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Allegretti JR, Brady JH, Wicker A, Latymer M, Wells A. Relevance of Adalimumab Product Attributes to Patient Experience in the Biosimilar Era: A Narrative Review. Adv Ther 2024; 41:1775-1794. [PMID: 38466559 PMCID: PMC11052875 DOI: 10.1007/s12325-024-02818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024]
Abstract
Adalimumab (ADL, Humira®, reference product), an anti-TNF-α biologic, has transformed the treatment of chronic, immune-mediated inflammatory diseases. However, the high cost of ADL therapy has driven the development of more affordable ADL biosimilars, agents with no clinically meaningful differences from the reference product. This review summarizes the product attributes of reference ADL and the nine ADL biosimilars approved and available in the USA in relation to patient experience of injection-site pain (ISP). Product formulation, delivery volume and device features (e.g., type and needle gauge size) influence patient experience of ISP with potential clinical consequences. Citrate-free formulations generally cause less ISP; injection volumes of > 1.5 ml may be associated with increased ISP. Reference ADL and all ADL biosimilars offer a citrate-free formulation, and reference ADL and four ADL biosimilars offer a high-concentration solution that allows a smaller injection volume. All available ADL products are injected subcutaneously using either a pre-filled pen (PFP) or pre-filled syringe (PFS). Patients prefer the PFP, but the PFS permits better control over the speed and duration of injection. Smaller (29-gauge) needle outer diameter is associated with less ISP; reference ADL and seven ADL biosimilars offer a device with a 29-gauge needle. In the USA, an approved biosimilar can be designated "interchangeable," allowing pharmacy-level substitution, where state law permits. In the USA, two ADL biosimilars have received interchangeability designation; others are seeking interchangeability designation from the Food and Drug Administration (n = 2), are being evaluated in clinical studies to support interchangeability (n = 2), or do not have/are not seeking interchangeability designation (n = 3). Product-related attributes influence patient experience of ISP caused by subcutaneous ADL injection. Reference ADL and ADL biosimilar products differ in their attributes, so discussion with patients about treatment options is essential to optimize adherence and outcomes.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | | | | | | | - Alvin Wells
- Department of Rheumatology, Advocate Health Medical Group, Franklin, WI, USA
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Yfanti C, Vestbjerg B, Van't Westende J, Edvardsson N, Monfort LM, Olesen MS, Bentzen BH, Grunnet M, Eveleens Maarse BC, Diness JG, Kemme MJB, Sørensen U, Moerland M, van Esdonk MJ, Klaassen ES, Gal P, Holst AG. A phase 1 trial of AP30663, a K Ca2 channel inhibitor in development for conversion of atrial fibrillation. Br J Clin Pharmacol 2024; 90:1027-1035. [PMID: 37990600 DOI: 10.1111/bcp.15973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/19/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS AP30663 is a novel compound under development for pharmacological conversion of atrial fibrillation by targeting the small conductance Ca2+ activated K+ (KCa2) channel. The aim of this extension phase 1 study was to test AP30663 at higher single doses compared to the first-in-human trial. METHODS Sixteen healthy male volunteers were randomized into 2 cohorts: 6- and 8-mg/kg intravenous single-dose administration of AP30663 vs. placebo. Safety, pharmacokinetic and pharmacodynamic data were collected. RESULTS AP30663 was associated with mild and transient infusion site reactions with no clustering of other adverse events but with an estimated maximum mean QTcF interval prolongation of 45.2 ms (95% confidence interval 31.5-58.9) in the 6 mg/kg dose level and 50.4 ms (95% confidence interval 36.7-64.0) with 8 mg/kg. Pharmacokinetics was dose proportional with terminal half-life of around 3 h. CONCLUSION AP30663 in doses up to 8 mg/kg was associated with mild and transient infusion site reactions and an increase of the QTcF interval. Supporting Information support that the QTc effect may be explained by an off-target inhibition of the IKr channel.
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Affiliation(s)
| | | | | | - Nils Edvardsson
- Acesion Pharma ApS, Copenhagen, Denmark
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Bo Hjorth Bentzen
- Acesion Pharma ApS, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Denmark
| | | | - Boukje C Eveleens Maarse
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
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Wang FY, McLaughlin KC, Schontz MJ, DeGrado JR, Dannemiller RE. Safety of Intravenous Push Valproate Compared with Intravenous Piggyback at a Tertiary Academic Medical Center. Clin Drug Investig 2024; 44:175-181. [PMID: 38363545 DOI: 10.1007/s40261-024-01349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Data are limited regarding the safety associated with administering valproate sodium by intravenous push (IVP) compared with intravenous piggyback (IVPB). The objective of this retrospective pre-post analysis was to compare the safety profile of valproate administration via IVPB from March to May 2022 and IVP from June to August 2022. METHODS A total of 890 IVPB and 440 IVP administrations were included. The major endpoint of this analysis was the incidence of infusion site reactions (infiltration or phlebitis). RESULTS The incidence of documented intravenous (IV) site reactions demonstrated minimal differences between both IVPB and IVP administration cohorts. Based on the Naranjo algorithm, all IVPB and IVP infusion site reactions were classified as possible or doubtful. Additional safety endpoints included bradycardia, hypotension, or sedation attributable to valproate sodium administration. Similar safety profiles were observed, including valproate-associated bradycardia, hypotension, and sedation events. All safety events were further classified as possible or doubtful by the Naranjo algorithm. Time from pharmacist verification to valproate administration was also collected. The mean time from pharmacist order verification to valproate administration was significantly faster in the IVP cohort compared to the IVPB cohort. CONCLUSION IVP valproate administration may be considered safe, allowing for more optimal clinical and operational outcomes in the acute care setting.
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Affiliation(s)
- Felicia Y Wang
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA.
| | - Kevin C McLaughlin
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
| | - Michael J Schontz
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
| | - Jeremy R DeGrado
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
| | - Robert E Dannemiller
- Department of Pharmacy, Brigham and Women's Hospital, 75 Francis St, Tower L2, Boston, MA, 02115, USA
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Mullins GR, Hodsdon ME, Li YG, Anglin G, Urva S, Schneck K, Bardos JN, Martins RF, Brown K, Calderon B. Tirzepatide Immunogenicity on Pharmacokinetics, Efficacy, and Safety: Analysis of Data From Phase 3 Studies. J Clin Endocrinol Metab 2024; 109:361-369. [PMID: 37700637 PMCID: PMC10795913 DOI: 10.1210/clinem/dgad532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
CONTEXT Antidrug antibodies (ADA) can potentially affect drug pharmacokinetics, safety, and efficacy. OBJECTIVE This work aimed to evaluate treatment-emergent (TE) ADA in tirzepatide (TZP)-treated participants across 7 phase 3 trials and their potential effect on pharmacokinetics, efficacy, and safety. METHODS ADA were assessed at baseline and throughout the study until end point, defined as week 40 (SURPASS-1, -2, and -5) or week 52 (SURPASS-3, -4, Japan-Mono, and Japan-Combo). Samples for ADA characterization were collected at SURPASS trial sites. Participants included ADA-evaluable TZP-treated patients with type 2 diabetes (N = 5025). Interventions included TZP 5, 10, or 15 mg. ADA were detected and characterized for their ability to cross-react with native glucose-dependent insulinotropic polypeptide (nGIP) and glucagon-like peptide-1 (nGLP-1), neutralize tirzepatide activity on GIP and GLP-1 receptors, and neutralize nGIP and nGLP-1. RESULTS TE ADA developed in 51.1% of tirzepatide-treated patients. Proportions were similar across dose groups. Maximum ADA titers ranged from 1:20 to 1: 81 920 among TE ADA+ patients. Neutralizing antibodies (NAb) against TZP activity on GIP and GLP-1 receptors were observed in 1.9% and 2.1% of patients, respectively. Less than 1.0% of patients had cross-reactive NAb against nGIP or nGLP-1. TE ADA status, ADA titer, and NAb status had no effect on the pharmacokinetics or efficacy of TZP. More TE ADA+ patients experienced hypersensitivity reactions or injection site reactions than TE ADA- patients. The majority of hypersensitivity and injection site reactions were nonserious and nonsevere, and most events occurred and/or resolved irrespective of TE ADA status or titer. CONCLUSION Immunogenicity did not affect TZP pharmacokinetics or efficacy. The majority of hypersensitivity or injection site reactions experienced by TE ADA+ patients were mild to moderate in severity.
