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Mészáros L, Lasch F, Delafont B, Guizzaro L. Estimands in CNS trials - A review of strategies for addressing intercurrent events. Contemp Clin Trials Commun 2024; 38:101266. [PMID: 38380344 PMCID: PMC10878841 DOI: 10.1016/j.conctc.2024.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/07/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Abstract
Background The estimands framework represents a significant innovation for the design, conduct, analysis, and interpretation of clinical trials. An aim of the framework is to increase precision and transparency on the handling of intercurrent events (IEs), defined as events occurring after treatment initiation and affecting the endpoint. While the experience in constructing and reporting estimands in the published literature is limited, developers performing confirmatory studies are already making use of the new paradigm, allowing to survey the strategies proposed by applicants and endorsed by regulators. Methods To identify strategies for handling IEs in confirmatory central nervous system (CNS) trials, we searched scientific advice letters issued by the European Medicines Agency (EMA) between 2017 and 2022. We developed a categorisation of the IEs and classified, according to the strategies defined in the framework, the strategies proposed by the Applicants and recommended by the agency. Strategies proposed and recommended were summarised by category of IEs, and the rationale for the choices was analysed qualitatively. Results In total, 170 IEs were identified in 52 confirmatory trials. A clear preference for the treatment policy strategy for treatment discontinuation and for the hypothetical strategy for pandemic-related disruptions was identified. For other categories of IEs, there are more mixed patterns. Discussion This study highlights the multidimensional nature of choosing a strategy for an IE. For different occurring IEs in confirmatory CNS trials different strategies are of regulatory interest, depending on the trial objective, underlying disease properties, rarity of disease, as well as frequency and timing of IEs and their relatedness to the disease.
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Affiliation(s)
- Lisa Mészáros
- European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, the Netherlands
| | - Florian Lasch
- European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, the Netherlands
- Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bruno Delafont
- ANSM Agence Nationale de Sécurité du Médicament et des Produits de Santé, 143/147 Boulevard Anatole, 93285, Saint Denis Cedex, France
| | - Lorenzo Guizzaro
- European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, the Netherlands
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Carboni L, Delafont B, Ivanchenko E, Ratti E, Learned SM, Alexander R, Domenici E. Folate metabolism biomarkers from two randomised placebo-controlled clinical studies with paroxetine and venlafaxine. World J Biol Psychiatry 2021; 22:315-321. [PMID: 32787676 DOI: 10.1080/15622975.2020.1805509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Based on the hypothesis of a role for folate and vitamin B12 in major depressive disorders (MDD), we aimed at validating the association between folate pathway biomarkers and depression or antidepressant response in clinical trial populations. METHODS We investigated serum levels erythrocyte folate and serum levels of homocysteine, vitamin B12, and folate as disease and response biomarkers for MDD in two independent randomised, placebo-controlled clinical trials, where paroxetine or venlafaxine were used as active controls, for a total of 881 patients. RESULTS Significant but weak correlations between depression severity and biomarker levels could be detected in the paroxetine study for serum folate and vitamin B12, with no correlations for any biomarker in the venlafaxine study. Besides a weak association for erythrocyte folate in the venlafaxine study, no significant associations were observed between treatment response and pre-treatment levels of any of the biomarkers tested. CONCLUSIONS Notwithstanding the relatively large number of patients tested, we did not find consistent associations between folate biomarkers and MDD severity, or response to paroxetine and venlafaxine. Our results may be related to the particular study design or clinical population; however, our findings do not support the hypothesis of a dysfunction of one-carbon metabolism in MDD.
