingly common for submissions to reimbursement agencies, such as the National Institute for Health and Care Excellence (NICE). These methods use individual patient data from a subset of trials to form population-adjusted indirect comparisons between treatments, in a specific target population. Recently proposed population adjustment methods include the Matching-Adjusted Indirect Comparison (MAIC) and the Simulated Treatment Comparison (STC). Despite increasing popularity, MAIC and STC remain largely untested. Furthermore, there is a lack of clarity about exactly how and when they should be applied in practice, and even whether the results are relevant to the decision problem. There is therefore a real and present risk that the assumptions being made in one submission to a reimbursement agency are fundamentally different to—or even incompatible with—the assumptions being made in another for the same indication. We describe the assumptions required for population-adjusted indirect comparisons, and demonstrate how these may be used to generate comparisons in any given target population. We distinguish between anchored and unanchored comparisons according to whether a common comparator arm is used or not. Unanchored comparisons make much stronger assumptions, which are widely regarded as infeasible. We provide recommendations on how and when population adjustment methods should be used, and the supporting analyses that are required to provide statistically valid, clinically meaningful, transparent and consistent results for the purposes of health technology appraisal. Simulation studies are needed to examine the properties of population adjustment methods and their robustness to breakdown of assumptions.
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Affiliation(s)
- David M Phillippo
- School of Social and Community Medicine, University of Bristol, Bristol, UK (DMP, AEA, SD, NJW)
| | - Anthony E Ades
- School of Social and Community Medicine, University of Bristol, Bristol, UK (DMP, AEA, SD, NJW)
| | - Sofia Dias
- School of Social and Community Medicine, University of Bristol, Bristol, UK (DMP, AEA, SD, NJW)
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK (SP)
| | - Keith R Abrams
- Department of Health Sciences, University of Leicester, Leicester, UK (KPA)
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK (DMP, AEA, SD, NJW)
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Cameron C, Zummo J, Desai DN, Drake C, Hutton B, Kotb A, Weiden PJ. Aripiprazole Lauroxil Compared with Paliperidone Palmitate in Patients with Schizophrenia: An Indirect Treatment Comparison. Value Health 2017; 20:876-885. [PMID: 28712616 DOI: 10.1016/j.jval.2017.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Aripiprazole lauroxil (AL) is a long-acting injectable atypical antipsychotic recently approved for treatment of schizophrenia on the basis of a large-scale trial of two doses of AL versus placebo. There are no direct-comparison studies with paliperidone palmitate (PP; long-acting antipsychotic used most often in acute settings) for the acute psychotic episode. OBJECTIVES To indirectly compare efficacy and safety of the pivotal AL study with all PP studies meeting indirect comparison criteria. METHODS Systematic searches of MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and gray literature were performed to identify randomized controlled trials of PP with similar designs to the AL trial. Bayesian network meta-analysis compared treatments with respect to symptom response and tolerability issues including weight gain, akathisia, parkinsonism, and likelihood of treatment-emergent adverse events. RESULTS Three appropriate PP studies were identified for indirect comparison. Both doses of AL (441 mg and 882 mg monthly) were used and compared with two efficacious doses of PP (156 mg and 234 mg monthly). All four active-treatment conditions were associated with comparable reductions in acute symptoms (Positive and Negative Syndrome Scale) versus placebo and were of similar magnitude (range of mean difference -8.12 to -12.01, with overlapping 95% credible intervals). Between-group comparisons of active-treatment arms were associated with summary estimates of magnitude near 0. No clinically meaningful differences in selected safety or tolerability parameter incidence were found between active treatments. CONCLUSIONS These results suggest that both AL and PP are effective for treatment of adults experiencing acute exacerbation of schizophrenia.
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Affiliation(s)
- Chris Cameron
- Cornerstone Research Group, Inc., Burlington, Ontario, Canada.
| | | | | | - Christine Drake
- Cornerstone Research Group, Inc., Burlington, Ontario, Canada
| | - Brian Hutton
- Cornerstone Research Group, Inc., Burlington, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ahmed Kotb
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Tarp S, Eric Furst D, Boers M, Luta G, Bliddal H, Tarp U, Heller Asmussen K, Brock B, Dossing A, Schjødt Jørgensen T, Thirstrup S, Christensen R. Risk of serious adverse effects of biological and targeted drugs in patients with rheumatoid arthritis: a systematic review meta-analysis. Rheumatology (Oxford) 2017; 56:417-425. [PMID: 28013201 DOI: 10.1093/rheumatology/kew442] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 04/19/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives To determine possible differences in serious adverse effects among the 10 currently approved biological and targeted synthetic DMARDs (b/ts-DMARDs) for RA. Methods Systematic review in bibliographic databases, trial registries and websites of regulatory agencies identified randomized trials of approved b/ts-DMARDs for RA. Network meta-analyses using mixed-effects Poisson regression models were conducted to calculate rate ratios for serious adverse events (SAEs) and deaths between each of the 10 drugs and control (i.e. no b/ts-DMARD treatment), based on subjects experiencing an event in relation to person-years. Confidence in the estimates was assessed by applying the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Results A total of 117 trials (47 615 patients) were included. SAEs were more common with certolizumab compared with abatacept (rate ratio = 1.58, 95% CI: 1.18, 2.14), adalimumab (1.36, 95% CI: 1.02, 1.81), etanercept (1.60, 95% CI: 1.18, 2.17), golimumab (1.45, 95% CI: 1.00, 2.08), rituximab (1.63, 95% CI: 1.16, 2.30), tofacitinib (1.44, 95% CI: 1.03, 2.02) and control (1.45, 95% CI: 1.13, 1.87); and tocilizumab compared with abatacept (1.30, 95% CI: 1.03, 1.65), etanercept (1.31, 95% CI: 1.04, 1.67) and rituximab (1.34, 95% CI: 1.01, 1.78). No other comparisons were statistically significant. Accounting for study duration confirmed our findings for up to 6 months' treatment but not for longer-term treatment (6-24 months). No differences in mortality between b/ts-DMARDs and control were found. Based on the GRADE approach, confidence in the estimates was low due to lack of head-to-head comparison trials and imprecision in indirect estimates. Conclusion Despite low confidence in the estimates, our analysis found potential differences in rates of SAEs. Our data suggest caution should be taken when deciding among available drugs. Systematic review registration number PROSPERO CRD42014014842.