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Affiliation(s)
- Garrett R Mullins
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Michael E Hodsdon
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Ying Grace Li
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Greg Anglin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Shweta Urva
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Karen Schneck
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Jennifer N Bardos
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | | | - Katelyn Brown
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Boris Calderon
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
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Maurer M, Lumry WR, Li HH, Aygören-Pürsün E, Busse PJ, Jacobs J, Nurse C, Ahmed MA, Watt M, Yu M. Lanadelumab in Patients 2 to Less Than 12 Years Old With Hereditary Angioedema: Results From the Phase 3 SPRING Study. J Allergy Clin Immunol Pract 2024; 12:201-211.e6. [PMID: 37730089 DOI: 10.1016/j.jaip.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Symptoms of hereditary angioedema (HAE) often first occur during childhood, and HAE attacks in children can be severe and substantially affect health-related quality of life (HRQoL). However, there are no approved long-term prophylaxis treatments for children aged less than 6 years. OBJECTIVE The SPRING Study (NCT04070326) evaluated the safety, pharmacokinetics, and efficacy of lanadelumab and HRQoL in patients aged 2 to less than 12 years. METHODS Over 52 weeks of treatment, patients aged 2 to less than 6 years received lanadelumab 150 mg every 4 weeks (Q4W) and patients aged 6 to less than 12 years received 150 mg every 2 weeks (Q2W) but could switch to Q4W if they were attack-free for 26 weeks. RESULTS We enrolled 21 patients (aged 2 to less than 6 years: n = 4; aged 6 to less than 12 years: n = 17), 20 of whom completed the study. There were no reported serious treatment-emergent adverse events or discontinuations resulting from such events. Treatment-emergent adverse events were reported for 17 patients (81.0%). The most common TEAE was injection site pain. Overall systemic exposure was comparable for both age groups. The mean (SD) attack rate during treatment decreased by 94.8% from baseline (1.84 [1.53] to 0.08 [0.17] attacks/mo), and 16 (76.2%) patients were attack-free. The attack rate reduction in both age groups was similar during the first 26-week fixed-dosing treatment. Seven patients switched from Q2W to Q4W and remained attack-free. A large, clinically meaningful increase in the Pediatric Quality of Life Inventory Generic Core Scale Total Score and a large increase in the Pediatric Quality of Life Inventory Generic Core Scale-Family Impact Module Total Score from baseline to end of study (better HRQoL) were observed. CONCLUSIONS Findings support safety, efficacy, and improved HRQoL with lanadelumab 150 mg Q2W and Q4W regimens for the prevention of HAE attacks in patients aged 2 to less than 12 years.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
| | | | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, Md
| | - Emel Aygören-Pürsün
- Department for Children and Adolescents, Angioedema Centre, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Jacobs
- Allergy and Asthma Clinical Research, Walnut Creek, Calif
| | | | - Mariam A Ahmed
- Takeda Development Center Americas, Inc, Lexington, Mass
| | - Maureen Watt
- Takeda Development Center Americas, Inc, Lexington, Mass
| | - Ming Yu
- Takeda Development Center Americas, Inc, Lexington, Mass
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Eun BW, Bahar E, Xavier S, Kim H, Borys D. Post-marketing surveillance study of the safety of the HPV-16/18 vaccine in Korea (2017-2021). Hum Vaccin Immunother 2023; 19:2184756. [PMID: 36896702 PMCID: PMC10026934 DOI: 10.1080/21645515.2023.2184756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Human papillomavirus (HPV) infection is associated with the risk of developing certain cancers, including cancers of the cervix, vulva, vagina, penis, anus, rectum, and oropharynx. In 2016, the bivalent HPV-16/18 vaccine was included in the Korea National Immunization Program. This vaccine protects against HPV types 16 and 18 and other oncogenic HPV types predominant in cervical and anal cancers. This post-marketing surveillance (PMS) study assessed the safety of the HPV-16/18 vaccine in Korea. The study was conducted in males and females aged between 9 and 25 years, from 2017 to 2021. Safety was measured in terms of frequency and intensity of adverse events (AEs), adverse drug reactions (ADRs), and serious adverse events (SAEs) after each vaccine dose. The safety analysis included all participants who were vaccinated as per prescribing information and who completed a 30-day follow-up after at least one dose. Data were collected using individual case report forms. The total safety cohort included 662 participants. A total of 220 AEs were reported in 144 subjects (21.75%), and there were 158 ADRs in 111 subjects (16.77%), with the most common being injection site pain in all cases. No SAEs or serious ADRs were reported. Most AEs were reported after the first dose and were injection site reactions with mild intensity that recovered. No individuals required hospitalization or an emergency department visit. Safety results showed that the HPV-16/18 vaccine was generally well tolerated in the Korean population, and no safety concerns were identified.ClinicalTrials.gov Identifier: NCT03671369.
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Affiliation(s)
- Byung-Wook Eun
- Nowon Eulji University Hospital, Seoul, Republic of Korea
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Ohtani S, Watanabe N, Ihara K, Takahashi N, Miyazaki N, Ishizuchi K, Takemura R, Hori S, Nakahara J, Takizawa T. Real-world evidence of fremanezumab for treating migraine in Japan: a retrospective study. BMC Neurol 2023; 23:404. [PMID: 37964188 PMCID: PMC10644569 DOI: 10.1186/s12883-023-03449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND There have been very few real-world studies reported in the literature solely focusing on fremanezumab in Asia. This study aimed to evaluate the efficacy and safety of fremanezumab in a real-world setting in Japan. METHOD This single-centered, observational, retrospective study examined patients with migraines who received four doses of fremanezumab between December 2021 and August 2022 at Keio University Hospital. We assessed the changes in monthly migraine days, responder rates, and migraine-associated symptoms, as well as injection site reactions and adverse events. RESULT Twenty-nine patients were enrolled, wherein 79.3% were women. Compared with those at baseline, the monthly migraine days decreased by 5.9 days at 4 months. The 50% responder rate was 55.2% at 4 months. A total of 57.9%, 47.8%, and 65.0% of patients showed improvement in the severity of photophobia, phonophobia, and nausea/vomiting, respectively. Moreover, injection site reactions were the most common adverse events (55.2%). CONCLUSION Fremanezumab is effective and safe for migraine prevention in Japan. Fremanezumab also improved migraine-associated symptoms in half of the patients.