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Affiliation(s)
- Lucia Carboni
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | | | - Susan M Learned
- Global Medicines Development, Indivior, Inc, Richmond, VA, USA
| | | | - Enrico Domenici
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy.,Fondazione The Microsoft Research-University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto (Trento), Italy
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Gracies JM, Jech R, Valkovic P, Marque P, Vecchio M, Denes Z, Vilain C, Delafont B, Picaut P. When can maximal efficacy occur with repeat botulinum toxin injection in upper limb spastic paresis? Brain Commun 2020; 3:fcaa201. [PMID: 33543139 PMCID: PMC7850141 DOI: 10.1093/braincomms/fcaa201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/05/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022] Open
Abstract
Repeated injection cycles with abobotulinumtoxinA, a botulinum toxin type A, are recommended in current clinical guidelines as a treatment option for adults with upper limb spastic paresis. However, the magnitude of the maximal therapeutic effect of repeated abobotulinumtoxinA treatment across different efficacy parameters and the number of injection cycles required to reach maximal effect remain to be elucidated. Here, we present a post hoc exploratory analysis of a randomized, double-blind, placebo-controlled trial (12–24 weeks; NCT01313299) and open-label extension study (up to 12 months; NCT0131331), in patients aged 18–80 years with hemiparesis for ≥6 months after stroke/traumatic brain injury. Two inferential methods were used to assess the changes in efficacy parameters after repeat abobotulinumtoxinA treatment cycles: Mixed Model Repeated Measures analysis and Non-Linear Random Coefficients analysis. Using the latter model, the expected maximal effect size (not placebo-controlled) and the number of treatment cycles to reach 90% of this maximal effect were estimated. Treatment responses in terms of passive and perceived parameters (i.e. modified Ashworth scale in primary target muscle group, disability assessment scale for principal target for treatment or limb position, and angle of catch at fast speed) were estimated to reach near-maximal effect in two to three cycles. Near-maximal treatment effect for active parameters (i.e. active range of motion against the resistance of extrinsic finger flexors and active function, assessed by the Modified Frenchay Scale) was estimated to be reached one to two cycles later. In contrast to most parameters, active function showed greater improvements at Week 12 (estimated maximal change from baseline-modified Frenchay Scale overall score: +0.8 (95% confidence interval, 0.6; 1.0) than at Week 4 (+0.6 [95% confidence interval, 0.4; 0.8]). Overall, the analyses suggest that repeated treatment cycles with abobotulinumtoxinA in patients chronically affected with upper limb spastic paresis allow them to relearn how to use the affected arm with now looser antagonists. Future studies should assess active parameters as primary outcome measures over repeated treatment cycles, and assess efficacy at the 12-week time-point of each cycle, as the benefits of abobotulinumtoxinA may be underestimated in the studies of insufficient duration. Abbreviated summary In this post hoc analysis of repeated abobotulinumtoxinA injection cycles in upper limb spastic paresis, Gracies et al. used statistical modelling to elucidate the maximal therapeutic effect of abobotulinumtoxinA. Notably, the number of injections required to reach this maximal effect was higher for active (e.g. active function) compared with passive (e.g. tone) parameters.
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Affiliation(s)
- Jean-Michel Gracies
- UR 7377 BIOTN, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Peter Valkovic
- 2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovak Republic
| | - Philippe Marque
- Service de médecine physique et réadaptation, Hôpital Rangueil, Toulouse, France
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Physical Medicine and Rehabilitation Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Zoltan Denes
- Brain Injury Rehabilitation Unit, National Institute for Medical Rehabilitation, Budapest, Hungary
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Carboni L, McCarthy DJ, Delafont B, Filosi M, Ivanchenko E, Ratti E, Learned SM, Alexander R, Domenici E. Biomarkers for response in major depression: comparing paroxetine and venlafaxine from two randomised placebo-controlled clinical studies. Transl Psychiatry 2019; 9:182. [PMID: 31375659 PMCID: PMC6677721 DOI: 10.1038/s41398-019-0521-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [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: 12/02/2018] [Revised: 04/19/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023] Open
Abstract
The identification of biomarkers of response might speed drug development and set the premises to assist clinical practice in psychiatry. In this work, we evaluated a panel of peripheral biomarkers (including IL-6, IL-10, TNF-α, TNFRII, BDNF, CRP, MMP9 and PAI1) in depressed patients receiving paroxetine, venlafaxine, or placebo. Samples were obtained from two randomised placebo-controlled studies evaluating the efficacy and tolerability of a novel drug candidate, using either paroxetine or venlafaxine as active comparators. In both studies, the biomarker candidates were analysed in plasma collected at randomization and after 10 weeks of treatment with either placebo or active comparator (for a total of 106 and 108 subjects in the paroxetine and venlafaxine study, respectively). Data were obtained by multiplexing sandwich-ELISA system. Data were subjected to statistical analysis to assess their correlation with baseline severity and with response outcome. Increases in biomarker levels were correlated with reduction in depression severity for TNF-α, IL-6 IL-10 and CRP. Response to paroxetine treatment correlated with baseline IL-10, IL-6 and TNF-α levels, with the strongest signal being observed in males. In the venlafaxine study, a correlation was observed only between CRP level at randomisation and response, suggesting differences between the two active treatments and the two studies. Our investigations suggest that a combination of pro- and anti-inflammatory cytokines may predict response outcome in patients treated with paroxetine. The potential for IL-10, IL-6 and TNF-α as response biomarkers for a wider range of antidepressants warrants further investigations in clinical trials with other monoamine reuptake inhibitors.
