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Fanciulli G, La Salvia A, Di Molfetta S, Cannavale G, Puliani G, Verrico M, Campolo F, Colao A, Faggiano A. Predictive Factors of Response to Streptozotocin in Neuroendocrine Pancreatic Neoplasms. J Clin Med 2023; 12:7557. [PMID: 38137624 PMCID: PMC10743702 DOI: 10.3390/jcm12247557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Pancreatic neuroendocrine neoplasms (Pan-NENs) may exhibit a heterogeneous clinical course, ranging from indolent to progressive/metastatic behavior. In the latter scenario, streptozocin (STZ) is considered the cornerstone of systemic treatment; however, response to STZ-based chemotherapy may vary among individuals. In this narrative review, we aimed to identify the predictive factors of response to STZ in advanced Pan-NENs. We performed an extensive search in international online databases for published studies and ongoing clinical trials evaluating STZ in Pan-NENs. We found 11 pertinent studies evaluating 17 patient-, tumor-, or treatment-related factors. Age, CgA blood levels, tumor grade, Ki-67% index, anatomical location of the primary tumor, tumor stage, site of metastasis origin, liver tumor burden, extrahepatic spread, functional status, O6-methylguanine-methyltransferase (MGMT) status, line of therapy, and response to previous treatments were all statistically associated with radiological response and/or survival. The identified predictors may help clinicians make appropriate treatment decisions, in this way improving clinical outcomes in patients with advanced Pan-NENs.
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Affiliation(s)
- Giuseppe Fanciulli
- Endocrine Oncology Program, Endocrine Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, University Hospital of Sassari, 07100 Sassari, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy;
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Giuseppe Cannavale
- Unit of Endocrinology, Andrology, Diabetology and Nutrition, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Giulia Puliani
- Oncological Endocrinology Unit, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy;
| | - Monica Verrico
- Department of Radiology, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federica Campolo
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Annamaria Colao
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, 80131 Naples, Italy;
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, The European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
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Lanctôt KL, Rivet L, Tumati S, Perin J, Sankhe K, Vieira D, Mintzer J, Rosenberg PB, Shade D, Lerner AJ, Padala PR, Brawman-Mintzer O, van Dyck CH, Porsteinsson AP, Craft S, Levey AI, Padala KP, Herrmann N. Heterogeneity of Response to Methylphenidate in Apathetic Patients in the ADMET 2 Trial. Am J Geriatr Psychiatry 2023; 31:1077-1087. [PMID: 37385898 PMCID: PMC10765607 DOI: 10.1016/j.jagp.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The Apathy in Dementia Methylphenidate Trial 2 (ADMET 2) found that methylphenidate was effective in treating apathy with a small-to-medium effect size but showed heterogeneity in response. We assessed clinical predictors of response to help determine individual likelihood of treatment benefit from methylphenidate. DESIGN Univariate and multivariate analyses of 22 clinical predictors of response chosen a priori. SETTING Data from the ADMET 2 randomized, placebo controlled multi-center clinical trial. PARTICIPANTS Alzheimer's disease patients with clinically significant apathy. MEASUREMENTS Apathy assessed with the Neuropsychiatric Inventory apathy domain (NPI-A). RESULTS In total, 177 participants (67% male, mean [SD] age 76.4 [7.9], mini-mental state examination 19.3 [4.8]) had 6-months follow up data. Six potential predictors met criteria for inclusion in multivariate modeling. Methylphenidate was more efficacious in participants without NPI anxiety (change in NPI-A -2.21, standard error [SE]:0.60) or agitation (-2.63, SE:0.68), prescribed cholinesterase inhibitors (ChEI) (-2.44, SE:0.62), between 52 and 72 years of age (-2.93, SE:1.05), had 73-80 mm Hg diastolic blood pressure (-2.43, SE: 1.03), and more functional impairment (-2.56, SE:1.16) as measured by the Alzheimer's Disease Cooperative Study Activities of Daily Living scale. CONCLUSION Individuals who were not anxious or agitated, younger, prescribed a ChEI, with optimal (73-80 mm Hg) diastolic blood pressure, or having more impaired function were more likely to benefit from methylphenidate compared to placebo. Clinicians may preferentially consider methylphenidate for apathetic AD participants already prescribed a ChEI and without baseline anxiety or agitation.
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Affiliation(s)
- Krista L Lanctôt
- Sunnybrook Research Institute (KLL, LR, ST, KS, DV, NH), University of Toronto, Toronto, Ontario, Canada.
| | - Luc Rivet
- Sunnybrook Research Institute (KLL, LR, ST, KS, DV, NH), University of Toronto, Toronto, Ontario, Canada
| | - Shankar Tumati
- Sunnybrook Research Institute (KLL, LR, ST, KS, DV, NH), University of Toronto, Toronto, Ontario, Canada
| | - Jamie Perin
- Bloomberg School of Public Health (JP, DS), Johns Hopkins University, Baltimore, MD
| | - Krushnaa Sankhe
- Sunnybrook Research Institute (KLL, LR, ST, KS, DV, NH), University of Toronto, Toronto, Ontario, Canada
| | - Danielle Vieira
- Sunnybrook Research Institute (KLL, LR, ST, KS, DV, NH), University of Toronto, Toronto, Ontario, Canada
| | - Jacobo Mintzer
- Ralph H. Johnson VA Medical Center (JM, OB-M), Medical University of South Carolina, Charleston, SC
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences (PBR), Johns Hopkins University, Baltimore, MD
| | - David Shade
- Bloomberg School of Public Health (JP, DS), Johns Hopkins University, Baltimore, MD
| | - Alan J Lerner
- University Hospitals Cleveland Medical Center (AJL), Case Western Reserve University School of Medicine, Cleveland, OH
| | - Prasad R Padala
- Central Arkansas Veterans Healthcare System (PRP, KPP), University of Arkansas for Medical Sciences, Little Rock, AR
| | - Olga Brawman-Mintzer
- Ralph H. Johnson VA Medical Center (JM, OB-M), Medical University of South Carolina, Charleston, SC
| | | | | | | | - Allan I Levey
- Emory Goizueta Alzheimer's Disease Research Center (AIL), Atlanta, GA
| | - Kalpana P Padala
- Central Arkansas Veterans Healthcare System (PRP, KPP), University of Arkansas for Medical Sciences, Little Rock, AR
| | - Nathan Herrmann
- Sunnybrook Research Institute (KLL, LR, ST, KS, DV, NH), University of Toronto, Toronto, Ontario, Canada
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Sánchez-Méndez JI, Horstmann M, Méndez N, Frías L, Moreno E, Yébenes L, Roca MJ, Hernández A, Martí C. Surgical Interest of an Accurate Real-World Prediction of Primary Systemic Therapy Response in HER2 Breast Cancers. Cancers (Basel) 2023; 15:2757. [PMID: 37345094 DOI: 10.3390/cancers15102757] [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: 04/16/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-enriched breast cancers (BC) present the highest rates of pathological response to primary systemic therapy (PST), but they are also the ones that tend to be larger at diagnosis, with microcalcifications and, often, with axillary involvement. If we do not have a reliable method to predict the degree of response, we may not be able to transfer the benefits of PST to surgery. The post-PST surgery planning is guided by the findings in the magnetic resonance imaging (MRI), whose predictive capacity, although high, is far from optimal. Thus, it seems interesting to find other variables to improve it. A retrospective observational study including women with HER2 BC treated with PST and further surgery was conducted. Information regarding clinical, radiological, and histopathological variables was gathered from a total of 132 patients included. Radiological complete response (rCR) was achieved in 65.9% of the sample, and pathological complete response (pCR), according to Miller and Payne criteria, in 58.3% of cases. A higher Ki67 value, the absence of Hormonal Receptors expression, and an rCR was significantly related to a pCR finding. This information impacts directly in surgery planning, as it permits adjustment of the breast resection volume.