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Affiliation(s)
- Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Nobuyuki Takahashi
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kei Ishizuchi
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Sharma V, Koprivnikar J, Drago K, Savage J, Bachelor A. Injection Site Reactions with Long-Term Pegcetacoplan Use in Patients with Paroxysmal Nocturnal Hemoglobinuria: A Brief Report. Adv Ther 2023; 40:5115-5129. [PMID: 37707673 PMCID: PMC10567944 DOI: 10.1007/s12325-023-02653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Pegcetacoplan is a targeted complement component 3 (C3) therapy approved for adults with paroxysmal nocturnal hemoglobinuria (PNH; US) or PNH plus anemia despite C5-targeted therapy for ≥ 3 months (EU). Patients with PNH receiving pegcetacoplan in the phase 3 PEGASUS trial who experienced injection site reactions (ISRs) mostly experienced mild events. We evaluated ISR incidence and severity with longer-term treatment in the PEGASUS cohort of the Study 307 open-label extension (307 OLE). METHODS Patients from PEGASUS enrolled in the 307 OLE continued pegcetacoplan subcutaneous self-administration twice or three times weekly or every 3 days for an additional 48 weeks. ISRs were coded as adverse events (AEs) or treatment-emergent AEs (TEAEs) and summarized by MedDRA System Organ Class and Preferred Term. RESULTS As of August 27, 2021, 58/64 patients from PEGASUS completed an additional 48 weeks of treatment in the 307 OLE (median treatment duration 337.0 [range 55-344] days); 95.3% (61/64) of patients achieved compliance ≥ 80%. ISRs occurred in 9/64 (14.1%) patients in the 307 OLE, which was lower than observed at PEGASUS completion (20/77; 26.0%). Most patients with ISRs in the 307 OLE had events with a maximum severity of mild (7/9 patients; 77.8%). Injection site erythema and induration were the most common overall (4/64 patients each; 6.3%) and pegcetacoplan-related (3/64 patients each; 4.7%) ISRs. The exposure-adjusted rates of these events were each 6.5 per 100 patient-years. No ISRs were classified as severe or serious TEAEs or led to drug discontinuation. CONCLUSION Though ISRs were common, most were mild, and the percentage of patients reporting ISRs declined from PEGASUS through the 307 OLE. Patient compliance remained high, and no patients discontinued because of ISRs, suggesting that ISRs do not pose a barrier to long-term pegcetacoplan treatment. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT03500549 (PEGASUS) and NCT03531255 (307 OLE).
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Affiliation(s)
| | - Jamie Koprivnikar
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
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Hide M, Ohsawa I, Nurse C, Yu M. Efficacy and safety of lanadelumab in Japanese patients with hereditary angioedema: A phase 3 multicenter, open-label study. J Dermatol 2023; 50:1381-1391. [PMID: 37574953 DOI: 10.1111/1346-8138.16909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
The safety and efficacy of lanadelumab for the prevention of hereditary angioedema (HAE) attacks have not been studied in Japanese patients. We report outcomes from a phase 3, multicenter, open-label study (NCT04180163) of lanadelumab in Japanese patients with HAE. Japanese patients with HAE aged ≥12 years with ≥1 investigator-confirmed HAE attack during the 4-week run-in baseline period were enrolled into the study and received lanadelumab 300 mg every 2 weeks subcutaneously for 52 weeks. Dosing could be reduced to 300 mg every 4 weeks during the second 26-week treatment period if patients had well-controlled symptoms (e.g., attack-free) for 6 months. The primary efficacy endpoint was no investigator-confirmed HAE attacks (attack-free status) during days 0-182. Other outcomes included the rate of investigator-confirmed HAE attacks per month (28 days) and lanadelumab safety. Twelve patients (mean ± SD age 41.9 ± 12.4 years) were enrolled. During the first 26 weeks (days 0-182), five (41.7%) patients were attack-free. The mean ± SD HAE attack rate per month decreased by 74.0%, from 3.8 ± 2.4 during baseline to 1.2 ± 2.6 during the overall 52-week treatment period. There were no deaths or discontinuations due to treatment-emergent adverse events (TEAEs), no severe or serious TEAEs related to lanadelumab, and no positive anti-drug antibody results. The most frequent TEAEs were injection-site reactions (37 events in six patients). Most of the injection-site reaction adverse events were mild in severity. Results of this study support the findings from two global phase 3 studies for lanadelumab use as prophylactic therapy in Japanese patients with HAE.
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Affiliation(s)
- Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - Isao Ohsawa
- Department of Nephrology, Internal Medicine, Saiyu Soka Hospital, Soka, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Christina Nurse
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Ming Yu
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
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Tang H, Civoli F, Tatarewicz S, Vandenkoornhuyse N, Finck B. Pharmacokinetic and Pharmacodynamic Bioequivalence of Pegfilgrastim-cbqv Delivered via a Prefilled Autoinjector and Prefilled Syringe in Healthy Male Participants. Adv Ther 2023; 40:4889-4906. [PMID: 37707674 PMCID: PMC10567933 DOI: 10.1007/s12325-023-02636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/02/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Pegfilgrastim-cbqv (UDENYCA®; Coherus BioSciences, Redwood City, CA, USA) is a pegfilgrastim (Neulasta®; Amgen, Thousand Oaks, CA, USA) biosimilar approved for administration by prefilled syringe (PFS). The recently approved pegfilgrastim-cbqv prefilled autoinjector (AI) was developed as another method of self-administration and to aid in-office use, providing flexibility in drug delivery. The objectives of the study were to assess the pharmacokinetics (PK) and pharmacodynamics (PD) to determine bioequivalence of the prefilled AI and the PFS for administration of pegfilgrastim-cbqv and to assess the safety profile of the prefilled AI. METHODS During this open-label, two-period crossover study, healthy adult males (N = 155) were randomly assigned (1:1 ratio) to receive a subcutaneous injection of pegfilgrastim-cbqv using a prefilled AI (n = 76) or a PFS (n = 79) in period 1. During period 2, participants received an injection using the other method. Primary PK and secondary PD parameters were calculated to assess the bioequivalence of the treatment as administered by the two delivery methods. Safety and immunogenicity were also assessed. RESULTS The 90% CIs of the geometric mean ratios for the PK and PD parameters were within the required range (80-125%), demonstrating bioequivalence between the pegfilgrastim-cbqv prefilled AI and PFS. Treatment-emergent adverse events (TEAEs) were reported by 75% and 74.1% of participants in the prefilled AI and PFS groups, respectively. The most common TEAEs in both treatment groups were myalgia, bone pain, and headache. AI-device-related TEAEs were injection site pain (1.4%) and injection site bruising (0.7%). The incidence of antidrug antibodies and neutralizing antibodies was low and was similar in both treatment sequences. CONCLUSIONS The bioequivalence of pegfilgrastim-cbqv administered using a prefilled AI and a PFS was established. The safety, including immunogenicity profiles, of pegfilgrastim-cbqv administered using the prefilled AI and the PFS were similar, with no new safety findings.
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Affiliation(s)
- Hong Tang
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive, Suite 600, Redwood City, CA, 94065, USA.
| | - Francesca Civoli
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive, Suite 600, Redwood City, CA, 94065, USA
| | - Suzanna Tatarewicz
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive, Suite 600, Redwood City, CA, 94065, USA
| | | | - Barbara Finck
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive, Suite 600, Redwood City, CA, 94065, USA
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11
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Ihara K, Ohtani S, Watanabe N, Takahashi N, Miyazaki N, Takemura R, Hori S, Nakahara J, Takizawa T. Switching between anti-calcitonin gene-related peptide monoclonal antibodies: A comparison of monthly and quarterly dosing. J Neurol Sci 2023; 453:120811. [PMID: 37757639 DOI: 10.1016/j.jns.2023.120811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Anti-calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) have dramatically changed preventive treatment options for patients with migraine. Although there is emerging real-world evidence on the use of CGRPmAbs globally, the change in efficacy and safety after switching between CGRPmAbs owing to patients' frequency of hospital visits preference remains unknown. METHODS We conducted a single-centre, retrospective, real-world study of patients with migraine who first received galcanezumab for 3 or 4 months and then switched to fremanezumab at Keio University Hospital. We investigated changes in monthly migraine days (MMD), responder rate, and adverse effects such as injection site reactions. RESULTS MMD increased only by 0.7 (95% CI, -4.1-5.5; p = 0.748) after 4 months of treatment with fremanezumab (6.1, 95% CI, 2.3-9.9) compared to before switching (5.4, 95% CI, 2.2-8.6). Furthermore, switching from galcanezumab to fremanezumab produced only minor adverse events, such as injection site reactions. CONCLUSIONS After switching from galcanezumab to fremanezumab out of the desire to visit the hospital less often, the reduction in MMD compared to baseline was sustained, and no serious adverse effects were observed.