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Affiliation(s)
- Lucia Carboni
- 0000 0004 1757 1758grid.6292.fDepartment of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Dennis J. McCarthy
- Indipendent Consultant, Clinical Pharmacology and Translational Science, Newark, DE USA
| | | | - Michele Filosi
- 0000 0004 1937 0351grid.11696.39Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | | | - Emiliangelo Ratti
- 0000 0004 0447 7762grid.419849.9Neuroscience Therapeutic Area Unit, Takeda, Boston, MA USA
| | - Susan M. Learned
- grid.504165.3Global Medicines Development, Indivior, Inc., Richmond, VA USA
| | - Robert Alexander
- 0000 0004 0447 7762grid.419849.9Neuroscience Therapeutic Area Unit, Takeda, Boston, MA USA
| | - Enrico Domenici
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy. .,Fondazione The Microsoft Research-University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto, TN, Italy.
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Delafont B, Carroll K, Vilain C, Pham E. Investigation of mixed model repeated measures analyses and non-linear random coefficient models in the context of long-term efficacy data. Pharm Stat 2018; 17:515-526. [PMID: 29781237 DOI: 10.1002/pst.1868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/19/2017] [Accepted: 04/12/2018] [Indexed: 11/09/2022]
Abstract
The longitudinal data from 2 published clinical trials in adult subjects with upper limb spasticity (a randomized placebo-controlled study [NCT01313299] and its long-term open-label extension [NCT01313312]) were combined. Their study designs involved repeat intramuscular injections of abobotulinumtoxinA (Dysport®), and efficacy endpoints were collected accordingly. With the objective of characterizing the pattern of response across cycles, Mixed Model Repeated Measures analyses and Non-Linear Random Coefficient (NLRC) analyses were performed and their results compared. The Mixed Model Repeated Measures analyses, commonly used in the context of repeated measures with missing dependent data, did not involve any parametric shape for the curve of changes over time. Based on clinical expectations, the NLRC included a negative exponential function of the number of treatment cycles, with its asymptote and rate included as random coefficients in the model. Our analysis focused on 2 specific efficacy parameters reflecting complementary aspects of efficacy in the study population. A simulation study based on a similar study design was also performed to further assess the performance of each method under different patterns of response over time. This highlighted a gain of precision with the NLRC model, and most importantly the need for its assumptions to be verified to avoid potentially biased estimates. These analyses describe a typical situation and the conditions under which non-linear mixed modeling can provide additional insights on the behavior of efficacy parameters over time. Indeed, the resulting estimates from the negative exponential NLRC can help determine the expected maximal effect and the treatment duration required to reach it.