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Affiliation(s)
- Jose Ignacio Sánchez-Méndez
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
| | - Mónica Horstmann
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Obstetrics & Gynecology Department, Hospital Clínico Universitario Valladolid, 47003 Valladolid, Spain
| | - Nieves Méndez
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Laura Frías
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Elisa Moreno
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Laura Yébenes
- Hospital La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Breast Unit, Pathology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Mᵃ José Roca
- Breast Unit, Radiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Alicia Hernández
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
| | - Covadonga Martí
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
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Gatto F, Wildemberg LE, Ferone D, Gadelha MR. Routine Evaluation of Somatostatin Receptor Type 2 in Patients With Acromegaly: Do We Still Need More Evidence? J Clin Endocrinol Metab 2022; 107:e4382-e4383. [PMID: 36215656 DOI: 10.1210/clinem/dgac584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Federico Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
| | - Luiz Eduardo Wildemberg
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Neuroendocrine Unit - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Diego Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genova, Genova 16132, Italy
| | - Monica R Gadelha
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Neuroendocrine Unit - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
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Ornello R, Baraldi C, Ahmed F, Negro A, Miscio AM, Santoro A, Alpuente A, Russo A, Silvestro M, Cevoli S, Brunelli N, Vernieri F, Grazzi L, Pani L, Andreou A, Lambru G, Frattale I, Kamm K, Ruscheweyh R, Russo M, Torelli P, Filatova E, Latysheva N, Gryglas-Dworak A, Straburzyński M, Butera C, Colombo B, Filippi M, Pozo-Rosich P, Martelletti P, Guerzoni S, Sacco S. Excellent Response to OnabotulinumtoxinA: Different Definitions, Different Predictors. Int J Environ Res Public Health 2022; 19:ijerph191710975. [PMID: 36078699 PMCID: PMC9518492 DOI: 10.3390/ijerph191710975] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/26/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 05/10/2023]
Abstract
The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
| | - Carlo Baraldi
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy
- Correspondence: ; Tel.: +39-0594222104
| | - Fayyaz Ahmed
- Department of Neurosciences, Hull University Teaching Hospitals, Hull HU3 2JZ, UK
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Anna Maria Miscio
- Headache Center, Unit of Neurology, Fondazione IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Antonio Santoro
- Headache Center, Unit of Neurology, Fondazione IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy
| | - Alicia Alpuente
- Headache Unit, Department of Neurology, Vall D’Hebron University, 08035 Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall D’Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Nicoletta Brunelli
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy
| | - Licia Grazzi
- Headache Center, Neuroalgology Department, IRCCS Foundation “Carlo Besta” Neurological Institute, Via Celoria, 11, 20133 Milan, Italy
| | - Luca Pani
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy
- Pharmacology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Coral Gables, FL 33146, USA
- VeraSci, Durham, NC 27707, USA
| | - Anna Andreou
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Giorgio Lambru
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, 00133 Rome, Italy
| | - Katharina Kamm
- Department of Neurology, Ludwig Maximilians University München, 80539 Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University München, 80539 Munich, Germany
| | - Marco Russo
- Headache Center, Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Paola Torelli
- Headache Center, University of Parma, 43121 Parma, Italy
| | - Elena Filatova
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Nina Latysheva
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | | | - Marcin Straburzyński
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Calogera Butera
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
| | - Massimo Filippi
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 71013 Milan, Italy
| | - Patricia Pozo-Rosich
- Headache Unit, Department of Neurology, Vall D’Hebron University, 08035 Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall D’Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
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Sandborn WJ, Armuzzi A, Liguori G, Irving PM, Sharara AI, Mundayat R, Lawendy N, Woolcott JC, Danese S. Predictors of Sustained Response With Tofacitinib Therapy in Patients With Ulcerative Colitis. Inflamm Bowel Dis 2022; 28:1338-1347. [PMID: 34958359 PMCID: PMC9434448 DOI: 10.1093/ibd/izab278] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis. We evaluate baseline characteristics as predictors of sustained response and remission in patients with ulcerative colitis receiving tofacitinib maintenance therapy. METHODS Patients with clinical response following OCTAVE Induction 1 and 2 entered OCTAVE Sustain and were rerandomized to receive tofacitinib 5 or 10 mg twice daily or placebo. Baseline characteristics were stratified by week 52 efficacy endpoints (remission, sustained remission, clinical response, sustained clinical response). Associations between baseline characteristics and efficacy endpoints were evaluated using logistic regression analyses. RESULTS Overall, 170 of 487 (34.9%) patients were in remission at week 52. In multivariable modeling, endoscopic subscore at baseline of OCTAVE Induction 1 and 2 (2 vs 3; odds ratio [OR], 1.60; 95% confidence interval [CI], 1.06-2.44]), partial Mayo score (<2 vs ≥2; OR, 1.92; 95% CI, 1.27-2.90), and age (per 10-years; OR, 1.19; 95% CI, 1.02-1.39) at baseline of OCTAVE Sustain (following 8 weeks' tofacitinib induction therapy) were associated with higher odds of remission at week 52. Oral corticosteroid use (OR, 0.63; 95% CI, 0.42-0.96) and C-reactive protein (per unit; OR, 0.94; 95% CI, 0.89-0.99) at baseline of OCTAVE Sustain were associated with reduced likelihood of remission at week 52. In general, opposite associations were observed for time to loss of response. CONCLUSION Patients with greater clinical improvement after 8 weeks of tofacitinib induction therapy are more likely to maintain response or remission with tofacitinib regardless of dose received during maintenance, highlighting the importance of a robust response to induction therapy.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Alessandro Armuzzi
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Ala I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
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Kostov KH, Kostov H, Larsson PG, Henning O, Eckmann CAC, Lossius MI, Peltola J. Norwegian population-based study of long-term effects, safety, and predictors of response of vagus nerve stimulation treatment in drug-resistant epilepsy: The NORPulse study. Epilepsia 2021; 63:414-425. [PMID: 34935136 DOI: 10.1111/epi.17152] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the efficacy of vagus nerve stimulation (VNS) over time, and to determine which patient groups derive the most benefit. METHODS Long-term outcomes are reported in 436 epilepsy patients from a VNS quality registry (52.8% adults, 47.2% children), with a median follow-up of 75 months. Patients were stratified according to evolution of response into constant responders, fluctuating responders, and nonresponders. The effect was evaluated at 6, 12, 24, 36, and 60 months. Multivariate regression analysis was used to identify predictors of response. RESULTS The cumulative probability of ≥50% seizure reduction was 60%; however, 15% of patients showed a fluctuating course. Of those becoming responders, 89.5% (230/257) did so within 2 years. A steady increase in effect was observed among constant responders, with 48.7% (19/39) of those becoming seizure-free and 29.3% (39/133) with ≥75% seizure reduction achieving these effects within 2-5 years. Some effect (25%-<50%) at 6 months was a positive predictor of becoming a responder (odds ratio [OR] = 10.18, p < .0001) and having ≥75% reduction at 2 years (OR = 3.34, p = .03). Patients without intellectual disability had ORs of 3.34 and 3.11 of having ≥75% reduction at 2 and 5 years, respectively, and an OR of 6.22 of being seizure-free at last observation. Patients with unchanged antiseizure medication over the observation period showed better responder rates at 2 (63.0% vs. 43.1%, p = .002) and 5 years (63.4% vs. 46.3%, p = .031) than patients whose antiseizure medication was modified. Responder rates were higher for posttraumatic (70.6%, p = .048) and poststroke epilepsies (75.0%, p = .05) than other etiologies (46.5%). SIGNIFICANCE Our data indicate that the effect of VNS increases over time and that there are important clinical decision points at 6 and 24 months for evaluating and adjusting the treatment. There should be better selection of candidates, as certain patient groups and epilepsy etiologies respond more favorably.
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Affiliation(s)
| | - Hrisimir Kostov
- National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | | | - Oliver Henning
- National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | | | - Morten Ingvar Lossius
- National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jukka Peltola
- Department of Neurology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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He Y, Ramesh A, Gusev Y, Bhuvaneshwar K, Giaccone G. Molecular predictors of response to pembrolizumab in thymic carcinoma. Cell Rep Med 2021; 2:100392. [PMID: 34622229 PMCID: PMC8484507 DOI: 10.1016/j.xcrm.2021.100392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022]
Abstract
Thymic carcinoma is rare and has a poorer prognosis than thymomas. The treatment options are limited after failure of platinum-based chemotherapy. We previously performed a single-center phase II study of pembrolizumab in patients with advanced thymic carcinoma, showing a 22.5% response rate. Here, we characterize the genomic and transcriptomic profile of thymic carcinoma samples from 10 patients (5 non-responders versus 5 responders) in this cohort, with the main aim of identifying potential predictors of response to immunotherapy. We find that expression of PDL1 and alterations in genes or pathways that correlated with PD-L1 expression (CYLD and BAP1) could be potential predictors for response or resistance to immunotherapy in patients with advanced thymic carcinoma. Our study provides insights into potential predictive markers/pathways to select patients with thymic carcinoma for anti-PD-1 immunotherapy.
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Affiliation(s)
- Yongfeng He
- Meyer Cancer Center, Weill Cornel Medicine, New York, NY 10065, USA
| | - Archana Ramesh
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, 20057, USA
| | - Yuriy Gusev
- Innovation Center of Biomedical Informatics (ICBI), Georgetown University Medical Center, Washington, DC, 20007, USA
| | - Krithika Bhuvaneshwar
- Innovation Center of Biomedical Informatics (ICBI), Georgetown University Medical Center, Washington, DC, 20007, USA
| | - Giuseppe Giaccone
- Meyer Cancer Center, Weill Cornel Medicine, New York, NY 10065, USA
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, 20057, USA
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9
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Baraldi C, Castro FL, Cainazzo MM, Pani L, Guerzoni S. Predictors of response to erenumab after 12 months of treatment. Brain Behav 2021; 11:e2260. [PMID: 34268907 PMCID: PMC8413721 DOI: 10.1002/brb3.2260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 03/23/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Erenumab is a monoclonal antibody acting against calcitonin gene-related peptide receptor and approved for the preventive treatment of chronic migraine. The aim of the present study is to identify clinical predictors of good response in patients with chronic migraine and medication overuse-headache. MATERIAL AND METHODS This was a retrospective single-center not funded study. Enrolled patients were affected by chronic migraine and medication overuse-headache treated with erenumab monthly, up to 1 year. At 1 year, patients were classified as good responders if they displayed a ≥50% reduction in the number of headache days per months compared to the baseline. RESULTS After 1 year, a significant improvement in the number of headache days per months, analgesic consumption, 6-items headache impact test, and migraine disability assessment questionnaire scores were obtained compared to the baseline. Patients who obtained a ≥50% reduction in the number of headache days per month compared to the baseline displayed a longer history of medication overuse-headache, a higher number of painkillers taken per month at the baseline and a higher number of failed preventive treatments in the past. CONCLUSIONS Patients with longer medication overuse-headache duration, higher analgesic intake, and a higher number of previous preventive treatment failures may receive less benefit with erenumab.