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Affiliation(s)
- Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Japan; Division of Drug Informatics, Keio University Faculty of Pharmacy, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Japan
| | | | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Japan.
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12
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Markovinović A, Quan J, Herauf M, Hracs L, Windsor JW, Sharifi N, Coward S, Caplan L, Gorospe J, Ernest-Suarez K, Ma C, Panaccione R, Ingram RJ, Kanji JN, Tipples G, Holodinsky JK, Bernstein CN, Mahoney DJ, Bernatsky S, Benchimol EI, Kaplan GG. Adverse Events and Serological Responses After SARS-CoV-2 Vaccination in Individuals With Inflammatory Bowel Disease. Am J Gastroenterol 2023; 118:1693-1697. [PMID: 37216598 PMCID: PMC10453345 DOI: 10.14309/ajg.0000000000002337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/23/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION We determined adverse events after 4 doses of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine in those with inflammatory bowel disease (IBD), associations between antibodies and injection site reactions (ISR), and risk of IBD flare. METHODS Individuals with IBD were interviewed for adverse events to SARS-CoV-2 vaccine. Multivariable linear regression assessed the association between antibody titers and ISR. RESULTS Severe adverse events occurred in 0.03%. ISR were significantly associated with antibody levels after the fourth dose (geometric mean ratio = 2.56; 95% confidence interval 1.18-5.57). No cases of IBD flare occurred. DISCUSSION SARS-CoV-2 vaccines are safe for those with IBD. ISR after the fourth dose may indicate increased antibodies.
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Affiliation(s)
- Ante Markovinović
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joshua Quan
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michelle Herauf
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Hracs
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W. Windsor
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nastaran Sharifi
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Coward
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Léa Caplan
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Ernest-Suarez
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard J.M. Ingram
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamil N. Kanji
- Alberta Precision Laboratories, Public Health Laboratory, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Graham Tipples
- Alberta Precision Laboratories, Public Health Laboratory, Alberta, Canada
- Department of Medical Microbiology and Immunology, Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Jessalyn K. Holodinsky
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charles N. Bernstein
- University of Manitoba IBD Clinical and Research Centre and Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Douglas J. Mahoney
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Eric I. Benchimol
- ICES, Toronto, Ontario, Canada
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G. Kaplan
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Lu X, Masuda S, Horlad H, Katoh T. Safety and adverse effects of the coronavirus disease 2019 vaccine among the general Japanese adult population. Vaccine 2023; 41:5090-5096. [PMID: 37455163 PMCID: PMC10130329 DOI: 10.1016/j.vaccine.2023.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES We aimed to identify and explore the association between the characteristics of coronavirus disease 2019 (COVID-19) vaccine recipients and the types of vaccine-related adverse effects in the general Japanese adult population. METHODS An anonymous self-report questionnaire was distributed to 4393 students and 1657 white and blue-collar workers (N = 6050). Data on vaccine-related adverse effects were collected twice, once after each vaccination. The data collection was performed daily from the day of injection (D0) until the sixth day after injection (D6). The list of adverse effects comprised local reactions at the injection site (pain, redness, and swelling) and systemic symptoms (fever, fatigue, headache, myalgia, joint pain, chills, and nausea or vomiting). The Student's t-test and Mann-Whitney U test were used to analyze parametric and non-parametric data, respectively. RESULTS The incidence of adverse reactions to the COVID-19 vaccination was higher after the second dose (e.g., redness: 47.1%; swelling: 60.6%; fever: 80.6%) of vaccination than after the first dose (e.g., redness: 16.4%; swelling: 37.2%; fever: 11.9%). Women reported adverse reactions to the vaccination more frequently. Some adverse reactions included more symptoms in younger participants, and participants with a lower body mass index were more at risk for these symptoms. CONCLUSIONS Some adverse reactions to the COVID-19 vaccination are a greater risk of symptoms in the younger group, women, and participants with lower BMI. Care should be taken to monitor women, younger people, and individuals with a low body mass index for adverse effects after receiving the COVID-19 vaccination.
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Affiliation(s)
- Xi Lu
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Shota Masuda
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hasita Horlad
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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14
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Wei X, Tan X, Guan Q, Zhang R, Lei S, Wei S. Immunogenicity and safety of quadrivalent inactivated influenza vaccine in children aged 6 to 35 months: A systematic review and meta-analysis. Hum Vaccin Immunother 2023; 19:2256510. [PMID: 37794647 PMCID: PMC10557567 DOI: 10.1080/21645515.2023.2256510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Evidence of the immunogenicity and safety of quadrivalent inactivated influenza vaccine in children aged 6 to 35 months has been emerging. To evaluate the immunogenicity and safety of quadrivalent inactivated influenza vaccine in children aged 6 to 35 months in a systematic review and meta-analysis. This meta-analysis included 12 studies with 6722 participants receiving QIV, 3575 participants receiving TIV, 4249 participants receiving full-dose QIV (F-QIV), and 3722 participants receiving half-dose QIV (H-QIV). Among children aged 6 to 35 months, QIV produces a better Immunogenicity against influenza B vaccine strains not contained in TIV. However, injection site reaction was more common for QIV, F-QIV showed superior efficacy for the B lineage, but fever and injection site pain was more frequently reported for F-QIV than H-QIV. These data support the immunogenicity and safety of quadrivalent inactivated influenza vaccine among children aged 6 to 35 months.
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Affiliation(s)
- Xia Wei
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Xue Tan
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Qinghu Guan
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Ruizhi Zhang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Shiguang Lei
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Shaofeng Wei
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
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15
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Singh R, McCain S, Feldman S, Strowd L. A Qualitative Study on Dupilumab's Impact on Atopic Dermatitis Among Adolescent and Adult Patients. J Drugs Dermatol 2023; 22:148-153. [PMID: 36745376 DOI: 10.36849/jdd.7053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common inflammatory skin disease and dupilumab is US Food and Drug Administration-approved in both adult and pediatric AD patients. OBJECTIVE To qualitatively assess the life experiences and impact of treatment in adult and adolescent patients with AD being treated with dupilumab. METHODS Sixteen semi-structured interviews were conducted with adult (n=9) and adolescent (n=7) participants who had received a diagnosis of AD between 1/1/2017 and 1/1/2022 after they had received treatment with dupilumab. Results were analyzed using qualitative research methods. RESULTS Most participants reported frustration with daily topical medications and starting dupilumab after exhausting other treatment options. Before treatment, participants described severe AD, social anxiety, and decreased self-esteem. Although most participants did not experience complete resolution of AD after treatment, all participants described a profound decrease in the physical and psychosocial burden of their disease. Participant satisfaction was high with dupilumab treatment. Injection-related pain was commonly reported as the most negative aspect of treatment. DISCUSSION AD was physically and psychosocially debilitating in our cohort. Dupilumab offered an efficacious treatment for these patients and helped improve the physical and psychosocial burden of their disease. J Drugs Dermatol. 2023;22(2):148-153. doi:10.36849/JDD.7053.
