1
|
Garcia-Guix M, Ardevol A, Sapena V, Alvarado-Tápias E, Huertas A, Brujats A, Fajardo J, Cuyas B, Poca M, Guarner C, Torras X, Escorsell À, Villanueva C. Influence of further decompensation on survival across clinical stages of decompensated cirrhosis: The role of portal hypertension and HVPG changes. Liver Int 2024. [PMID: 38634685 DOI: 10.1111/liv.15937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIMS Decompensated-cirrhosis encompasses several stages with different prognosis, such as bleeding, ascites and bleeding-plus-ascites. Development of further-decompensation worsens survival, while non-selective β-blockers (NSBBs) can modify the risk. However, how this applies to each stage is uncertain. We aimed to investigate, in each stage of decompensated-cirrhosis, the influence of further-decompensation on mortality and whether changes in portal-pressure (HVPG) under NSBBs influence these outcomes. METHODS Patients with variceal bleeding were consecutively included differentiating those with bleeding-alone from those who also had ascites. Patients with ascites and high-risk varices referred for primary-prophylaxis were also investigated. A baseline haemodynamic study was performed and was repeated after 1-3-months under NSBBs. Outcomes were investigated by competing-risk. RESULTS Totally 103 patients had bleeding-alone, 186 bleeding-plus-ascites and 187 ascites-alone. Mean follow-up was 32-months (IQR, 12-60). Patients with bleeding-plus-ascites had higher HVPG and were more hyperdynamic than patients with ascites-alone and these than those with bleeding-alone. At each stage, the mortality risk was more than twice in patients developing further-decompensation vs. those without (p < .001). In each stage, HVPG-decrease under NSBBs showed better discrimination to predict further-decompensation than the baseline MELD, Child-Pugh or HVPG, by time-dependent ROC-curves (c-statistic >70%). At each stage, patients without HVPG-decreases, either ≥10% or ≥20% from the baseline, had higher risk of further-decompensation (sHR from 2.43 to 6.73, p < .01) and worse survival. CONCLUSIONS In each stage of decompensated cirrhosis, mortality risk significantly and very markedly increase with further-decompensation. HVPG-non-response to NSBBs may adequately stratify the risk of further decompensation and death, in each stage. This suggests potential benefit with pre-emptive therapies in HVPG-non-responders at each-stage.
Collapse
Affiliation(s)
- Marta Garcia-Guix
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Alba Ardevol
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor Sapena
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
- Medical Statistics Core Faculty, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Edilmar Alvarado-Tápias
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Anna Huertas
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Brujats
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Javier Fajardo
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Cuyas
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - María Poca
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Carlos Guarner
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Xavier Torras
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Àngels Escorsell
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| |
Collapse
|
2
|
D'Amico G, Zipprich A, Villanueva C, Sordà JA, Morillas RM, Garcovich M, García Retortillo M, Martinez J, Calès P, D'Amico M, Dollinger M, García-Guix M, Gonzalez Ballerga E, Tsochatzis E, Cirera I, Albillos A, Roquin G, Pasta L, Colomo A, Daruich J, Canete N, Boursier J, Dallio M, Gasbarrini A, Iacobellis A, Gobbo G, Merli M, Federico A, Svegliati Baroni G, Pozzoni P, Addario L, Chessa L, Ridola L, Garcia-Tsao G. Further decompensation in cirrhosis: Results of a large multicenter cohort study supporting Baveno VII statements. Hepatology 2024; 79:869-881. [PMID: 37916970 DOI: 10.1097/hep.0000000000000652] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/03/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND AIMS The prognostic weight of further decompensation in cirrhosis is still unclear. We investigated the incidence of further decompensation and its effect on mortality in patients with cirrhosis. APPROACH AND RESULTS Multicenter cohort study. The cumulative incidence of further decompensation (development of a second event or complication of a decompensating event) was assessed using competing risks analysis in 2028 patients. A 4-state model was built: first decompensation, further decompensation, liver transplant, and death. A cause-specific Cox model was used to assess the adjusted effect of further decompensation on mortality. Sensitivity analyses were performed for patients included before or after 1999. In a mean follow-up of 43 months, 1192 patients developed further decompensation and 649 died. Corresponding 5-year cumulative incidences were 52% and 35%, respectively. The cumulative incidences of death and liver transplant after further decompensation were 55% and 9.7%, respectively. The most common further decompensating event was ascites/complications of ascites. Five-year probabilities of state occupation were 24% alive with first decompensation, 21% alive with further decompensation, 7% alive with a liver transplant, 16% dead after first decompensation without further decompensation, 31% dead after further decompensation, and <1% dead after liver transplant. The HR for death after further decompensation, adjusted for known prognostic indicators, was 1.46 (95% CI: 1.23-1.71) ( p <0.001). The significant impact of further decompensation on survival was confirmed in patients included before or after 1999. CONCLUSIONS In cirrhosis, further decompensation occurs in ~60% of patients, significantly increases mortality, and should be considered a more advanced stage of decompensated cirrhosis.