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Affiliation(s)
- Carlo Baraldi
- PhD School in Neuroscience, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Flavia Lo Castro
- Post-graduate School of Pharmacology and Clinical Toxicology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Michela Cainazzo
- Medical Toxicology-headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Pani
- Medical Toxicology-headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Pharmacology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida, USA.,VeraSci, Durham, North Carolina, USA
| | - Simona Guerzoni
- Medical Toxicology-headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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10
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Williet N, Petrillo A, Roth G, Ghidini M, Petrova M, Forestier J, Lopez A, Thoor A, Weislinger L, De Vita F, Taieb J, Phelip JM. Gemcitabine/Nab-Paclitaxel versus FOLFIRINOX in Locally Advanced Pancreatic Cancer: A European Multicenter Study. Cancers (Basel) 2021; 13:cancers13112797. [PMID: 34199796 PMCID: PMC8200096 DOI: 10.3390/cancers13112797] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). By carefully selecting patients, it is likely these two regimens lead to similar survival outcomes. Through a multicenter European study, biases regarding practice habits are reduced. Hence, we observed no difference between GN and FFX as first-line treatments in patients with LAPC in terms of either survival, tumor response or tumor resection rate. Further trials are needed to confirm these data. Abstract Background: Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). Methods: This is a retrospective European multicenter study including patients with LAPC treated with either GN or FFX as the first-line therapy between 2010 and 2019. Coprimary objectives were progression-free survival (PFS) and overall survival (OS), both estimated using the Kaplan–Meier method. Results: A total of 147 patients (GN: n = 60; FFX: n = 87) were included. Tumor resection rates were similar between the two groups (16.7% vs. 16.1%; p = 1), with similar R0 resection rates (88.9%). Median PFS rates were not statistically different: 9 months (95% CI: 8–13.5) vs. 12.1 months (95% CI: 10.1–14.6; p = 0.8), respectively. Median OS rates were 15.7 months (95% CI: 12.6–20.2) and 16.7 months (95% CI: 14.8–20.4; p = 0.7), respectively. Abdominal pain at the baseline (HR = 2.03, p = 0.03), tumors located in the tail of the pancreas (HR = 4.35, p = 0.01), CA19-9 > 200 UI/L (HR = 2.03, p = 0.004) and tumor resection (HR = 0.37, p = 0.007) were independent prognostic factors for PFS, similarly to OS. CA19-9 ≤ 200 UI/L (OR = 2.6, p = 0.047) was predictive of the tumor response. Consolidation chemoradiotherapy, more often used in the FFX group (11.7% vs. 50.6%; p < 0.001), was not predictive. Conclusion: This retrospective study did not show any difference between GN and FFX as the first-line treatment in patients with LAPC.
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Affiliation(s)
- Nicolas Williet
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
- Correspondence:
| | - Angelica Petrillo
- Department of Precision Medecine, University of Study of Campania «L. Vanvitelli», 81100 Naples, Italy; (A.P.); (F.D.V.)
| | - Gaël Roth
- Hepato-Gastroenterology Department, University Hospital of Grenoble, 38043 Grenoble, France; (G.R.); (A.T.)
| | - Michele Ghidini
- Department of Medical Oncology, Cancer Center, Hospital of Cremona, 26100 Cremona, Italy;
| | - Mila Petrova
- Department of Medical Oncology, MHAT Nadezhda, 1220 Sofia, Bulgaria;
| | - Julien Forestier
- Department of Medical Oncology, Hôpital Edouard Herriot, 69622 Lyon, France;
| | - Anthony Lopez
- Hepato-Gastroenterology Department, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (A.L.); (L.W.)
| | - Audrey Thoor
- Hepato-Gastroenterology Department, University Hospital of Grenoble, 38043 Grenoble, France; (G.R.); (A.T.)
| | - Lucie Weislinger
- Hepato-Gastroenterology Department, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (A.L.); (L.W.)
| | - Ferdinando De Vita
- Department of Precision Medecine, University of Study of Campania «L. Vanvitelli», 81100 Naples, Italy; (A.P.); (F.D.V.)
| | - Julien Taieb
- Department of Gastroenterology and Gastro-Intestinal Oncology, Hôpital Européen Georges-Pompidou, APHP, Paris Descartes University, Sorbonne Paris Cité, 75004 Paris, France;
| | - Jean Marc Phelip
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
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11
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Castro N, Nadeau SE, Kendall DL. The Challenge of Achieving Greater Generalization in Phonological Treatment of Aphasia. Aphasiology 2021; 36:170-197. [PMID: 35280517 PMCID: PMC8916712 DOI: 10.1080/02687038.2020.1856327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/22/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Stimulus selection is important to anomia treatment because similarity between trained and untrained words in the mental lexicon may influence treatment generalization. We focused on phonological similarity between trained and untrained words from a clinical trial of Phonomotor Treatment (PMT) that showed gains in confrontation naming accuracy of untrained words post-treatment. One way to capture the amount of similarity between the trained and untrained words is to consider the phonological network path distance between words. We posited that the distance between trained and untrained words in a phonological network could account for the improvement in confrontation naming accuracy post-treatment. AIM To define the phonological network distance between trained and untrained words that influences change in confrontation naming accuracy post-treatment. METHODS AND PROCEDURES We retrospectively analyzed data from 28 people with aphasia who received PMT as part of a clinical trial. Participants completed confrontation naming (baseline, post-treatment, and 3-months post-treatment) of words varying in phonological distance to the treatment stimuli. We used a phonological network to calculate the average shortest path length (ASPL), defined by number of phoneme differences, between an untrained word and all trained words. We used mixed effects regression models to predict change in confrontation naming accuracy of untrained words post-treatment from ASPL. Several post-hoc analyses were also conducted. OUTCOMES AND RESULTS We found no effect of ASPL on change in confrontation naming accuracy of untrained words immediately post- and 3-months post-treatment. However, post-hoc analyses indicated significant subject heterogeneity and limitations in observable path distance between trained and untrained words. CONCLUSION Despite the clinical trial report that confrontation naming of untrained words improved after PMT, we found no overall effect of ASPL on the amount of improvement. We discuss further investigation of the entire domain of phonological sequence knowledge (the phonological sequence knowledge landscape) and its influence on treatment generalization, and the potential importance of identifying predictors of treatment response to enhance the effects of treatment generalization.
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Affiliation(s)
- Nichol Castro
- Department of Speech and Hearing Sciences, University of Washington
| | | | - Diane L. Kendall
- Department of Speech and Hearing Sciences, University of Washington
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12
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Kumar Jaiswal S, Sarathi V, Samad Memon S, Garg R, Malhotra G, Verma P, Shah R, Kaur Sehemby M, A Patil V, Jadhav S, Ranjan Lila A, S Shah N, R Bandgar T. 177Lu-DOTATATE therapy in metastatic/inoperable pheochromocytoma-paraganglioma. Endocr Connect 2020; 9:864-873. [PMID: 32784267 PMCID: PMC7487189 DOI: 10.1530/ec-20-0292] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION 177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) is a promising therapy for metastatic and/or inoperable pheochromocytoma and paraganglioma (PPGL). We aim to evaluate the efficacy and safety of and identify predictors of response to 177Lu-DOTATATE therapy in metastatic and/or inoperable PPGL. METHODS This retrospective study involved 15 patients of metastatic or unresectable PPGL, who received 177Lu-DOTATATE PRRT therapy. Clinical, biochemical (plasma-free normetanephrine), and radiological (anatomical and functional) responses were compared before and after the last therapy. RESULTS A total of 15 patients (4 PCC, 4 sPGL, 5 HNPGL, 1 PCC + sPGL, 1 HNPGL + sPGL) were included. The median duration of follow up was 27 (range: 11-62) months from the start of PRRT. Based on the RECIST (1.1) criteria, progressive disease was seen in three (20%), stable disease in eight (53%), partial response in one (7%), and minor response in three (20%) and controlled disease in 12 (80%). On linear regression analysis the presence of PGL (P= 0.044) and baseline SUVmax >21 (P < 0.0001) were significant positive predictors of early response to PRRT. Encouraging safety profiles were noted with no long term nephrotoxicity and hematotoxicity. CONCLUSION 177Lu-DOTATATE therapy is an effective and safe modality of treatment for patients with metastatic/inoperable PPGL. Although it is not prudent to withhold PRRT in metastatic PPGL with baseline SUVmax < 21, baseline SUVmax >21 can be used to predict early response to PRRT.