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Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, Thomas M. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim Care Respir Med 2017; 27:22. [PMID: 28373682 PMCID: PMC5434773 DOI: 10.1038/s41533-017-0016-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/16/2016] [Accepted: 02/01/2017] [Indexed: 11/09/2022] Open
Abstract
Inhaler device errors are common and may impact the effectiveness of the delivered drug. There is a paucity of up-to-date systematic reviews (SRs) or meta-analyses (MAs) of device errors in asthma and chronic obstructive pulmonary disease (COPD) patients. This SR and MA provides an estimate of overall error rates (both critical and non-critical) by device type and evaluates factors associated with inhaler misuse. The following databases from inception to July 23, 2014 (Embase®, MEDLINE®, MEDLINE® In-Process and CENTRAL) were searched, using predefined search terms. Studies in adult males and females with asthma or COPD, reporting at least one overall or critical error, using metered dose inhalers and dry powder inhalers were included. Random-effect MAs were performed to estimate device error rates and to compare pairs of devices. Overall and critical error rates were high across all devices, ranging from 50-100% and 14-92%, respectively. However, between-study heterogeneity was also generally >90% (I-squared statistic), indicating large variability between studies. A trend towards higher error rates with assessments comprising a larger number of steps was observed; however no consistent pattern was identified. This SR and MA highlights the relatively limited body of evidence assessing device errors and the lack of standardised checklists. There is currently insufficient evidence to determine differences in error rates between different inhaler devices and their impact on clinical outcomes. A key step in improving our knowledge on this topic would be the development of standardised checklists for each device. CHRONIC LUNG DISEASES CALL TO STANDARDISE RESEARCH INTO INHALER DEVICE ERRORS: Researchers should adopt a standardised approach to investigate the incorrect use of inhalers and its associated clinical implications. Henry Chrystyn at Plymouth University, together with scientists across the UK and the Netherlands, conducted a review of research related to inhaled medication errors made by patients with asthma or chronic obstructive pulmonary disease. It is widely acknowledged that many patients with lung conditions don't use their inhaler devices correctly, which affects drug effectiveness and disease control. While Chrystyn's team found high critical error rates reported across all devices, their meta-analysis and systematic review highlighted significant gaps in knowledge regarding different inhalers and associated error rates, and how these affect clinical outcomes. The researchers call for in-depth studies into device use, alongside standardised checklists and definitions for such studies to use to ensure consistency.
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Affiliation(s)
- Henry Chrystyn
- Inhalation Consultancy Ltd, Yeadon, Leeds and Faculty of Human and Health Sciences, Plymouth University, Plymouth, UK.
| | - Job van der Palen
- Department of Research Methodology, Measurement, and Data Analysis, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands.,Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Neil Barnes
- GSK, Brentford, UK.,William Harvey Institute, St Bartholomew Hospital and The London School of Medicine and Dentistry, London, UK
| | | | | | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK.,NIHR Wessex Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Southampton, UK
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Howe A, O'Hare P, Crawford P, Delafont B, McAlister O, Di Maio R, Clutton E, Adgey J, McEneaney D. An investigation of thrust, depth and the impedance cardiogram as measures of cardiopulmonary resuscitation efficacy in a porcine model of cardiac arrest. Resuscitation 2015; 96:114-20. [PMID: 26234892 DOI: 10.1016/j.resuscitation.2015.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Optimising the depth and rate of applied chest compressions following out of hospital cardiac arrest is crucial in maintaining end organ perfusion and improving survival. The impedance cardiogram (ICG) measured via defibrillator pads produces a characteristic waveform during chest compressions with the potential to provide feedback on cardiopulmonary resuscitation (CPR) and enhance performance. The objective of this pre-clinical study was to investigate the relationship between mechanical and physiological markers of CPR efficacy in a porcine model and examine the strength of correlation between the ICG amplitude, compression depth and end-tidal CO2 (ETCO2). METHODS Two experiments were performed using 24 swine (12 per experiment). For experiment 1, ventricular fibrillation (VF) was induced and mechanical CPR commenced at varying thrusts (0-60 kg) for 2 min intervals. Chest compression depth was recorded using a Philips QCPR device with additional recording of invasive physiological parameters: systolic blood pressure, ETCO2, cardiac output and carotid flow. For experiment 2, VF was induced and mechanical CPR commenced at varying depths (0-5 cm) for 2 min intervals. The ICG was recorded via defibrillator pads attached to the animal's sternum and connected to a Heartsine 500 P defibrillator. ICG amplitude, chest compression depth, systolic blood pressure and ETCO2 were recorded during each cycle. In both experiments the within-animal correlation between the measured parameters was assessed using a mixed effect model. RESULTS In experiment 1 moderate within-animal correlations were observed between physiological parameters and compression depth (r=0.69-0.77) and thrust (r=0.66-0.82). A moderate correlation was observed between compression depth and thrust (r=0.75). In experiment 2 a strong within-animal correlation and moderate overall correlations were observed between ICG amplitude and compression depth (r=0.89, r=0.79) and ETCO2 (r=0.85, r=0.64). CONCLUSION In this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO2 suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance.