Collapse
Affiliation(s)
- Gennaro D'Amico
- Gastroenterology Unit, Department of Medicine, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- Gastroenterology Unit, Department of Medicine, Clinica La Maddalena, Palermo, Italy
| | - Alexander Zipprich
- Department of Internal Medicine IV, Jena University Hospitals, Am Klinikum 1, Jena, Germany
| | - Càndid Villanueva
- Department of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Antonio Sordà
- Hepatology Section, Gastroenterology Division, Medicine Department, Hospital de Clínicas San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Rosa Maria Morillas
- Department of Medicine, Liver Unit, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Matteo Garcovich
- Department of Liver and Digestive Health, Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
- Department of Medicine and Translational Surgery, Internal Medicine and Gastroenterology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Montserrat García Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar. Hospital del Mar Research Institute, Barcelona, Spain
| | - Javier Martinez
- Department of Gastroenterology and Instituto Ramón y Cajal De Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal and University of Alcalá, Madrid, Spain
| | - Paul Calès
- Gastroenterology and Digestive Oncology, Hôpital Universitaire d'Angers, Angers, France
| | - Mario D'Amico
- Gastroenterology Unit, Department of Medicine, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- Interventional Radiology Unit, Department of Radiology, Ospedale Civico Benfratelli, Palermo, Italy
| | - Matthias Dollinger
- Department of Medicine I (Gastroenterology, Hepatology, Diabetology & Nephrology), Klinikum Landshut, Landshut, Germany
| | - Marta García-Guix
- Department of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esteban Gonzalez Ballerga
- Hepatology Section, Gastroenterology Division, Medicine Department, Hospital de Clínicas San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Emmanuel Tsochatzis
- Department of Liver and Digestive Health, Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
| | - Isabel Cirera
- Liver Section, Gastroenterology Department, Hospital del Mar. Hospital del Mar Research Institute, Barcelona, Spain
| | - Agustìn Albillos
- Department of Gastroenterology and Instituto Ramón y Cajal De Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal and University of Alcalá, Madrid, Spain
| | - Guillaume Roquin
- Gastroenterology and Digestive Oncology, Hôpital Universitaire d'Angers, Angers, France
| | - Linda Pasta
- Gastroenterology Unit, Department of Medicine, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Alan Colomo
- Department of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Daruich
- Hepatology Section, Gastroenterology Division, Medicine Department, Hospital de Clínicas San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Nuria Canete
- Liver Section, Gastroenterology Department, Hospital del Mar. Hospital del Mar Research Institute, Barcelona, Spain
| | - Jérôme Boursier
- Gastroenterology and Digestive Oncology, Hôpital Universitaire d'Angers, Angers, France
| | - Marcello Dallio
- Department of Hepato-Gastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Gasbarrini
- Department of Medicine and Translational Surgery, Internal Medicine and Gastroenterology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Iacobellis
- Department of Gastroenterology and Endoscopy, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulia Gobbo
- Internal Medicine Unit, Department of Medicine, IRCCS Policlinico San Donato, Milano, Italy
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Department of Translational and Precision Medicine, Università Sapienza, Roma, Italy
| | - Alessandro Federico
- Department of Hepato-Gastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gianluca Svegliati Baroni
- Liver Injury and Transplant Unit, Department of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Pietro Pozzoni