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Affiliation(s)
- Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Robin Garg
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Priyanka Verma
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ravikumar Shah
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Manjeet Kaur Sehemby
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Virendra A Patil
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Swati Jadhav
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag Ranjan Lila
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
- Correspondence should be addressed to T R Bandgar:
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13
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Tepper SJ, Vasudeva R, Krege JH, Rathmann SS, Doty E, Vargas BB, Magis D, Komori M. Evaluation of 2-Hour Post-Dose Efficacy of Lasmiditan for the Acute Treatment of Difficult-to-Treat Migraine Attacks. Headache 2020; 60:1601-1615. [PMID: 32634275 PMCID: PMC7496706 DOI: 10.1111/head.13897] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify factors predicting response (2-hour headache pain freedom or most bothersome symptom freedom) to lasmiditan based on individual patient characteristics, migraine disease characteristics, and migraine attack characteristics. Further, efficacy specifically in difficult-to-treat patient/migraine disease characteristics or attack characteristics (ie, historically considered less responsive to certain acute therapies) subgroups was analyzed. BACKGROUND Knowledge of factors associated with a positive or negative response to acute treatment would be useful to practitioners prescribing acute treatments for migraine. Additionally, practitioners and patients would benefit from understanding the efficacy of lasmiditan specifically in subgroups of patients with migraine disease characteristics and migraine attack characteristics historically associated with decreased pain threshold, reduced efficacy of acute treatment, or increased burden of migraine. METHODS Pooled analyses were completed from 2 Phase 3 double-blind clinical trials, SPARTAN and SAMURAI. Data from baseline to 2 hours after taking lasmiditan (50, 100, or 200 mg) or placebo were analyzed to assess efficacy based on patient characteristics, migraine disease characteristics, and migraine attack characteristics. A total of 3981 patients comprising the intent-to-treat population were treated with placebo (N = 1130), lasmiditan 50 mg (N = 598), lasmiditan 100 mg (N = 1133), or lasmiditan 200 mg (N = 1120). Data were analyzed for the following efficacy measures at 2 hours: headache pain freedom and most bothersome symptom freedom. RESULTS None of the analyzed subgroups based on individual patient characteristics, migraine disease characteristics, or migraine attack characteristics predicted headache pain freedom or most bothersome symptom freedom response at 2 hours following lasmiditan treatment (interaction P ≥ .1). For the difficult-to-treat patient/migraine disease characteristics subgroups (defined as those with ≥24 headache days in the past 3 months, duration of migraine history ≥20 years, severe disability [Migraine Disability Assessment score ≥21], obesity [≥30 kg/m2 ], and history of psychiatric disorder), single doses of lasmiditan (100 or 200 mg) were significantly more effective than placebo (P ≤ .002) in achieving both endpoints. Headache pain freedom response rates for higher doses of lasmiditan were numerically greater than for lower doses of lasmiditan. For the difficult-to-treat migraine attack subgroups, patients with severe headache, co-existent nausea at the time of treatment, or who delayed treatment for ≥2 hours from the time of headache onset, both endpoint response rates after lasmiditan 100 or 200 mg were significantly greater than after placebo. Among those who delayed treatment for ≥4 hours from the time of headache onset, headache pain freedom response rates for the 200 mg dose of lasmiditan met statistical significance vs placebo (32.4% vs 15.9%; odds ratio = 2.7 [1.17, 6.07]; P = .018). While the predictors of response interaction test showed similar efficacy of lasmiditan vs placebo across subgroups defined by baseline functional disability (mild, moderate, or needs complete bed rest) at the time of treatment, analyses of lasmiditan efficacy within the subgroup "needs complete bed rest" appeared to show less efficacy (eg, in the 200 mg vs placebo group, 25.9% vs 18.5%; odds ratio = 1.56 [0.96, 2.53]; P = .070). CONCLUSIONS Efficacy of lasmiditan 200 and 100 mg for headache pain freedom and most bothersome symptom freedom at 2 hours post-treatment was generally not influenced by the individual patient characteristics, migraine disease history, or migraine attack characteristics that were analyzed. In the analyses of difficult-to-treat subgroups, patients receiving lasmiditan achieved greater responses (2-hour headache pain freedom and most bothersome symptom freedom) vs placebo recipients.
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Affiliation(s)
- Stewart J. Tepper
- Department of NeurologyGeisel School of Medicine at DartmouthHanoverNHUSA
| | | | | | | | - Erin Doty
- Eli Lilly and Company, IndianapolisINUSA
| | - Bert B. Vargas
- Eli Lilly and Company, IndianapolisINUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Delphine Magis
- Department of Neurology and Headache and Pain Multimodal Management ClinicCHR East Belgium HospitalVerviersBelgium
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14
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Rinker F, Bremer CM, Schröder K, Wiegand SB, Bremer B, Manns MP, Kraft AR, Wedemeyer H, Yang L, Pavlovic V, Wat C, Gerlich WH, Glebe D, Cornberg M. Quantitation of large, middle and small hepatitis B surface proteins in HBeAg-positive patients treated with peginterferon alfa-2a. Liver Int 2020; 40:324-332. [PMID: 31721419 DOI: 10.1111/liv.14298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Hepatitis B virus (HBV) contains three viral surface proteins, large, middle and small hepatitis B surface protein (LHBs, MHBs, SHBs). Proportions of LHBs and MHBs are lower in patients with inactive vs active chronic infection. Interferon alfa may convert hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) to an inactive carrier state, but prediction of sustained response is unsatisfactory. The aim of this study was to test the hypothesis that quantification of MHBs and LHBs may allow for a better prognosis of therapeutic response than total hepatitis B surface antigen (HBsAg) concentration. METHODS Hepatitis B surface proteins were measured before and during peginterferon alfa-2a therapy in serum from 127 Asian patients with HBeAg-positive CHB. Sustained response was defined as HBeAg seroconversion 24 weeks post-treatment. RESULTS Mean total HBs levels were significantly lower in responders vs nonresponders at all time points (P < .05) and decreased steadily during the initial 24 weeks treatment (by 1.16 vs 0.86 ng/mL in responders/nonresponders respectively) with unchanged relative proportions. Genotype B had a two-fold higher proportion of LHBs than genotype C (13% vs 6%). HBV DNA, HBeAg, HBsAg and HBs protein levels predicted response equally well but not optimally (area under the receiver operating characteristic curve values >0.70). CONCLUSIONS Hepatitis B surface protein levels differ by HBV genotype. However, quantification of HBs proteins has no advantage over the already established HBsAg assays to predict response to peginterferon alfa-2a therapy in HBeAg-positive patients.
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Affiliation(s)
- Franziska Rinker
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Corinna M Bremer
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D viruses, Giessen, Germany.,German Center for Infection Research (DZIF), Giessen-Marburg-Langen, Germany
| | - Kathrin Schröder
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D viruses, Giessen, Germany.,German Center for Infection Research (DZIF), Giessen-Marburg-Langen, Germany
| | - Steffen B Wiegand
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Birgit Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Anke R Kraft
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Lei Yang
- Roche (China) Holding Ltd, Product Development-Biometrics/Biostatistics, Shanghai, China
| | - Vedran Pavlovic
- Roche Products Ltd, Product Development-Clinical Science, Welwyn Garden City, UK
| | - Cynthia Wat
- Roche Products Ltd, Product Development-Clinical Science, Welwyn Garden City, UK
| | - Wolfram H Gerlich
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D viruses, Giessen, Germany
| | - Dieter Glebe
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D viruses, Giessen, Germany.,German Center for Infection Research (DZIF), Giessen-Marburg-Langen, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany.,Centre for Individualized Infection Medicine (CIIM), A Joint Venture of Helmholtz Centre for Infection Research and Hannover Medical School, Hannover, Germany
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15
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Angelison L, Almer S, Davidsdottir L, Hammarlund P, Lindgren S, Hindorf U, Marsal J, Hertervig E. Short and long-term efficacy of adalimumab in ulcerative colitis: a real-life study. Scand J Gastroenterol 2020; 55:154-162. [PMID: 31961234 DOI: 10.1080/00365521.2020.1713210] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Randomized controlled trials have shown the effectiveness of Adalimumab in ulcerative colitis. However, real-life data is scarce. We aimed to assess the effectiveness and predictive factors of effectiveness in a large Swedish cohort.Methods: Retrospective capture of data from local registries at five Swedish IBD centers. Clinical response and remission rates were assessed at three months after starting adalimumab treatment and patients were followed until colectomy or need for another biological. Bio-naive patients were compared to bio experienced patients. Factors associated with short term responses were assessed using logistic regression model. Failure on drug was assessed using a Cox proportional hazards regression model.Results: 118 patients (59 males, 59 females) with median age 34.4 years (IQR 27.0-51.4) were included. Median disease duration was 4.3 years (IQR 2.0-9.0) and follow-up 1.27 years (IQR 0.33-4.1). A clinical corticosteroid-free remission was achieved by 38/118 (32.2%) and response by 91/118 (77%) after three months. CRP >3 mg/l at baseline was predictive of short-term failure to reach corticosteroid-free remission. Factors associated with survival on the drug were male gender, CRP <3 mg/l and absence of primary sclerosing cholangitis. Patients >42 years of age at diagnosis were more likely to respond to adalimumab and remain on treatment compared to patients <20 years.Conclusions: An elevated CRP-level, primary sclerosing cholangitis and female gender were predictors of treatment failure. In contrast older age at diagnosis was a predictor of short-term clinical response and drug survival. Prior infliximab failure, regardless of cause, did not influence the outcome of adalimumab treatment.