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Affiliation(s)
- Andrew Howe
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK.
| | | | - Paul Crawford
- Veterinary Anaesthesia Consultancy, Larne, Co Antrim, UK
| | | | | | | | - Eddie Clutton
- Royal (Dick) School of Veterinary Studies, Dept. of Anaesthesia, University of Edinburgh, Edinburgh, UK
| | - Jennifer Adgey
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - David McEneaney
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK
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Di Maio R, O’Hare P, McAlister O, McIntyre C, Delafont B, McEneany D, Adgey J. The correlation between the impedance cardiogram and end-tidal carbon dioxide during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Roden M, Weng J, Eilbracht J, Delafont B, Kim G, Woerle HJ, Broedl UC. Empagliflozin monotherapy with sitagliptin as an active comparator in patients with type 2 diabetes: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Diabetes Endocrinol 2013; 1:208-19. [PMID: 24622369 DOI: 10.1016/s2213-8587(13)70084-6] [Citation(s) in RCA: 328] [Impact Index Per Article: 29.8] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND We aimed to investigate the efficacy and tolerability of empagliflozin, an oral, potent, and selective inhibitor of sodium-glucose co-transporter 2, in patients with type 2 diabetes who had not received drug treatment in the preceding 12 weeks. METHODS In our multicentre, randomised, placebo-controlled, phase 3 trial, we enrolled adults (aged ≥18 years) who had not received oral or injected anti-diabetes treatment in the previous 12 weeks. Eligible patients had HbA1c concentrations of 7-10%. We randomly allocated patients (1:1:1:1) with a computer-generated random sequence, stratified by region, HbA1c, and estimated glomerular filtration rate at screening, to placebo, empagliflozin 10 mg, empagliflozin 25 mg, or sitagliptin 100 mg once daily for 24 weeks. Patients and investigators were masked to treatment assignment. The primary endpoint was change from baseline in HbA1c at week 24 by ANCOVA in all randomly allocated patients who were treated with at least one dose of study drug and had a baseline HbA1c value. This study is completed and registered with ClinicalTrials.gov, number NCT01177813. FINDINGS Between Aug 12, 2010, and March 19, 2012, we randomly allocated 228 patients to receive placebo, 224 to receive empagliflozin 10 mg, 224 to receive empagliflozin 25 mg, and 223 to receive sitagliptin. Compared with placebo, adjusted mean differences in change from baseline HbA1c at week 24 were -0·74% (95% CI -0·88 to -0·59; p<0·0001) for empagliflozin 10 mg, -0·85% (-0·99 to -0·71; p<0·0001) for empagliflozin 25 mg, and -0·73% (-0·88 to -0·59; p<0·0001) for sitagliptin. 140 (61%) patients in the placebo group reported adverse events (four [2%] severe and six [3%] serious), as did 123 (55%) patients in the empagliflozin 10 mg group (eight [4%] severe and eight [4%] serious), 135 (60%) patients in the empagliflozin 25 mg group (seven [3%] severe and five [2%] serious), and 119 (53%) patients in the sitagliptin group (five [2%] severe and six [3%] serious). INTERPRETATION Empagliflozin provides a tolerable and efficacious strategy to reduce HbA1c in patients with type 2 diabetes who had not previously received drug treatment. FUNDING Boehringer Ingelheim and Eli Lilly.