- Hepatology Unit, Department of General Medicine, PO Alessandro Manzoni, ASST Lecco, Lecco, Italy
| | - Luigi Addario
- Hepatology Unit, Department of Gastroenterology, Cardarelli Hospital, Naples, Italy
| | - Luchino Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lorenzo Ridola
- Gastroenterology Unit, ASL Latina, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Guadalupe Garcia-Tsao
- Digestive Disease Section, Department of General Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- VA-CT Healthcare System, Department of General Medicine, West Haven, Connecticut, USA
| |
Collapse
|
3
|
Brujats A, Villanueva C. EXAMINING THE THERAPEUTIC LANDSCAPE OF BETA-BLOCKERS IN PORTAL HYPERTENSION. Clin Mol Hepatol 2024:cmh.2024.0144. [PMID: 38447532 DOI: 10.3350/cmh.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Anna Brujats
- Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute Sant Pau (IIB Sant Pau). 08025 Barcelona. Universitat Autònoma de Barcelona
| | - Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute Sant Pau (IIB Sant Pau). 08025 Barcelona. Universitat Autònoma de Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| |
Collapse
|
4
|
Villanueva C. The hidden face of preemptive TIPS. Hepatology 2024; 79:535-537. [PMID: 38085849 DOI: 10.1097/hep.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| |
Collapse
|
5
|
Villanueva C, Sapena V, Lo GH, Seo YS, Shah HA, Singh V, Tripathi D, Schepke M, Gheorghe C, Bonilha DQ, Jutabha R, Wang HM, Rodrigues SG, Brujats A, Lee HA, Azam Z, Kumar P, Hayes PC, Sauerbruch T, Chen WC, Iacob S, Libera ED, Jensen DM, Alvarado E, Torres F, Bosch J. Improving primary prophylaxis of variceal bleeding by adapting therapy to the clinical stage of cirrhosis. A competing-risk meta-analysis of individual participant data. Aliment Pharmacol Ther 2024; 59:306-321. [PMID: 38108646 DOI: 10.1111/apt.17824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/24/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND & AIMS Non-selective β-blockers (NSBBs) and endoscopic variceal-ligation (EVL) have similar efficacy preventing first variceal bleeding. Compensated and decompensated cirrhosis are markedly different stages, which may impact treatment outcomes. We aimed to assess the efficacy of NSBBs vs EVL on survival in patients with high-risk varices without previous bleeding, stratifying risk according to compensated/decompensated stage of cirrhosis. METHODS By systematic review, we identified RCTs comparing NSBBs vs EVL, in monotherapy or combined, for primary bleeding prevention. We performed a competing-risk, time-to-event meta-analysis, using individual patient data (IPD) obtained from principal investigators of RCTs. Analyses were stratified according to previous decompensation of cirrhosis. RESULTS Of 25 RCTs eligible, 14 failed to provide IPD and 11 were included, comprising 1400 patients (656 compensated, 744 decompensated), treated with NSBBs (N = 625), EVL (N = 546) or NSBB+EVL (N = 229). Baseline characteristics were similar between groups. Overall, mortality risk was similar with EVL vs. NSBBs (subdistribution hazard-ratio (sHR) = 1.05, 95% CI = 0.75-1.49) and with EVL + NSBBs vs either monotherapy, with low heterogeneity (I2 = 28.7%). In compensated patients, mortality risk was higher with EVL vs NSBBs (sHR = 1.76, 95% CI = 1.11-2.77) and not significantly lower with NSBBs+EVL vs NSBBs, without heterogeneity (I2 = 0%). In decompensated patients, mortality risk was similar with EVL vs. NSBBs and with NSBBs+EVL vs. either monotherapy. CONCLUSIONS In patients with compensated cirrhosis and high-risk varices on primary prophylaxis, NSBBs significantly improved survival vs EVL, with no additional benefit noted adding EVL to NSBBs. In decompensated patients, survival was similar with both therapies. The study suggests that NSBBs are preferable when advising preventive therapy in compensated patients.