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Affiliation(s)
- Leif Angelison
- Department of Medicine, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Loa Davidsdottir
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Hammarlund
- Department of Medicine, Ängelholm Hospital, Ängelholm, Sweden
| | - Stefan Lindgren
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skane University Hospital, Lund/Malmö, Sweden
| | - Ulf Hindorf
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jan Marsal
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skane University Hospital, Lund/Malmö, Sweden
| | - Erik Hertervig
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Gastroenterology, Skane University Hospital, Lund/Malmö, Sweden
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16
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Bateman ED, Djukanović R, Castro M, Canvin J, Germinaro M, Noble R, Garin M, Buhl R. Predicting Responders to Reslizumab after 16 Weeks of Treatment Using an Algorithm Derived from Clinical Studies of Patients with Severe Eosinophilic Asthma. Am J Respir Crit Care Med 2020; 199:489-495. [PMID: 30346831 DOI: 10.1164/rccm.201708-1668oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Reslizumab is a humanized anti-IL-5 monoclonal antibody used as add-on maintenance treatment for patients with uncontrolled eosinophilic asthma. OBJECTIVES To predict response and nonresponse to intravenous reslizumab at 52 weeks with an algorithm we developed based on clinical indicators from pivotal clinical trials. METHODS Patients aged 18 years and older who met Global Initiative for Asthma 4 or 5 criteria and received intravenous reslizumab (n = 321) in two trials ( www.clinicaltrials.gov identifiers, NCT01287039 and NCT01285323) were selected as the data source. A mathematical model was constructed that was based on change from baseline to 16 weeks in Asthma Control Questionnaire and Asthma Quality of Life Questionnaire scores and FEV1, and number of clinical asthma exacerbations during the year before enrollment and in the first 16 weeks of treatment, and these measures were evaluated for their ability to predict the outcome at 52 weeks: responder, nonresponder, or indeterminate. MEASUREMENTS AND MAIN RESULTS The algorithm predicted that 276 patients would be classified as responders; in 248 (89.9%), the prediction was correct. In comparison, 26 patients were predicted to be nonresponders; 50.0% of these predictions were correct. Nineteen patients were classified as indeterminate. The algorithm had 95.4-95.5% sensitivity and 40.6-54.1% specificity. Jackknife and cross-study validation confirmed the robustness of the algorithm. CONCLUSIONS Our algorithm enabled prediction at 16 weeks of treatment of the response to intravenous reslizumab treatment at 52 weeks, but it was not suitable for predicting nonresponse. A positive score at 16 weeks should encourage continued treatment, and a negative score should prompt close monitoring to determine whether discontinuation is warranted.
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Affiliation(s)
| | | | - Mario Castro
- 3 Washington University School of Medicine, St. Louis, Missouri
| | - Janice Canvin
- 4 Teva Pharmaceuticals Europe BV, Amsterdam, the Netherlands
| | | | - Robert Noble
- 5 Teva Pharmaceuticals, Frazer, Pennsylvania; and
| | | | - Roland Buhl
- 6 Johannes Gutenberg University Mainz, Mainz, Germany
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Gahlot M, Goyal A, Singh AKC, Jyotsna VP, Gupta N, Khadgawat R. Long-term Response to Recombinant Human Growth Hormone Therapy in Indian Children with Growth Hormone Deficiency. Indian J Endocrinol Metab 2019; 23:446-451. [PMID: 31741904 PMCID: PMC6844160 DOI: 10.4103/ijem.ijem_300_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Growth hormone deficiency (GHD) remains the most common indication for use of recombinant human growth hormone (rhGH) therapy in clinical practice. However, there is a paucity of studies focusing on long-term response to rhGH therapy in the Indian context. AIM To determine the response to rhGH therapy and its predictors in children with GHD followed up at a tertiary care center in North India. MATERIALS AND METHODS We performed a retrospective review of the records of children with GHD who received rhGH therapy for at least 1 year. The relevant anthropometric, biochemical and radiological data at baseline and follow-up were recorded. RESULTS A total of 99 children (64 boys, 35 girls; 61 isolated GHD, 38 multiple pituitary hormone deficiency) were studied. The mean (±SD) age and height SDS at treatment initiation were 12.4 (±3.0) years and -4.0 (±1.1) respectively, while median (IQR) serum insulin-like growth factor 1 (IGF-1) and peak growth hormone level on clonidine stimulation were 73 (25-167) ng/ml and 1.1 (0.4-3.6) ng/ml respectively. The height velocity was highest during the first year of treatment (10.6 ± 3.0 cm/year), declining to 8.7 ± 2.7 and 7.9 ± 2.2 cm/year during second and third year, respectively. Over the subsequent years, there was further graded fall in height velocity, declining to 4.8 ± 3.6 cm/year (n = 2) during the seventh year. The height gain during first year was negatively correlated with age at initiation of treatment, baseline height SDS, baseline serum IGF-1 and peak serum GH level on GH stimulation test, while it showed a positive correlation with bone age delay at baseline. Only baseline height SDS was found to have a significant negative correlation with height gain during the second year. CONCLUSIONS This study provides data on long-term response to rhGH therapy and its predictors in Indian children with GHD.
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Affiliation(s)
- Monita Gahlot
- Department of Dietetics, All India Institute of Medical Sciences, New Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Arun K. C. Singh
- Department of Endocrinology and Metabolism, Sarvodaya Hospital and Research Centre, Faridabad, Haryana, India
| | - Viveka P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Philip NS, Leuchter AF, Cook IA, Massaro J, Goethe JW, Carpenter LL. Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder. Depress Anxiety 2019; 36:278-285. [PMID: 30480860 DOI: 10.1002/da.22862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/26/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Synchronized transcranial magnetic stimulation (sTMS) is a new modality to reduce symptoms of major depressive disorder (MDD). sTMS uses rotating neodymium magnets to deliver low-field stimulation matched to the individual alpha frequency (IAF). A previous multisite study showed that sTMS significantly reduced MDD symptoms in the per-protocol sample. To this end, we evaluated clinical features associated with optimal sTMS outcomes. METHODS Using the per-protocol sample (n = 120) from the parent sham-controlled trial, we performed univariate and stepwise linear regression to identify predictors of response after 6 weeks of sTMS. A subsample (n = 83) that entered a 4-week open/active continuation phase also was examined. Candidate variables included age, sex, comorbid anxiety, number of failed antidepressants in the current depressive episode, MDD severity (17-item Hamilton Depression Rating Scale; HAMD17), anxiety symptom severity (HAMD17 anxiety/somatization factor), and IAF. RESULTS We found that greater baseline depressive (p < 0.001) and anxiety (p < 0.001) symptom severity were associated with better response to active sTMS, whereas fewer failed antidepressant trials predicted superior response to sham (p < 0.001). MDD severity and antidepressant resistance predicted outcomes in open/active phase sTMS; lower IAF predicted poorer response in participants who received 10 weeks of active sTMS (p = 0.001). CONCLUSIONS Participants with greater severity of depression and higher anxiety had superior responses to active sTMS, whereas treatment naïve individuals exhibited a greater response to sham. These results lend support to the primary efficacy findings, and support further investigation of sTMS as a therapeutic noninvasive brain stimulation modality.
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Affiliation(s)
- Noah S Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, 02908, USA.,Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA
| | - Andrew F Leuchter
- Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ian A Cook
- Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science at UCLA, Los Angeles, CA, 90095, USA.,Mood and TMS Services, Greater Los Angeles VA Health System, Los Angeles, CA, 90073, USA
| | - Joe Massaro
- Boston University School of Public Health, Boston, MA, USA
| | | | - Linda L Carpenter
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA
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Affiliation(s)
- Michèle Beniey
- Division of Surgical Oncology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM); Université de Montréal; Institut du cancer de Montréal and Centre de Recherche du CHUM (CRCHUM), Montreal, Quebec, Canada
| | - Takrima Haque
- Division of Surgical Oncology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM); Université de Montréal; Institut du cancer de Montréal and Centre de Recherche du CHUM (CRCHUM), Montreal, Quebec, Canada
| | - Saima Hassan
- Division of Surgical Oncology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM); Université de Montréal; Institut du cancer de Montréal and Centre de Recherche du CHUM (CRCHUM), Montreal, Quebec, Canada
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Bozzatello P, Bellino S, Rocca P. Predictive Factors of Treatment Resistance in First Episode of Psychosis: A Systematic Review. Front Psychiatry 2019; 10:67. [PMID: 30863323 PMCID: PMC6399388 DOI: 10.3389/fpsyt.2019.00067] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/29/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Clinical and functional outcome improvement in psychotic disorders is a challenge for the investigators. Recent advances offered opportunities for ameliorating the course of the illness during its early stages and for identifying treatment-resistant patients. Patients who had not response to two different antipsychotics, administered at correct doses for a sufficient period, can be operationally considered treatment-resistant. Available evidence suggested that the response's trajectory to the antipsychotic treatment revealed that a small proportion of subjects are poor responders (8.2%), the majority of patients have a moderate response (76.4%), and only 15.4% can be considered rapid responders with the greatest magnitude of response. Patients with first episode of psychosis generally obtain a more favorable response profile. Nevertheless, in around 25% of these patients symptoms of psychosis persist with a worse long-term course of illness. Objectives: The aim of this review is to report current evidences on the main predictors of treatment non-response in patients at early stage of psychosis. Methods: We used a specific string that guaranteed a high sensitive search in pubmed. We included the following types of publications: randomized-controlled trials, observational studies, longitudinal studies, retrospective studies, case-control studies, open-label investigations, cohort studies, and reviews. Publications must concern predictors of treatment resistance in early psychosis. Results: Forty-seven records were included: 5 reviews, 3 meta-analyses, 22 longitudinal studies, 2 retrospective studies, 1 naturalistic study, 6 randomized controlled trials, 2 open-label studies, 2 case-control studies, 4 cohort studies, 2 retrospective studies. Several factors were identified as predictors of treatment resistance: lower premorbid functioning; lower level of education; negative symptoms from first psychotic episode; comorbid substance use; younger age at onset; lack of early response; non-adherence to treatment; and longer duration of untreated psychosis. The role of gender and marital status is still controversial. More evidences are needed about neurobiological, genetic, and neuroimaging factors. Conclusions: The identification of specific predictive factors of treatment resistance in patients with first episode of psychosis ameliorates the quality of clinical management of these patients in the critical early phase of schizophrenia.