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16
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Rosenbaum E, Chugh R, Ryan CW, Agulnik M, Milhem MM, George S, Jones RL, Chmielowski B, Van Tine BA, Tawbi H, Elias AD, Read WL, Budd GT, Qin LX, Rodler ET, Hirman J, Weiden P, Bennett CM, Livingston PO, Ragupathi G, Hansen D, D'Angelo SP, Tap WD, Schwartz GK, Maki RG, Carvajal RD. A randomised phase II trial of a trivalent ganglioside vaccine targeting GM2, GD2 and GD3 combined with immunological adjuvant OPT-821 versus OPT-821 alone in metastatic sarcoma patients rendered disease-free by surgery. Eur J Cancer 2022; 176:155-163. [PMID: 36215947 PMCID: PMC10204709 DOI: 10.1016/j.ejca.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrence after resection of metastatic sarcoma is common. The gangliosides GM2, GD2 and GD3 are strongly expressed across sarcoma subtypes. We hypothesised that generation of anti-ganglioside antibodies would control micrometastases and improve outcomes in sarcoma patients who were disease-free after metastasectomy. METHODS We conducted a randomised phase II trial of the immunological adjuvant OPT-821 with a KLH-conjugated ganglioside vaccine targeting GM2, GD2 and GD3, versus OPT-821 alone in patients with metastatic sarcoma following complete metastasectomy. Patients received 10 subcutaneous injections at Weeks 1, 2, 3, 8, 16, 28, 40, 52, 68 and 84 and were followed for evidence of recurrent disease. The primary end-point was relapse-free survival. Secondary end-points included overall survival and serologic response. RESULTS A total of 136 patients were randomised, 68 to each arm. The mean age was 51.2, 52.2% were male, 90.4% had relapsed disease, 86.8% had high-grade tumours and 14% had ≥4 metastases resected. Histologies included leiomyosarcoma (33%), spindle cell sarcoma (14%), undifferentiated pleomorphic sarcoma (13%), osteosarcoma (10%), synovial sarcoma (9%), liposarcoma (9%) and others (12%). Most adverse events were Grade ≤2 (83.8% and 70.6% in the vaccine and adjuvant arms, respectively). The most common (≥20% of patients) were injection site reaction (89.7%), fatigue (44.1%) and pyrexia (27.9%) on the vaccine arm, and injection site reaction (69.1%) on the adjuvant only arm. The 1-year relapse-free survival rate (34.5% and 34.8% in the vaccine and OPT-821 monotherapy arm, respectively) did not differ between arms (P = 0.725). One-year overall survival rates were 93.1% and 91.5% in the vaccine and OPT-821 monotherapy arm, respectively (P = 0.578). Serologic responses at week 9 were more frequent on the vaccine arm (96.5% of patients) than in the adjuvant arm (32.8%), and the difference between groups was durable. CONCLUSIONS A sustained serologic response to vaccination was induced with the vaccine, but no difference in recurrence-free or overall survival was observed between treatment arms. CLINICALTRIALS gov identifier: NCT01141491.
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Affiliation(s)
- Evan Rosenbaum
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical Center, New York, NY, USA
| | | | - Christopher W Ryan
- Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA
| | | | - Mohammed M Milhem
- University of Iowa and Clinic Holden Cancer Center, Iowa City, IA, USA
| | | | - Robin L Jones
- Royal Marsden/Institute of Cancer Research, London, GB. Previous Affiliation: University of Washington/ Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Bartosz Chmielowski
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Hussein Tawbi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Li-Xuan Qin
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Eve T Rodler
- UC Davis Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Joe Hirman
- Pacific Northwest Statistical Consulting, Inc, USA
| | | | | | | | | | | | - Sandra P D'Angelo
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical Center, New York, NY, USA
| | - William D Tap
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical Center, New York, NY, USA
| | | | - Robert G Maki
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA, USA
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17
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Lian BS, Choo KJL, Chong CJ, Hanif IM, Naing CS, Lee HY. Injection site reactions after COVID-19 mRNA vaccination. Ann Acad Med Singap 2022; 51:247-249. [PMID: 35506410 DOI: 10.47102/annals-acadmedsg.2021415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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18
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Aschenbrenner DS. FDA Warns Against Using Needle-Free Injection Devices For Dermal Fillers. Am J Nurs 2022; 122:24-25. [PMID: 35085145 DOI: 10.1097/01.naj.0000820548.06416.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Food and Drug Administration (FDA) has issued a safety communication to warn the public and health care professionals not to use needle-free devices for injection of dermal fillers. These devices are not approved by the FDA. FDA-approved dermal fillers are for prescription use only with a syringe and either a needle or cannula.Nurses should inform patients not to purchase any needle-free devices or products over the internet. Adverse effects from these devices should be reported to the FDA's MedWatch system.
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Affiliation(s)
- Diane S Aschenbrenner
- Diane S. Aschenbrenner is a former member of the faculty at Notre Dame of Maryland University and the Johns Hopkins University School of Nursing. She coordinates Drug Watch :
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Lenders M, Brand E. Mechanisms of Neutralizing Anti-drug Antibody Formation and Clinical Relevance on Therapeutic Efficacy of Enzyme Replacement Therapies in Fabry Disease. Drugs 2021; 81:1969-1981. [PMID: 34748189 PMCID: PMC8602155 DOI: 10.1007/s40265-021-01621-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by mutations in the α-galactosidase A (AGAL/GLA) gene. The lysosomal accumulation of the substrates globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3) results in progressive renal failure, cardiomyopathy associated with cardiac arrhythmia, and recurrent strokes, significantly limiting life expectancy in affected patients. Current treatment options for FD include recombinant enzyme-replacement therapies (ERTs) with intravenous agalsidase-α (0.2 mg/kg body weight) or agalsidase-β (1 mg/kg body weight) every 2 weeks, facilitating cellular Gb3 clearance and an overall improvement of disease burden. However, ERT can lead to infusion-associated reactions, as well as the formation of neutralizing anti-drug antibodies (ADAs) in ERT-treated males, leading to an attenuation of therapy efficacy and thus disease progression. In this narrative review, we provide a brief overview of the clinical picture of FD and diagnostic confirmation. The focus is on the biochemical and clinical significance of neutralizing ADAs as a humoral response to ERT. In addition, we provide an overview of different methods for ADA measurement and characterization, as well as potential therapeutic approaches to prevent or eliminate ADAs in affected patients, which is representative for other ERT-treated lysosomal storage diseases.