Collapse
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Victor Sapena
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Gin-Ho Lo
- Division of Gastroenterology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hasnain Ali Shah
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dhiraj Tripathi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Schepke
- Helios Clinic Siegburg, Department Gastroenterology and Hepatology, Siegburg, Germany
| | - Cristian Gheorghe
- Center of Gastroenterology & Hepatology, Fundeni Clinical Institute, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Daniell Q Bonilha
- Department of Gastroenterology, Federal University of São Paulo, State University of Campinas, Campinas, Brazil
| | - Rome Jutabha
- University of Southern California (USC) School of Medicine, Los Angeles, USA
- Keck School of Medicine of University of Southern California and Clinical Outreach and Development, Los Angeles, USA
| | - Huay-Min Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans, General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Susana G Rodrigues
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Anna Brujats
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Han Ah Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Zahid Azam
- National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Pramod Kumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Peter C Hayes
- Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tilman Sauerbruch
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Wen-Chi Chen
- Division of Gastroenterology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Speranta Iacob
- Center of Gastroenterology & Hepatology, Fundeni Clinical Institute, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ermelindo D Libera
- Department of Gastroenterology, Federal University of São Paulo, State University of Campinas, Campinas, Brazil
| | - Dennis M Jensen
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Center for the Health Sciences, Los Angeles, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Center for Ulcer Research and Education: Digestive Diseases Research Center
| | - Edilmar Alvarado
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Ferran Torres
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Jaume Bosch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| |
Collapse
|
6
|
Rowe IA, Villanueva C, Shearer JE, Torres F, Albillos A, Genescà J, Garcia-Pagan JC, Tripathi D, Hayes PC, Bosch J, Abraldes JG. Quantifying the benefit of nonselective beta-blockers in the prevention of hepatic decompensation: A Bayesian reanalysis of the PREDESCI trial. Hepatology 2023; 78:530-539. [PMID: 36897269 DOI: 10.1097/hep.0000000000000342] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/21/2022] [Accepted: 02/09/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND AIMS Beta-blockers have been studied for the prevention of variceal bleeding and, more recently, for the prevention of all-cause decompensation. Some uncertainties regarding the benefit of beta-blockers for the prevention of decompensation remain. Bayesian analyses enhance the interpretation of trials. The purpose of this study was to provide clinically meaningful estimates of both the probability and magnitude of the benefit of beta-blocker treatment across a range of patient types. APPROACH AND RESULTS We undertook a Bayesian reanalysis of PREDESCI incorporating 3 priors (moderate neutral, moderate optimistic, and weak pessimistic). The probability of clinical benefit was assessed considering the prevention of all-cause decompensation. Microsimulation analyses were done to determine the magnitude of the benefit. In the Bayesian analysis, the probability that beta-blockers reduce all-cause decompensation was >0.93 for all priors. The Bayesian posterior hazard ratios (HR) for decompensation ranged from 0.50 (optimistic prior, 95% credible interval 0.27-0.93) to 0.70 (neutral prior, 95% credible interval 0.44-1.12). Exploring the benefit of treatment using microsimulation highlights substantial treatment benefits. For the neutral prior derived posterior HR and a 5% annual incidence of decompensation, at 10 years, an average of 497 decompensation-free years per 1000 patients were gained with treatment. In contrast, at 10 years 1639 years per 1000 patients were gained from the optimistic prior derived posterior HR and a 10% incidence of decompensation. CONCLUSIONS Beta-blocker treatment is associated with a high probability of clinical benefit. This likely translates to a substantial gain in decompensation-free life years at the population level.