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Affiliation(s)
| | - Silvio Bellino
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
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Abstract
OBJECTIVES Real world data regarding clinical response to ustekinumab in Crohn's disease is lacking. We report our experience of ustekinumab use using a novel subcutaneous (SC) induction strategy and aim to identify predictors of response. MATERIALS AND METHODS A retrospective, observational study of compassionate ustekinumab use in Crohn's disease was conducted with the use of a standard or high dose SC induction protocol. Symptomatic response was assessed after 3 months (short-term), and if remaining on therapy, within 3-12 months (medium-term) and at least 12 months (long-term). Endoscopic or radiologic response was assessed when available. Survival analysis of time to failure (cessation of ustekinumab) and multivariate logistic regression to identify predictors of response were performed. RESULTS Seventy-nine patients commenced ustekinumab, with six patients lost to follow-up and five asymptomatic at baseline. Symptomatic response was assessed in 68 patients; 56% (38) of patients had a short-term symptomatic response. Type of preceding anti-TNF response was the only significant predictor of short-term response, with primary non-response being a strong predictor. In the medium-term, symptomatic response occurred in 72% (30/42) of patients and endoscopic or radiologic response was achieved in 72% (26/36) of patients assessed. The median time to failure was 22 months. Maintenance dose escalation to 90 mg every 4 weeks was successful in three of 16 patients. CONCLUSIONS Fifty-six percent of patients had short-term symptomatic response, with a history of primary non-response to prior anti-TNF therapy being a predictor of response. Dose escalation had only modest benefit.
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Affiliation(s)
- Astrid-Jane Greenup
- a Department of Medicine , Division of Gastroenterology, University of British Columbia , Vancouver , Canada
| | - Greg Rosenfeld
- a Department of Medicine , Division of Gastroenterology, University of British Columbia , Vancouver , Canada
| | - Brian Bressler
- a Department of Medicine , Division of Gastroenterology, University of British Columbia , Vancouver , Canada
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Abstract
Pegylated interferon-α (PEG-IFN-α) is a first line option in the treatment of chronic hepatitis B. Compared with nucleos(t)ide analogues (NAs), therapy with PEG-IFN-α has the advantages of finite treatment duration and higher rates of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) seroconversion, but the disadvantage of greater adverse effects. Choosing PEG-IFN-α requires careful evaluation of the likelihood of achieving a sustained off-treatment response. Sustained off-treatment response with PEG-IFN-α can be predicted by baseline factors in HBeAg positive disease. These include genotype A or B, low viral load, high alanine aminotransferase (ALT), older age and female gender. On the other hand, no pre-treatment factors have been identified that can reliably predict response in HBeAg negative disease. Using on-treatment quantitative HBsAg levels, failure of a long term response can be identified with high negative predictive value (NPV). However, no combination of on treatment parameters have been identified so far that can precisely forecast successful treatment. Up until recently, there was little evidence supporting the use of combining PEG-IFN with NAs. The addition of PEG-IFN in patients who already have viral suppression with NAs therapy appears superior to continuing NAs alone in achieving a sustained response. Also, tenofovir disoproxil fumarate (TDF) in combination with PEG-IFN has been reported to enable significantly higher HBsAg loss than with either monotherapy alone. This occurred in both HBeAg positive and negative patients across all genotypes. In spite of recent developments, rates of HBsAg loss are still only in the order of 10% and so cure remains elusive. Further research is required to identify the optimal combination or sequential therapy regimen, and the subgroups with the highest rates of response so that they can be targeted.
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Affiliation(s)
- Aaron Shu Jeng Woo
- Division of Gastroenterology and Hepatology, Alexandra Health Khoo Teck Puat Hospital, Singapore
| | - Raymond Kwok
- Division of Gastroenterology and Hepatology, Alexandra Health Khoo Teck Puat Hospital, Singapore
| | - Taufique Ahmed
- Division of Gastroenterology and Hepatology, Alexandra Health Khoo Teck Puat Hospital, Singapore
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Vastesaeger N, Kutzbach AG, Amital H, Pavelka K, Lazaro MA, Moots RJ, Wollenhaupt J, Zerbini CAF, Louw I, Combe B, Beaulieu A, Schulze-Koops H, Dasgupta B, Fu B, Huyck S, Weng HH, Govoni M, Durez P. Prediction of remission and low disease activity in disease-modifying anti-rheumatic drug-refractory patients with rheumatoid arthritis treated with golimumab. Rheumatology (Oxford) 2016; 55:1466-76. [PMID: 27114562 PMCID: PMC4957672 DOI: 10.1093/rheumatology/kew179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 06/13/2015] [Indexed: 12/22/2022] Open
Abstract
Objective. To create a tool to predict probability of remission and low disease activity (LDA) in patients with RA being considered for anti-TNF treatment in clinical practice. Methods. We analysed data from GO-MORE, an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ⩾3.2) despite DMARD therapy. Patients received 50 mg s.c. golimumab (GLM) once monthly for 6 months. In secondary analyses, regression models were used to determine the best set of baseline factors to predict remission (DAS28-ESR <2.6) at month 6 and LDA (DAS28-ESR ⩽3.2) at month 1. Results. In 3280 efficacy-evaluable patients, of 12 factors included in initial regression models predicting remission or LDA, six were retained in final multivariable models. Greater likelihood of LDA and remission was associated with being male; younger age; lower HAQ, ESR (or CRP) and tender joint count (or swollen joint count) scores; and absence of comorbidities. In models predicting 1-, 3- and 6-month LDA or remission, area under the receiver operating curve was 0.648–0.809 (R2 = 0.0397–0.1078). The models also predicted 6-month HAQ and EuroQoL-5-dimension scores. A series of matrices were developed to easily show predicted rates of remission and LDA. Conclusion. A matrix tool was developed to show predicted GLM treatment outcomes in patients with RA, based on a combination of six baseline characteristics. The tool could help provide practical guidance in selection of candidates for anti-TNF therapy.
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Affiliation(s)
| | | | - Howard Amital
- Department of Internal Medicine B and Research Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Karel Pavelka
- Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic
| | | | - Robert J Moots
- Department of Rheumatology, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - Jürgen Wollenhaupt
- Department of Rheumatology, Klinik für Rheumatologie, Schön Klinik Hamburg-Eilbek, Hamburg, Germany
| | - Cristiano A F Zerbini
- Department of Rheumatology, Centro Paulista de Investigação Clinica, São Paulo, Brazil
| | - Ingrid Louw
- Panorama Medical Centre, Cape Town, South Africa
| | - Bernard Combe
- Departement de Rhumatologie, Hôpital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, University of Munich, Munich, Germany
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Bo Fu
- Department of Biostatistics
| | | | - Haoling H Weng
- Clinical Development, Merck & Co, Inc., Kenilworth, NJ, USA
| | - Marinella Govoni
- Department of Immunology, MSD Italy, Global Medical Affairs, Rome, Italy
| | - Patrick Durez
- Department of Rheumatology, Université Catholique de Louvain, Brussels, Belgium
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Boccaccio V, Russo ML, Carbone M, Bruno S. Treatment discontinuation with peg-interferon: what to consider. Expert Rev Clin Pharmacol 2015; 8:761-8. [PMID: 26437265 DOI: 10.1586/17512433.2015.1090872] [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: 11/08/2022]
Abstract
Eradication of chronic hepatitis C virus infection improves the outcome of both liver and extrahepatic-related diseases and interferon-based regimens represented, for years, the standard of care to achieve this goal. Several baseline and on-treatment predictors of response, associated with a lower chance to achieve sustained virological response after interferon-based treatment, were developed. In the past few years, the advent of direct acting antivirals has dramatically modified the landscape of antiviral therapy, leading to an evolution from interferon-based to interferon-free therapies. This review will focus on the usefulness of futility stopping rules that allow the discontinuation of therapy in patients with a reduced chance to obtain sustained virological response if treated with interferon-containing regimens.
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Affiliation(s)
- Vincenzo Boccaccio
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy
| | - Maria Luisa Russo
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy
| | - Marco Carbone
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy
| | - Savino Bruno
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy.,b 2 Department of Internal Medicine, Humanitas University Medicine , Rozzano, Italy
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Ionescu DF, Luckenbaugh DA, Niciu MJ, Richards EM, Zarate CA. A single infusion of ketamine improves depression scores in patients with anxious bipolar depression. Bipolar Disord 2015; 17:438-43. [PMID: 25400146 PMCID: PMC4431955 DOI: 10.1111/bdi.12277] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patents with anxious bipolar disorder have worse clinical outcomes and are harder to treat with traditional medication regimens compared to those with non-anxious bipolar disorder. Ketamine has been shown to rapidly and robustly decrease symptoms of depression in depressed patients with bipolar disorder. We sought to determine whether baseline anxiety status reduced ketamine's ability to decrease symptoms of depression. METHODS Thirty-six patients with anxious (n = 21) and non-anxious (n = 15) treatment-resistant bipolar depression (types I and II; concurrently treated with either lithium or valproate) received a single infusion of ketamine (0.5 mg/kg) over 40 min. Post-hoc analyses compared changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HDRS) in anxious versus non-anxious depressed patients with bipolar disorder through 14 days post-infusion. Anxious bipolar depression was defined as DSM-IV bipolar depression plus a HDRS Anxiety/Somatization Factor score of ≥ 7. RESULTS A linear mixed model revealed a significant effect of anxiety group on the MADRS (p = 0.04) and HDRS (p = 0.04). Significant drug effects (all p < 0.001) suggested that both anxious and non-anxious groups had an antidepressant response to ketamine. The drug-by-anxiety interactions were not significant (all p > 0.28). CONCLUSIONS Both anxious and non-anxious patients with bipolar depression had significant antidepressant responses to ketamine, although the anxious depressed group did not show a clear antidepressant response disadvantage over the non-anxious group. Given that anxiety has been shown to be a predictor of poor treatment response in bipolar depression when traditional treatments are used, our findings suggest a need for further investigations into ketamine's novel role in the treatment of anxious bipolar depression.