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Affiliation(s)
- Malte Lenders
- Department of Internal Medicine D, Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Eva Brand
- Department of Internal Medicine D, Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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20
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Ramos CL, Kelso JM. "COVID Arm": Very delayed large injection site reactions to mRNA COVID-19 vaccines. J Allergy Clin Immunol Pract 2021; 9:2480-2481. [PMID: 33864927 PMCID: PMC8056968 DOI: 10.1016/j.jaip.2021.03.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Courtney L Ramos
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
| | - John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
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21
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Beer K, Kaufman-Janette J, Bank D, Biesman B, Dayan S, Kim W, Chawla S, Schumacher A. Safe and Effective Chin Augmentation With the Hyaluronic Acid Injectable Filler, VYC-20L. Dermatol Surg 2021; 47:80-85. [PMID: 33347003 PMCID: PMC7752233 DOI: 10.1097/dss.0000000000002795] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND VYC-20L is a hyaluronic acid soft tissue filler with lidocaine designed to restore facial volume. OBJECTIVE Evaluate the safety and effectiveness of VYC-20L in patients with chin retrusion. MATERIALS AND METHODS Adults with chin retrusion were randomized (3:1) to receive VYC-20L in the chin at study onset (treatment group) or 6 months later (control group). The primary effectiveness end point was ≥1-point improvement on the Allergan Chin Retrusion Scale (ACRS) from baseline at Month 6. Safety assessments included injection site responses (ISRs) and adverse events (AEs). RESULTS VYC-20L was administered to 192 participants (treatment group, n = 144; control group, n = 48). At Month 6, significantly more participants had an ACRS response in the treatment versus control group (56.3% vs 27.5%; p = .0019). Effectiveness was also demonstrated by the proportion of participants with improved/much improved Global Aesthetic Improvement Scale scores and responses on the FACE-Q Satisfaction with Chin questionnaire and FACE-Q Psychological Wellbeing module. Treatment benefit remained evident at Month 12. Most common ISRs were tenderness (81.1%) and firmness (75.1%). One participant (0.5%) discontinued the study due to 2 treatment-related serious AEs of facial cellulitis and injection site inflammation, both resolved without sequelae. CONCLUSION VYC-20L significantly improved an ACRS response and was generally safe and well tolerated.
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Affiliation(s)
| | | | - David Bank
- The Center for Dermatology, Cosmetic & Laser Surgery, Mount Kisco, New York
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22
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Abstract
OBJECTIVE This study is aims to compare the anesthetic safety of propofol combined with etomidate for painless gastroscopy. METHODS Three hundred patients undergoing painless gastroscopy were randomly assigned to P, PE1, and PE2 groups. Patients were anesthetized with propofol (P group) or propofol combined with etomidate (volume ratio 1: 1, PE1 group; volume ratio 2: 1, PE2 group). The hemodynamics and adverse reactions were observed. The sleep quality satisfaction and nature of dreams were recorded. RESULTS Compared with pre-anesthesia, the mean arterial pressure and heart rate of the 3 groups were significantly slower during the examination and at the end of the examination. PE1 group had a higher incidence of muscle spasm, body moving, choking, and deglutition. The incidence of hypoxemia and injection pain was higher in P group. P and PE2 group had higher sleep quality satisfaction and dream incidence after awaking. However, there was no difference in the nature of dreams among 3 groups. CONCLUSION Our data indicate that the combination of 10 ml 1.0% propofol and 5 ml 0.2% etomidate for painless gastroscopy reduces adverse reactions while not affecting the patients respiratory function. Moreover, it is safe and effective, which is worthy of clinical application and promotion.
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Affiliation(s)
- Lina Hao
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, 1st Swan lake road, Shushan District, Hefei, Anhui Province, China
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Savarirayan R, Tofts L, Irving M, Wilcox W, Bacino CA, Hoover-Fong J, Ullot Font R, Harmatz P, Rutsch F, Bober MB, Polgreen LE, Ginebreda I, Mohnike K, Charrow J, Hoernschemeyer D, Ozono K, Alanay Y, Arundel P, Kagami S, Yasui N, White KK, Saal HM, Leiva-Gea A, Luna-González F, Mochizuki H, Basel D, Porco DM, Jayaram K, Fisheleva E, Huntsman-Labed A, Day J. Once-daily, subcutaneous vosoritide therapy in children with achondroplasia: a randomised, double-blind, phase 3, placebo-controlled, multicentre trial. Lancet 2020; 396:684-692. [PMID: 32891212 DOI: 10.1016/s0140-6736(20)31541-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are no effective therapies for achondroplasia. An open-label study suggested that vosoritide administration might increase growth velocity in children with achondroplasia. This phase 3 trial was designed to further assess these preliminary findings. METHODS This randomised, double-blind, phase 3, placebo-controlled, multicentre trial compared once-daily subcutaneous administration of vosoritide with placebo in children with achondroplasia. The trial was done in hospitals at 24 sites in seven countries (Australia, Germany, Japan, Spain, Turkey, the USA, and the UK). Eligible patients had a clinical diagnosis of achondroplasia, were ambulatory, had participated for 6 months in a baseline growth study and were aged 5 to less than 18 years at enrolment. Randomisation was done by means of a voice or web-response system, stratified according to sex and Tanner stage. Participants, investigators, and trial sponsor were masked to group assignment. Participants received either vosoritide 15·0 μg/kg or placebo, as allocated, for the duration of the 52-week treatment period administered by daily subcutaneous injections in their homes by trained caregivers. The primary endpoint was change from baseline in mean annualised growth velocity at 52 weeks in treated patients as compared with controls. All randomly assigned patients were included in the efficacy analyses (n=121). All patients who received one dose of vosoritide or placebo (n=121) were included in the safety analyses. The trial is complete and is registered, with EudraCT, number, 2015-003836-11. FINDINGS All participants were recruited from Dec 12, 2016, to Nov 7, 2018, with 60 assigned to receive vosoritide and 61 to receive placebo. Of 124 patients screened for eligibility, 121 patients were randomly assigned, and 119 patients completed the 52-week trial. The adjusted mean difference in annualised growth velocity between patients in the vosoritide group and placebo group was 1·57 cm/year in favour of vosoritide (95% CI [1·22-1·93]; two-sided p<0·0001). A total of 119 patients had at least one adverse event; vosoritide group, 59 (98%), and placebo group, 60 (98%). None of the serious adverse events were considered to be treatment related and no deaths occurred. INTERPRETATION Vosoritide is an effective treatment to increase growth in children with achondroplasia. It is not known whether final adult height will be increased, or what the harms of long-term therapy might be. FUNDING BioMarin Pharmaceutical.
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Affiliation(s)
- Ravi Savarirayan
- Murdoch Children's Research Institute, Royal Children's Hospital, and University of Melbourne, Parkville, VIC, Australia.
| | - Louise Tofts
- Kids Rehab, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Melita Irving
- Guy's and St Thomas' NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | | | | | - Julie Hoover-Fong
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Frank Rutsch
- Department of General Pediatrics, Muenster University Children's Hospital, Muenster, Germany
| | - Michael B Bober
- Nemours-Alfred I. du Pont Hospital for Children, Wilmington, DE, USA
| | - Lynda E Polgreen
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | - Joel Charrow
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | | - Yasemin Alanay
- Acibadem Mehmet Ali Aydiniar University, School of Medicine, Istanbul, Turkey
| | - Paul Arundel
- Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Sheffield, UK
| | | | | | | | - Howard M Saal
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Donald Basel
- Medical College of Wisconsin, Milwaukee, WI, USA
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Tazmini K, Fraz MSA, Nymo SH, Stokke MK, Louch WE, Øie E. Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation-A single-blinded, randomized clinical trial. Am Heart J 2020; 221:114-124. [PMID: 31986288 DOI: 10.1016/j.ahj.2019.12.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The optimal antiarrhythmic management of recent-onset atrial fibrillation (ROAF) or atrial flutter is controversial and there is a considerable variability in clinical treatment strategies. It is not known if potassium infusion has the potential to convert ROAF or atrial flutter to sinus rhythm (SR). Therefore, we aimed to investigate if patients with ROAF or atrial flutter and plasma-potassium levels ≤4.0 mmol/L have increased probability to convert to SR if the plasma-potassium level is increased towards the upper reference range (4.1-5.0 mmol/L). METHODS In a placebo-controlled, single-blinded trial, patients with ROAF or atrial flutter and plasma-potassium ≤4.0 mmol/L presenting between April 2013 and November 2017 were randomized to receive potassium chloride (KCl) infusion (n = 60) or placebo (n = 53). Patients in the KCl group received infusions at one of three different rates: 9.4 mmol/h (n = 11), 12 mmol/h (n = 19), or 15 mmol/h (n = 30). RESULTS There was no statistical difference in the number of conversions to SR between the KCl group and placebo [logrank test, P = .29; hazard ratio (HR) 1.20 (CI 0.72-1.98)]. However, KCl-infused patients who achieved an above-median hourly increase in plasma-potassium (>0.047 mmol/h) exhibited a significantly higher conversion rate compared with placebo [logrank P = .002; HR 2.40 (CI 1.36-4.21)] and KCl patients with below-median change in plasma-potassium [logrank P < .001; HR 4.41 (CI 2.07-9.40)]. Due to pain at the infusion site, the infusion was prematurely terminated in 10 patients (17%). CONCLUSIONS Although increasing plasma-potassium levels did not significantly augment conversion of ROAF or atrial flutter to SR in patients with potassium levels in the lower-normal range, our results indicate that this treatment may be effective when a rapid increase in potassium concentration is tolerated and achieved.