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Affiliation(s)
- Simon Tarp
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Daniel Eric Furst
- David Geffen School of Medicine, University of California Los Angeles, CA.,Division of Rheumatology, University of Washington, Seattle, WA, USA.,Division of Rheumatology, University of Florence, Florence, Italy
| | - Maarten Boers
- Department of Epidemiology and Biostatistics.,Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ulrik Tarp
- Department of Rheumatology, Aarhus University Hospital, Aarhus N
| | - Karsten Heller Asmussen
- Department of Rheumatology, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen
| | - Birgitte Brock
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N
| | - Anna Dossing
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tanja Schjødt Jørgensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Steffen Thirstrup
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Zheng J, Chow SC, Yuan M. On assessing bioequivalence and interchangeability between generics based on indirect comparisons. Stat Med 2017; 36:2978-2993. [PMID: 28497561 DOI: 10.1002/sim.7326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/07/2016] [Revised: 04/03/2017] [Accepted: 04/08/2017] [Indexed: 12/18/2022]
Abstract
As more and more generics become available in the market place, the safety/efficacy concerns may arise as the result of interchangeably use of approved generics. However, bioequivalence assessment for regulatory approval among generics of the innovative drug product is not required. In practice, approved generics are often used interchangeably without any mechanism of safety monitoring. In this article, based on indirect comparisons, we proposed several methods to assessing bioequivalence and interchangeability between generics. The applicability of the methods and the similarity assumptions were discussed, as well as the inappropriateness of directly adopting adjusted indirect comparison to the field of generics' comparison. Besides, some extensions were given to take into consideration the important topics in clinical trials for bioequivalence assessments, for example, multiple comparisons and simultaneously testing bioequivalence among three generics. Extensive simulation studies were conducted to investigate the performances of the proposed methods. The studies of malaria generics and HIV/AIDS generics prequalified by the WHO were used as real examples to demonstrate the use of the methods. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jiayin Zheng
- National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Duke University School of Medicine, 2424 Erwin Road, Hock Plaza, Suite 1102, Durham, 27705, NC, U.S.A
| | - Shein-Chung Chow
- National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Duke University School of Medicine, 2424 Erwin Road, Hock Plaza, Suite 1102, Durham, 27705, NC, U.S.A
| | - Mengdie Yuan
- Center for Drug Evaluation and Research Organization, Food and Drug Administration, Silver Spring, Maryland, U.S.A
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50
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Rodrigues FB, Duarte GS, Costa J, Ferreira JJ, Wild EJ. Tetrabenazine Versus Deutetrabenazine for Huntington's Disease: Twins or Distant Cousins? Mov Disord Clin Pract 2017; 4:582-585. [PMID: 28920068 PMCID: PMC5573977 DOI: 10.1002/mdc3.12483] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/25/2017] [Accepted: 02/12/2017] [Indexed: 01/13/2023] Open
Abstract
Background Tetrabenazine is the only US Food and Drug Administration‐approved drug for Huntington's disease, and deutetrabenazine was recently tested against placebo. A switching‐trial from tetrabenazine to deutetrabenazine is underway, but no head‐to‐head, blinded, randomized controlled trial is planned. Using meta‐analytical methodology, the authors compared these molecules. Methods RCTs comparing tetrabenazine or deutetrabenazine with placebo in Huntington's disease were searched. The authors assessed the Cochrane risk‐of‐bias tool, calculated indirect treatment comparisons, and applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results The evidence network for this report comprised 1 tetrabenazine trial and 1 deutetrabenazine trial, both against placebo. Risk of bias was moderate in both. Participants in the tetrabenazine and deutetrabenazine trials did not differ significantly on motor scores or adverse events. Depression and somnolence scales significantly favored deutetrabenazine. Conclusion There is low‐quality evidence that tetrabenazine and deutetrabenazine do not differ in efficacy or safety. It is important to note that these results are likely to remain the only head‐to‐head comparison between these 2 compounds in Huntington's disease.
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Affiliation(s)
- Filipe B Rodrigues
- Huntington's Disease Center Institute of Neurology University College London London United Kingdom.,Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisbon Portugal.,Clinical Pharmacology UnitInstituto de Medicina Molecular Lisbon Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisbon Portugal.,Clinical Pharmacology UnitInstituto de Medicina Molecular Lisbon Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisbon Portugal.,Clinical Pharmacology UnitInstituto de Medicina Molecular Lisbon Portugal.,Cochrane Movement Disorders Group Faculty of Medicine University of Lisbon Lisbon Portugal.,Center for Evidence-Based Medicine Faculty of Medicine University of Lisbon Lisbon Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisbon Portugal.,Clinical Pharmacology UnitInstituto de Medicina Molecular Lisbon Portugal
| | - Edward J Wild
- Huntington's Disease Center Institute of Neurology University College London London United Kingdom
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