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Affiliation(s)
- Dawn F Ionescu
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA
,Harvard Medical School, Boston, MA
| | - David A Luckenbaugh
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Mark J Niciu
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Erica M Richards
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Koenig AM, Jarrett RB, Gallop R, Barrett MS, Thase ME. Extreme nonresponse to acute phase cognitive therapy for depression: an attempt to replicate and extend. Behav Ther 2014; 45:300-13. [PMID: 24680227 PMCID: PMC4221276 DOI: 10.1016/j.beth.2013.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 12/14/2013] [Accepted: 12/14/2013] [Indexed: 12/13/2022]
Abstract
As with other interventions for major depressive disorder (MDD), cognitive therapy (CT) results in treatment failure for about half of all participants. In 2007, Coffman and colleagues in Seattle studied this topic by identifying a group of patients who demonstrated an extremely poor response to CT (i.e., posttreatment BDI score≥31). They called these patients "extreme nonresponders" (ENR) and described the pretreatment characteristics that predicted response status. In the current study, we attempt a replication of the Seattle study with a larger sample of adults with recurrent MDD (N=473) who received a 16-20 session (12-14week) course of CT. The rate of ENR in this large sample was only 6.3% (30/473), compared to 22.2% (10/45) in the Seattle sample. Four pretreatment measures of symptom severity and functioning differed significantly among ENR and non-ENR participants. In each case, higher symptoms or poorer functioning were associated with ENR status. However, the combination of these factors in a regression model did not predict actual ENR status with the high degree of sensitivity or specificity observed in the Seattle study. These findings suggest that extreme nonresponse to CT is not as common as previously described and, although poor outcomes are associated with pretreatment clinical status, it is difficult to predict posttreatment symptom severity with a high degree of accuracy across different research samples.
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Affiliation(s)
- Aaron M. Koenig
- Department of Psychiatry – Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania,Department of Psychiatry – University of Pittsburgh Medical Center Pittsburgh, Pennsylvania,Contact Information (Corresponding Author): Aaron M. Koenig, MD, Western Psychiatric Institute and Clinic, Office of Residency Training, 3811 O’Hara Street, Pittsburgh, PA15213, Phone: 412-586-9590, Fax: 412-404-8425,
| | - Robin B. Jarrett
- Department of Psychiatry – The University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Robert Gallop
- Department of Psychiatry – Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania,Department of Mathematics – West Chester University West Chester, Pennsylvania
| | - Marna S. Barrett
- Department of Psychiatry – Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
| | - Michael E. Thase
- Department of Psychiatry – Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania,Department of Psychiatry – University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
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Pers YM, Fortunet C, Constant E, Lambert J, Godfrin-Valnet M, De Jong A, Mercier G, Pallot Prades B, Wendling D, Gaudin P, Jorgensen C, Marotte H, Maillefert JF. Predictors of response and remission in a large cohort of rheumatoid arthritis patients treated with tocilizumab in clinical practice. Rheumatology (Oxford) 2013; 53:76-84. [PMID: 24056521 DOI: 10.1093/rheumatology/ket301] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [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: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify predictors of response and remission to tocilizumab (TCZ) in RA patients seen in daily routine clinical practice. METHODS The efficacy of TCZ was evaluated after 12 and 24 weeks of treatment by the European League Against Rheumatism (EULAR) response criteria. Regression analysis was performed to study the association between remission or EULAR response and the following characteristics: gender, age, current smokers, prior cardiovascular disease (CVD), 28-joint disease activity score (DAS28), CRP, RF or ACPA positivity, combination therapy with DMARDs and TCZ as the first biological therapy or after failure of at least one biological therapy. RESULTS In total, 204 patients were included with a mean DAS28 score of 5.14. EULAR response and remission were obtained in 86.1% and 40% of patients, respectively, at week 24. In multiple regression analysis, a high baseline CRP level [odds ratio (OR) 4.454 (95% CI 1.446, 13.726)] was significantly associated with EULAR response at week 24 and, inversely, age >55 years [OR 0.285 (95% CI 0.086, 0.950)] and prior CVD [OR 0.305 (95% CI 0.113, 0.825)] were significantly associated with lower EULAR response at week 24. Older age was also associated with less remission at week 24 [OR 0.948 (95% CI 0.920, 0.978)]. No additional effectiveness was found when TCZ was used in combination with a DMARD or when patients were naive to biological agents. CONCLUSION In daily practice we identified three predictors of a better response for TCZ therapy in RA: a younger age, a high baseline CRP level and no history of CVD.
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Affiliation(s)
- Yves-Marie Pers
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, CHRU Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
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Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis--a systematic review. Rheumatology (Oxford) 2013; 52:1022-32. [PMID: 23264554 PMCID: PMC3651612 DOI: 10.1093/rheumatology/kes368] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [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: 09/11/2012] [Revised: 10/26/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE IA steroid injections (IASIs) have been shown to relieve pain in knee OA and are widely used in clinical practice. There is, however, evidence of some variation in response. Knowledge of predictors of response could aid in the selection of patients for this therapy. The aim of this systematic review was to determine factors associated with response to IASI in knee OA. METHODS Medline, Embase, AMED, CINAHL, Web of Science and Cochrane Central Registers for Controlled Trials up to January 2012 were searched with additional hand searches of relevant articles. Studies included were those that involved adults diagnosed with knee OA in whom IASIs were administered and factors that predicted treatment response were investigated. RESULTS Eleven publications meeting these criteria were reviewed and relevant information extracted. It was not possible to pool the results because of the different predictors studied, variable outcome measures, different criteria for symptom change and missing data. Given the relative paucity of data and small heterogeneously designed studies, it was difficult to identify predictors of response. Data from individual publications, although not consistent across studies, suggest that the presence of effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under US guidance and greater symptoms at baseline may all improve the likelihood of response to IASI. CONCLUSION Further larger-scale studies using standardized methods are required to characterize predictors of response and should focus on synovitis, effusion, pain and structural severity of disease. Such data would help in better targeting therapy to those most likely to benefit.
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Affiliation(s)
- Nasimah Maricar
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK.
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Abstract
While immune monitoring of tumor immunotherapy often focuses on the generation of productive Th1-type inflammatory immune responses, the importance of regulatory immune responses is often overlooked, despite the well-documented effects of regulatory immune responses in suppressing anti-tumor immunity. In a variety of malignancies, the frequency of regulatory cell populations has been shown to correlate with disease progression and a poor prognosis, further emphasizing the importance of characterizing the effects of immunotherapy on these populations. This review focuses on the role of suppressive immune populations (regulatory T cells, myeloid-derived suppressor cells, and tumor-associated macrophages) in inhibiting anti-tumor immunity, how these populations have been used in the immune monitoring of clinical trials, the prognostic value of these responses, and how the monitoring of these regulatory responses can be improved in the future.
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Affiliation(s)
- Brian M Olson
- Department of Medicine, University of Wisconsin Carbone Cancer Center Madison, WI, USA
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Romão VC, Canhão H, Fonseca JE. Old drugs, old problems: where do we stand in prediction of rheumatoid arthritis responsiveness to methotrexate and other synthetic DMARDs? BMC Med 2013; 11:17. [PMID: 23343013 PMCID: PMC3606422 DOI: 10.1186/1741-7015-11-17] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/23/2013] [Indexed: 02/08/2023] Open
Abstract
Methotrexate (MTX) is the central drug in the management of rheumatoid arthritis (RA) and other immune mediated inflammatory diseases. It is widely used either in monotherapy or in association with other synthetic and biologic disease modifying anti-rheumatic drugs (DMARDs). Although comprehensive clinical experience exists for MTX and synthetic DMARDs, to date it has not been possible to preview correctly whether or not a patient will respond to treatment with these drugs. Predicting response to MTX and other DMARDs would allow the selection of patients based on their likelihood of response, thus enabling individualized therapy and avoiding unnecessary adverse effects and elevated costs. However, studies analyzing this issue have struggled to obtain consistent, replicable results and no factor has yet been recognized to individually distinguish responders from nonresponders at treatment start. Variables possibly influencing drug effectiveness may be disease-, patient- or treatment-related, clinical or biological (genetic and nongenetic). In this review we summarize current evidence on predictors of response to MTX and other synthetic DMARDs, discuss possible causes for the heterogeneity observed and address its translation into daily clinical practice.