Collapse
Affiliation(s)
- Ian A Rowe
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Salud Carlos III, Spain
| | - Jessica E Shearer
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ferran Torres
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Agustín Albillos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Salud Carlos III, Spain
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid, Spain
| | - Joan Genescà
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Salud Carlos III, Spain
- Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan C Garcia-Pagan
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas). Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Dhiraj Tripathi
- University Hospitals Birmingham NHS Foundation Trust. Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham. UK
- Department of Hepatology. Royal Infirmary of Edinburgh. Edinburgh, UK
| | - Peter C Hayes
- Department of Hepatology. Royal Infirmary of Edinburgh. Edinburgh, UK
| | - Jaume Bosch
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas). Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Juan G Abraldes
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
7
|
Villanueva C, Torres F, Tripathi D, Bosch J. Reply to: "Carvedilol in patients with compensated cirrhosis: The ongoing benefits of definitive randomised trials over meta-analysis in patients with small varices". J Hepatol 2023; 79:e23-e24. [PMID: 36848975 DOI: 10.1016/j.jhep.2023.02.025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dhiraj Tripathi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jaume Bosch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland; Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Villanueva C, Tripathi D. Carvedilol, probably the β-blocker of choice for everyone with cirrhosis and portal hypertension: But not so fast! Liver Int 2023; 43:1154-1156. [PMID: 37166136 DOI: 10.1111/liv.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Dhiraj Tripathi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Nicoară-Farcău O, Lozano JJ, Alonso C, Sidorova J, Villanueva C, Albillos A, Genescà J, Llop E, Calleja JL, Aracil C, Bañares R, Morillas R, Poca M, Peñas B, Augustin S, Tantău M, Thompson M, Perez-Campuzano V, Baiges A, Turon F, Hernández-Gea V, Abraldes JG, Tapias EA, Torres F, Bosch J, García-Pagán JC. Metabolomics as a tool to predict the risk of decompensation or liver-related death in patients with compensated cirrhosis. Hepatology 2023; 77:2052-2062. [PMID: 36811400 DOI: 10.1097/hep.0000000000000316] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND AIMS Patients with compensated cirrhosis with clinically significant portal hypertension (CSPH: HVPG > 10 mm Hg) have a high risk of decompensation. HVPG is, however, an invasive procedure not available in all centers. The present study aims to assess whether metabolomics can improve the capacity of clinical models in predicting clinical outcomes in these compensated patients. APPROACH AND RESULTS This is a nested study from the PREDESCI cohort (an RCT of nonselective beta-blockers vs. placebo in 201 patients with compensated cirrhosis and CSPH), including 167 patients for whom a blood sample was collected. A targeted metabolomic serum analysis, using ultra-high-performance liquid chromatography-mass spectrometry, was performed. Metabolites underwent univariate time-to-event cox regression analysis. Top-ranked metabolites were selected using Log-Rank p -value to generate a stepwise cox model. Comparison between models was done using DeLong test. Eighty-two patients with CSPH were randomized to nonselective beta-blockers and 85 to placebo. Thirty-three patients developed the main endpoint (decompensation/liver-related death). The model, including HVPG, Child-Pugh, and treatment received ( HVPG/Clinical model ), had a C-index of 0.748 (CI95% 0.664-0.827). The addition of 2 metabolites, ceramide (d18:1/22:0) and methionine (HVPG/Clinical/Metabolite model), significantly improved the model's performance [C-index of 0.808 (CI95% 0.735-0.882); p =0.032]. The combination of these 2 metabolites together with Child-Pugh and the type of treatment received (Clinical/Metabolite model) had a C-index of 0.785 (CI95% 0.710-0.860), not significantly different from the HVPG-based models including or not metabolites. CONCLUSIONS In patients with compensated cirrhosis and CSPH, metabolomics improves the capacity of clinical models and achieves similar predictive capacity than models including HVPG.
Collapse
Affiliation(s)
- Oana Nicoară-Farcău
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology 'Prof. Dr. Octavian Fodor', University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - Juan J Lozano
- Bioinformatics Platform, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
| | | | - Julia Sidorova
- Bioinformatics Platform, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
| | - Càndid Villanueva
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Hospital De La Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Autonomus University of Barcelona, Barcelona, Spain
| | - Augustín Albillos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Ramón y Cajal University Hospital, Ramón y Cajal Institute of Health Research (IRYCIS), University of Alcalá, Madrid, Spain
| | - Joan Genescà
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Autonomus University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Elba Llop
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Puerta de Hierro University Hospital, Puerta de Hierro Hospital, Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Jose L Calleja
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Puerta de Hierro University Hospital, Puerta de Hierro Hospital, Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Carles Aracil
- Institute of Biomedical Research, Arnau de Vilanova University Hospital (IRBLleida), Lleida, Spain