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Affiliation(s)
- Michael Roden
- Clinics of Endocrinology and Diabetology, Heinrich-Heine University, Düsseldorf, Germany; German Diabetes Center, Institute for Clinical Diabetology, Düsseldorf, Germany.
| | - Jianping Weng
- Diabetes Institute of Guangdong Province, Key Lab of Diabetology of Guangdong Province, The Third Affiliated Hospital of Sun Yat-sen University, Canton, China
| | - Jens Eilbracht
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | | | - Gabriel Kim
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
| | - Hans J Woerle
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
| | - Uli C Broedl
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
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Napolitano A, Miller SR, Murgatroyd PR, Delafont B, Brooke A, Elkhawad M, Tan CY, Virtue S, Vidal-Puig A, Nunez DJ. Prediction of weight loss and regain following dietary, lifestyle, and pharmacologic intervention. Clin Pharmacol Ther 2012; 91:1027-34. [PMID: 22336590 DOI: 10.1038/clpt.2011.333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To develop statistical models for predicting weight loss and regain, we analyzed the phenotypic responses in an outpatient study of 60 obese subjects randomized to one of three 12-week interventions, diet (-600 kcal) alone, diet with exercise, and diet with sibutramine. This was followed by 12 weeks of observation. The best of the "baseline covariates" models was one that incorporated intervention group and baseline homeostasis model assessment-estimated insulin resistance (HOMA(IR)). It predicted week 12 weight change with R(2) of 0.38 and root mean square error (√MSE) of 2.92 kg. An alternative model incorporating baseline fat mass plus change in weight and HOMA(IR) at week 4 improved the prediction (R(2), 0.67, √MSE, 2.19 kg). We could not identify a satisfactory model to predict weight regain. We conclude that prediction of weight loss over 12 weeks is significantly improved when short-term weight change is incorporated into the model. This information could be utilized to forecast the success of a weight-loss program and to motivate and contribute to innovative designing of obesity trials.
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Affiliation(s)
- A Napolitano
- Clinical Unit in Cambridge, GlaxoSmithKline, Cambridge University Hospital NHS Trust, Cambridge, UK
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Thomas EL, Makwana A, Newbould R, Rao AW, Gambarota G, Frost G, Delafont B, Mishra RG, Matthews PM, Berk ES, Schwartz SM, Bell JD, Beaver JD. Pragmatic study of orlistat 60 mg on abdominal obesity. Eur J Clin Nutr 2011; 65:1256-62. [PMID: 21697820 DOI: 10.1038/ejcn.2011.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES It is well established that combining a reduced calorie, low-fat diet with the lipase inhibitor orlistat results in significantly greater weight loss than placebo plus diet. This weight loss is accompanied by changes in adipose tissue (AT) distribution. As 60 mg orlistat is now available as an over-the-counter medication, the primary objective of this study was to determine whether 60 mg orlistat is effective as a weight loss option in a free-living community population with minimal professional input. METHODS AT and ectopic lipid content were measured using magnetic resonance imaging and (1)H MR spectroscopy, respectively, in 27 subjects following 3 months treatment with orlistat 60 mg and a reduced calorie, low-fat diet. RESULTS Significant reductions in intra-abdominal AT (-10.6%, P=0.023), subcutaneous (-11.7% P<0.0001) and pericardial fat (-9.8%, P=0.034) volumes and intrahepatocellular lipids (-43.3%, P=0.0003) were observed. These changes in body fat content and distribution were accompanied by improvements in plasma lipids and decreases in blood pressure and heart rate. CONCLUSION These findings suggest that over-the-counter 60 mg orlistat, in combination with the type of advice a subject could expect to be given when obtaining 60 mg orlistat in a community setting, does indeed result in potentially clinically beneficial changes in body composition and risk factors for metabolic diseases.
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Affiliation(s)
- E L Thomas
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK.
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