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Affiliation(s)
- Vasco Crispim Romão
- Rheumatology Research Unit, Instituto de Medicina Molecular - Faculdade de Medicina da Universidade de Lisboa, Edifício Egas Moniz - Av, Prof, Egas Moniz, Lisboa 1649-028, Portugal
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Luckenbaugh DA, Ibrahim L, Brutsche N, Franco-Chaves J, Mathews D, Marquardt CA, Cassarly C, Zarate CA. Family history of alcohol dependence and antidepressant response to an N-methyl-D-aspartate antagonist in bipolar depression. Bipolar Disord 2012; 14:880-7. [PMID: 22978511 PMCID: PMC3504126 DOI: 10.1111/bdi.12003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Both ketamine and ethanol are N-methyl-d-aspartate (NMDA) receptor antagonists. Ketamine has rapid antidepressant properties in major depressive disorder (MDD) as well as bipolar depression. In individuals with MDD, a positive family history of alcohol dependence (FHP) was associated with greater improvement in depressive symptoms after ketamine administration compared to individuals whose family history of alcohol dependence was negative (FHN). This study investigated whether FHP influences ketamine's antidepressant and perceptual effects in individuals with bipolar depression. METHODS A post hoc analysis was conducted on 33 subjects with DSM-IV bipolar disorder (BD) type I or II depression pooled from two previously published studies. All subjects had undergone a double-blind, randomized, crossover trial of a single intravenous infusion of ketamine (0.5 mg/kg) combined with lithium or valproate therapy. Subjects were rated at baseline; at 40, 80, 120, and 230 min; and at days 1, 2, 3, 7, 10, and 14 post-infusion. The primary outcome measure was Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Patients were categorized as FHP when they reported at least one first-degree relative with alcohol dependence. Measures of psychosis, dissociation, and dysphoria were also collected. RESULTS After ketamine infusion, subjects with FHP showed significantly greater improvement on MADRS scores than FHN subjects. In addition, patients with FHP had attenuated psychotomimetic and dissociative scores compared to FHN patients. CONCLUSIONS FHP appears to predict a more sustained antidepressant response to ketamine in individuals with BD. Family history of alcoholism may be an important consideration in the development of glutamatergic-based therapies for depression.
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Affiliation(s)
- David A Luckenbaugh
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Program, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
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Rallón NI, Soriano V, Naggie S, Restrepo C, McHutchison J, Vispo E, Benito JM. Impact of IL28B gene polymorphisms on interferon-λ3 plasma levels during pegylated interferon-α/ribavirin therapy for chronic hepatitis C in patients coinfected with HIV. J Antimicrob Chemother 2012; 67:1246-9. [PMID: 22294646 PMCID: PMC3695611 DOI: 10.1093/jac/dkr598] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/21/2011] [Accepted: 12/23/2011] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The mechanism explaining the strong association between IL28B rs12979860 polymorphisms and treatment outcome in chronic hepatitis C remains unclear. We explore whether IL28B protein [interferon (IFN)-λ3] plasma levels may vary according to IL28B genotype and/or following pegylated IFN-α/ribavirin therapy. PATIENTS AND METHODS A total of 112 HIV/hepatitis C virus (HCV)-coinfected patients who completed a course of pegylated IFN-α/ribavirin therapy were examined. Sustained virological response (SVR) was achieved by 56% of patients. IL28B rs12979860 alleles were genotyped using the 5' nuclease assay with specific TaqMan probes. A specific enzyme immunoassay was used to measure IFN-λ3 plasma levels before initiating anti-HCV therapy and at week 4 of treatment. RESULTS No significant differences between CC and non-CC IL28B carriers were found at baseline, either in the proportion of patients with detectable IFN-λ3 plasma levels or in their median values. In contrast, median IFN-λ3 plasma levels at week 4 of therapy significantly increased with respect to baseline in CC carriers [34.3 (16.7-56.3) versus 15.6 (15.6-30.3) pg/mL, respectively; P < 0.0001], but not in CT/TT carriers. Unexpectedly, increases in IFN-λ3 at week 4 of therapy did not predict SVR. CONCLUSIONS The exogenous administration of IFN-α may induce IFN-λ3 release in IL28B CC carriers, but not in CT/TT carriers. However, this finding does not account for the link between IL28B polymorphisms and treatment outcome.
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Affiliation(s)
- Norma I Rallón
- Infectious Diseases Department, Hospital Carlos III, Madrid, Spain.
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Tominaga K, Okazaki M, Higuchi H, Utagawa I, Nakamura E, Yamaguchi N. Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression. Int J Gen Med 2011; 4:515-9. [PMID: 21845058 PMCID: PMC3150173 DOI: 10.2147/ijgm.s21029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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: 07/07/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression. METHODS This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores. RESULTS The mean pretreatment factor 2 score for responders (n = 7) was significantly lower than that for nonresponders (n = 11). Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and nonresponders. CONCLUSION This study suggests that a low pretreatment factor 2 score is a good predictor of response to ECT in older patients with major depression.
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Affiliation(s)
- Keiichiro Tominaga
- Department of Neuropsychiatry, St Marianna University School of Medicine, Miyamae-ku, Kawasaki City, Kanagawa
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Yennurajalingam S, Palmer JL, Chacko R, Bruera E. Factors associated with response to methylphenidate in advanced cancer patients. Oncologist 2011; 16:246-53. [PMID: 21282671 PMCID: PMC3228096 DOI: 10.1634/theoncologist.2010-0214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 12/18/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There has been increasing interest in the use of methylphenidate for cancer-related fatigue (CRF) in patients with advanced cancer. However, there is limited literature on the specific patient characteristics associated with response to methylphenidate. Our objective of this study was to identify the specific patient characteristics associated with response to methylphenidate and to compare day 1 response with day 8 response. METHODS We retrospectively reviewed the records of patients in two prospective controlled clinical trials that we had conducted who had received methylphenidate for cancer-related fatigue. Baseline patient characteristics, symptoms (as assessed by the Edmonton Symptom Assessment System [ESAS] and Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]), and response (change in fatigue) at the end of day 1 treatment were analyzed to determine their association with response to methylphenidate on day 8. RESULTS A total of 82 patients with advanced cancer who received methylphenidate for CRF were included in our review. The median age was 55 years, 66% were female, 74% were white, and the most common cancer type was breast (37%). Fifty out of 82 patients (61%) responded to methylphenidate (≥ 7 points in FACIT-F). The intensity of baseline fatigue positively correlated with the response to methylphenidate (p < .001). Change in fatigue in response to methylphenidate was not associated with intensity of baseline depression, anxiety, drowsiness, or daily opioid dose. Better improvement of fatigue after treatment on day 1 was associated with more improvement with fatigue on day 8 as assessed by FACIT-F (p = .0004) and ESAS (p = .0001). Day 1 response as a predictor of day 8 response had a sensitivity of 0.84, a positive predictive value of 0.67, and specificity of 0.6. CONCLUSIONS Response to methylphenidate is associated with higher baseline fatigue but not with higher baseline depression or sedation. Additionally, day 1 improvement is highly sensitive as a predictor of long-term improvement.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, Unit 008, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Abstract
Hematopoietic disorders such as myelodysplastic syndromes (MDS) show a high frequency of methylation of tumor suppressor genes. DNA methyltransferase (DNMT) inhibitors such as azacitidine and decitabine are used to target DNA methylation in MDS patients. Combining these drugs with histone deacetylase (HDAC) inhibitors in vitro resulted in synergistic tumor suppressor gene re-expression. Several phase I trials have examined methylation, gene expression and DNA damage as markers of clinical response to DNMT and HDAC inhibitors, with conflicting results. Trials are ongoing to investigate early methylation changes and DNA damage markers to understand the mechanisms of these drugs and as potential predictors of clinical response.
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Affiliation(s)
- Steven D Gore
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD 21287, USA.
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Sivaprakash B, Chandrasekaran R, Sahai A. Predictors of response to electro-convulsive therapy in major depression. Indian J Psychiatry 2000; 42:148-55. [PMID: 21407928 PMCID: PMC2957705] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study analyses the predictors of response to electro-convulsive therapy in major depression The significance of the initial response to ECT as a predictor of outcome was also studied. 30 patients who met the diagnostic catena for major depression, single episode, as defined by DSM-IIIR were treated with 6-10 ECT sessions. Patients who had shown overall improvement by 50% or more on the Hamilton Depression Rating Scale (HDRS) were considered responders. 19 (63.33%) patients were responders while 11 (36.67%) patients were non-responders. These two groups differed significantly with regard to presence/absence of a delusion, diurnal variation of mood, and baseline HDRS score for hypochondriasis. Early improvement in depression was found to have a positive correlation with overall improvement in depression after the full course of ECT. Multiple linear regression analysis showed that approximately 56% of variability m outcome could be explained by the variables hypochondriasis, delusion and diurnal variation of mood taken together. A logistic regression model nosed on these 3 variables classified 83.3% of the patients correctly. The implications of these findings are discussed.
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Affiliation(s)
- B Sivaprakash
- B. SIVAPRAKASH, MD., Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Pondicherry - 605006
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Gupta N, Avasthi A, Kulhara P. Clinical variables as predictors of response to electroconvulsive therapy in endogenous depression. Indian J Psychiatry 2000; 42:60-5. [PMID: 21407910 PMCID: PMC2957005] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There is lack of consensus on the clinical variables that predict response to ECT. Identification of clinical variables could help in predicting the type of response before the start of ECT Therefore, a prospective study on 22 patients of severe depression, some of whom were drug-naive and others drug free at time of ECT was undertaken. A maximum of six ECT were administered with a prior definition of 'good response' (60% or greater reduction in Hamilton Depression Rating Scale scores) Results showed that three clinical variables could distinguish between good responders and poor responders Hence, response to ECT was associated with the duration of past depressive episodes, suicidal thoughts and somatic symptoms.
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Affiliation(s)
- N Gupta
- NITIN GUPTA, MD., Assistant Professor, Department of Psychiatry, PGIMER, Chandigarh-160012
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