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Affiliation(s)
- Kiarash Tazmini
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway; Institute of Experimental Medical Research, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway.
| | - Mai S Aa Fraz
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Ståle H Nymo
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Mathis K Stokke
- K.G. Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway; Clinic of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - William E Louch
- Institute of Experimental Medical Research, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
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Laher F, Moodie Z, Cohen KW, Grunenberg N, Bekker LG, Allen M, Frahm N, Yates NL, Morris L, Malahleha M, Mngadi K, Daniels B, Innes C, Saunders K, Grant S, Yu C, Gilbert PB, Phogat S, DiazGranados CA, Koutsoukos M, Van Der Meeren O, Bentley C, Mkhize NN, Pensiero MN, Mehra VL, Kublin JG, Corey L, Montefiori DC, Gray GE, McElrath MJ, Tomaras GD. Safety and immune responses after a 12-month booster in healthy HIV-uninfected adults in HVTN 100 in South Africa: A randomized double-blind placebo-controlled trial of ALVAC-HIV (vCP2438) and bivalent subtype C gp120/MF59 vaccines. PLoS Med 2020; 17:e1003038. [PMID: 32092060 PMCID: PMC7039414 DOI: 10.1371/journal.pmed.1003038] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND HVTN 100 evaluated the safety and immunogenicity of an HIV subtype C pox-protein vaccine regimen, investigating a 12-month booster to extend vaccine-induced immune responses. METHODS AND FINDINGS A phase 1-2 randomized double-blind placebo-controlled trial enrolled 252 participants (210 vaccine/42 placebo; median age 23 years; 43% female) between 9 February 2015 and 26 May 2015. Vaccine recipients received ALVAC-HIV (vCP2438) alone at months 0 and 1 and with bivalent subtype C gp120/MF59 at months 3, 6, and 12. Antibody (IgG, IgG3 binding, and neutralizing) and CD4+ T-cell (expressing interferon-gamma, interleukin-2, and CD40 ligand) responses were evaluated at month 6.5 for all participants and at months 12, 12.5, and 18 for a randomly selected subset. The primary analysis compared IgG binding antibody (bAb) responses and CD4+ T-cell responses to 3 vaccine-matched antigens at peak (month 6.5 versus 12.5) and durability (month 12 versus 18) timepoints; IgG responses to CaseA2_gp70_V1V2.B, a primary correlate of risk in RV144, were also compared at these same timepoints. Secondary and exploratory analyses compared IgG3 bAb responses, IgG bAb breadth scores, neutralizing antibody (nAb) responses, antibody-dependent cellular phagocytosis, CD4+ polyfunctionality responses, and CD4+ memory sub-population responses at the same timepoints. Vaccines were generally safe and well tolerated. During the study, there were 2 deaths (both in the vaccine group and both unrelated to study products). Ten participants became HIV-infected during the trial, 7% (3/42) of placebo recipients and 3% (7/210) of vaccine recipients. All 8 serious adverse events were unrelated to study products. Less waning of immune responses was seen after the fifth vaccination than after the fourth, with higher antibody and cellular response rates at month 18 than at month 12: IgG bAb response rates to 1086.C V1V2, 21.0% versus 9.7% (difference = 11.3%, 95% CI = 0.6%-22.0%, P = 0.039), and ZM96.C V1V2, 21.0% versus 6.5% (difference = 14.5%, 95% CI = 4.1%-24.9%, P = 0.004). IgG bAb response rates to all 4 primary V1V2 antigens were higher 2 weeks after the fifth vaccination than 2 weeks after the fourth vaccination: 87.7% versus 75.4% (difference = 12.3%, 95% CI = 1.7%-22.9%, P = 0.022) for 1086.C V1V2, 86.0% versus 63.2% (difference = 22.8%, 95% CI = 9.1%-36.5%, P = 0.001) for TV1c8.2.C V1V2, 67.7% versus 44.6% (difference = 23.1%, 95% CI = 10.4%-35.7%, P < 0.001) for ZM96.C V1V2, and 81.5% versus 60.0% (difference = 21.5%, 95% CI = 7.6%-35.5%, P = 0.002) for CaseA2_gp70_V1V2.B. IgG bAb response rates to the 3 primary vaccine-matched gp120 antigens were all above 90% at both peak timepoints, with no significant differences seen, except a higher response rate to ZM96.C gp120 at month 18 versus month 12: 64.5% versus 1.6% (difference = 62.9%, 95% CI = 49.3%-76.5%, P < 0.001). CD4+ T-cell response rates were higher at month 18 than month 12 for all 3 primary vaccine-matched antigens: 47.3% versus 29.1% (difference = 18.2%, 95% CI = 2.9%-33.4%, P = 0.021) for 1086.C, 61.8% versus 38.2% (difference = 23.6%, 95% CI = 9.5%-37.8%, P = 0.001) for TV1.C, and 63.6% versus 41.8% (difference = 21.8%, 95% CI = 5.1%-38.5%, P = 0.007) for ZM96.C, with no significant differences seen at the peak timepoints. Limitations were that higher doses of gp120 were not evaluated, this study was not designed to investigate HIV prevention efficacy, and the clinical significance of the observed immunological effects is uncertain. CONCLUSIONS In this study, a 12-month booster of subtype C pox-protein vaccines restored immune responses, and slowed response decay compared to the 6-month vaccination. TRIAL REGISTRATION ClinicalTrials.gov NCT02404311. South African National Clinical Trials Registry (SANCTR number: DOH--27-0215-4796).
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Affiliation(s)
- Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Zoe Moodie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Kristen W. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Nicole Grunenberg
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mary Allen
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nicole Frahm
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Nicole L. Yates
- Departments of Surgery and Immunology, Duke Human Vaccine Institute, Durham, North Carolina, United States of America
| | - Lynn Morris
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kathryn Mngadi
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Brodie Daniels
- South African Medical Research Council, Durban, South Africa
| | - Craig Innes
- Aurum Institute, Klerksdorp Research Centre, Klerksdorp, South Africa
| | - Kevin Saunders
- Departments of Surgery and Immunology, Duke Human Vaccine Institute, Durham, North Carolina, United States of America
| | - Shannon Grant
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Chenchen Yu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Peter B. Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Sanjay Phogat
- Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
| | | | | | | | - Carter Bentley
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Nonhlanhla N. Mkhize
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael N. Pensiero
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Vijay L. Mehra
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - James G. Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - David C. Montefiori
- Departments of Surgery and Immunology, Duke Human Vaccine Institute, Durham, North Carolina, United States of America
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Durban, South Africa
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Georgia D. Tomaras
- Departments of Surgery and Immunology, Duke Human Vaccine Institute, Durham, North Carolina, United States of America
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Swamy GK, Dotters-Katz SK. Safety and varicella outcomes after varicella zoster immune globulin administration in pregnancy. Am J Obstet Gynecol 2019; 221:655-656. [PMID: 31279845 DOI: 10.1016/j.ajog.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University, Durham, NC.
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27
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Pearce SH, Dayan C, Wraith DC, Barrell K, Olive N, Jansson L, Walker-Smith T, Carnegie C, Martin KF, Boelaert K, Gilbert J, Higham CE, Muller I, Murray RD, Perros P, Razvi S, Vaidya B, Wernig F, Kahaly GJ. Antigen-Specific Immunotherapy with Thyrotropin Receptor Peptides in Graves' Hyperthyroidism: A Phase I Study. Thyroid 2019; 29:1003-1011. [PMID: 31194638 PMCID: PMC6648194 DOI: 10.1089/thy.2019.0036] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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] [Indexed: 12/14/2022]
Abstract
Background: Graves' disease is one of the most common autoimmune conditions, but treatment remains imperfect. This study explores the first-in-human use of antigen-specific immunotherapy with a combination of two thyrotropin receptor (TSHR) peptides (termed ATX-GD-59) in Graves' hyperthyroidism. Methods: Twelve participants (11 female) with previously untreated mild to moderate Graves' hyperthyroidism were enrolled in a Phase I open label trial to receive 10 doses of ATX-GD-59 administered intradermally over an 18-week period. Adverse events, tolerability, changes in serum free thyroid hormones, and TSHR autoantibodies were measured. Results: Ten subjects received all 10 doses of ATX-GD-59, five (50%) of whom had free triiodothyronine within the reference interval by the 18-week visit. Two further subjects had improved free thyroid hormones by the end of the study (7/10 responders), whereas three subjects showed worsening thyrotoxicosis during the study. Serum TSHR autoantibody concentrations reduced during the study and correlated with changes in free thyroid hormones (r = 0.85, p = 0.002 for TSHR autoantibody vs. free triiodothyronine). Mild injection-site swelling and pain were the most common adverse events. Conclusions: These preliminary data suggest that ATX-GD-59 is a safe and well-tolerated treatment. The improvement in free thyroid hormones in 70% of subjects receiving the medication suggests potential efficacy as a novel treatment for Graves' hyperthyroidism.
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Affiliation(s)
- Simon H.S. Pearce
- Institute for Genetic Medicine, Newcastle University, and Newcastle Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
- Address correspondence to: Simon Pearce, MD, FRCP, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle upon Tyne, NE1 3BZ, United Kingdom
| | - Colin Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David C. Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham United Kingdom
- Apitope Technology (Bristol) Ltd., Chepstow, United Kingdom
- Apitope International NV, Diepenbeek, Belgium
| | - Kevin Barrell
- Apitope Technology (Bristol) Ltd., Chepstow, United Kingdom
| | - Natalie Olive
- Apitope Technology (Bristol) Ltd., Chepstow, United Kingdom
| | | | | | | | | | - Kristien Boelaert
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham United Kingdom
| | - Jackie Gilbert
- Department of Endocrinology, King's College Hospital, London, United Kingdom
| | - Claire E. Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ilaria Muller
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Robert D. Murray
- Department of Endocrinology, St. James's University Hospital, Leeds, United Kingdom
| | - Petros Perros
- Endocrine Unit, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Salman Razvi
- Institute for Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bijay Vaidya
- Macleod Diabetes & Endocrine Centre, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Florian Wernig
- Department of Endocrinology, Imperial College, London, United Kingdom
| | - George J. Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
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Willcocks RJ, Forbes SC, Walter GA, Vandenborne K. Magnetic resonance imaging characteristics of injection site reactions after long-term subcutaneous delivery of drisapersen. Eur J Pediatr 2019; 178:777-778. [PMID: 30790036 PMCID: PMC6530557 DOI: 10.1007/s00431-019-03349-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca J Willcocks
- Department of Physical Therapy, University of Florida, 1225 Center Drive, Gainesville, FL, USA.
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, 1225 Center Drive, Gainesville, FL, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, 1345 Center Drive, Gainesville, FL, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, 1225 Center Drive, Gainesville, FL, USA
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Freeman LK. Adverse events following immunization. Can Fam Physician 2019; 65:163. [PMID: 30867170 PMCID: PMC6515964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Olamoyegun MA, Akinlade AT, Ala OA. Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria. Afr Health Sci 2018; 18:852-864. [PMID: 30766548 PMCID: PMC6354893 DOI: 10.4314/ahs.v18i4.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 12/20/2022] Open
Abstract
Background Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. Objective There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics. Methods A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained. Results Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10–20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants. Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection. Conclusion The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.
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Affiliation(s)
- Michael A Olamoyegun
- Department of Internal Medicine, Endocrinology, Diabetes & Metabolism Unit, Ladoke Akintola University of Technology, & LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | | | - Oluwabukola A Ala
- Department of Medicine, BOWEN University & BOWEN University Teaching Hospital, Ogbomoso
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Lorvick J, Browne EN, Lambdin BH, Comfort M. Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine. Addict Behav 2018; 85:94-99. [PMID: 29883856 DOI: 10.1016/j.addbeh.2018.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/05/2018] [Revised: 04/05/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of multiple illicit drugs (polydrug use) is associated with health-related harms and elevated risk of drug overdose. Polydrug use in common among women who use 'hard' drugs, such as cocaine, heroin or methamphetamine. METHODS Quantitative data collection was conducted with a community-recruited sample of 624 women who used heroin, methamphetamine or cocaine in Oakland, CA during 2014-2015. We conducted latent class analysis to classify polydrug use patterns. We assessed associations between classes of polydrug use and infectious disease risk behaviors, health care utilization and unmet health care need. RESULTS We identified four distinct classes of drug use: (1) predominantly crack (52% of women); (2) powder cocaine & non-heroin opioids (8%); (3) moderate polydrug use (25%); (4) heavy polydrug use (15%). Odds of sexual risk, injection drug use and unmet healthcare need were twice as high in the heavy polydrug use class as the predominantly crack class (p > 0.01 for each outcome). The rate of binge drinking (as days per month) was also significantly higher in the heavy polydrug class (p = 0.01). The moderate polydrug use class had higher odds of injection drug use and drug treatment participation, compared to the mainly crack class (p < 0.001 for each outcome). There were no differences between classes in health insurance or health care utilization. DISCUSSION Reduction of polydrug use could be an effective harm reduction strategy to address sexual and injection risk among women. The use of both opioids and stimulants in three of the four classes suggests that multi-modal substance abuse treatment approaches may be most appropriate.
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Affiliation(s)
- Jennifer Lorvick
- RTI International, Behavioral and Urban Health Program, United States.
| | - Erica N Browne
- RTI International, Women's Global Health Imperative, United States
| | - Barrot H Lambdin
- RTI International, Behavioral and Urban Health Program, United States; University of Washington, United States
| | - Megan Comfort
- RTI International, Behavioral and Urban Health Program, United States; University of California, San Francisco, United States
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Osteoarthritis of the knee. Prescrire Int 2017; 26:78. [PMID: 30730623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As of mid-2016, there is still no evidence that hyaluronic acid is more effective than placebo in osteoarthritis of the knee. It does however have adverse effects.
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