| | - Rafael Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Gregorio Marañón University General Hospital, Gregorio Marañón Sanitary Research Institute, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Rosa Morillas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Autonomus University of Barcelona, Barcelona, Spain
- Hepatology Department, Hospital Germans Trias I Pujol, Germans Trias I Pujol Research Institute, Badalona, Spain
| | - Maria Poca
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Hospital De La Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Beatriz Peñas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Ramón y Cajal University Hospital, Ramón y Cajal Institute of Health Research (IRYCIS), University of Alcalá, Madrid, Spain
| | - Salvador Augustin
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Autonomus University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marcel Tantău
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology 'Prof. Dr. Octavian Fodor', University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - Marcos Thompson
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Hepatology Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Valeria Perez-Campuzano
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Anna Baiges
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
| | - Fanny Turon
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
| | - Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
| | - Juan G Abraldes
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Edilmar A Tapias
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Hospital De La Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaime Bosch
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Switzerland
| | - Juan C García-Pagán
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto De Salud Carlos III, Spain
| |
Collapse
|
10
|
Magaz M, Giudicelli-Lett H, Nicoară-Farcău O, Rajoriya N, Goel A, Raymenants K, Hillaire S, Crespo G, Téllez L, Elkrief L, Fondevila C, Orts L, Nery F, Shukla A, Larrue H, Fundora Y, Degroote H, Aguilera V, LLop E, Turco L, Indulti F, Gioia S, Tosetti G, Bitto N, Becchetti C, Alvarado E, Roig C, Diaz R, Praktiknjo M, Konicek AL, Soy G, Olivas P, Fortea JI, Masnou H, Puente Á, Ardèvol A, Álvarez-Navascués C, Romero M, Scheiner B, Semmler G, Mandorfer M, Damião F, Baiges A, Turon F, Simón-Talero M, González-Alayón C, Díaz A, García-Criado Á, de Gottardi A, Reverter E, Blasi A, Genescà J, Roux O, Francoz C, Noronha Ferreira C, Reiberger T, Rodríguez M, Morillas RM, Crespo J, Trebicka J, Bañares R, Villanueva C, Berzigotti A, Primignani M, La Mura V, Riggio O, Schepis F, Procopet B, Verhelst X, Calleja JL, Bureau C, Albillos A, Nevens F, Hernández-Gea V, Tripathi D, Rautou PE, Durand F, García-Pagán JC. Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Long-term Outcome. Transplantation 2023; 107:1330-1340. [PMID: 36479977 DOI: 10.1097/tp.0000000000004444] [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: 12/13/2022]
Abstract
BACKGROUND Porto-sinusoidal vascular liver disorder (PSVD) is a rare disease that occasionally requires liver transplantation (LT), despite usually presenting preserved liver function. There remains a paucity of data pertaining to LT in PSVD. The aim was to identify features associated with post-LT outcomes in PSVD. METHODS Retrospective multicentre study of 79 patients who received LT for PSVD. RESULTS Median post-LT follow-up was 37 (range 1-261) mo. Refractory ascites 24 (30%), hepatic encephalopathy 16 (20%), and hepatopulmonary syndrome 13 (16.3%) were the most frequent indications for LT. Hepatocellular carcinoma was the indication in only 2 patients. Twenty-four patients died, 7 due to liver and 17 to non-liver related causes. Post-LT survival was 82.2%, 80.7%, and 68.6% at 1, 2, and 5 y, respectively. Post-LT survival was significantly better in patients without (n = 58) than in those with a persistent severe PSVD-associated condition (n = 21). Pre-LT hyperbilirubinemia levels and creatinine >100 µmol/L were also independently associated with poor survival. Six patients (7.6%) required a second LT. Recurrence of PSVD was confirmed by liver biopsy in only 1 patient and in 3 further patients it was likely. CONCLUSIONS LT in PSVD is associated with an acceptable outcome in the absence of associated severe conditions. However, persistence of a severe associated condition, pre-LT high bilirubin levels, or creatinine >100 µmol/L impact outcome, and these are features that should be considered when evaluating PSVD patients for LT. PSVD recurrence is possible after LT and needs to be explored, at least, in cases of posttransplant portal hypertension.
Collapse
Affiliation(s)
- Marta Magaz
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Heloïse Giudicelli-Lett
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - Oana Nicoară-Farcău
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Regional Institute of Gastroenterology and Hepatology "Octavian Fodor," Hepatology Department and "Iuliu Hatieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania
| | - Neil Rajoriya
- The Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ashish Goel
- The Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Karlien Raymenants
- Department of Gastroenterology and Hepatology, University Hospital KU Leuven, Leuven, Belgium
| | - Sophie Hillaire
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - Gonzalo Crespo
- Liver Transplantation Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Téllez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERehd, Universidad de Alcalá, Madrid, Spain
| | - Laure Elkrief
- Service d'Hépato-Gastroentérologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland. Service d'Hépato-Gastroentérologie, CHU de Tours, France
- Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
| | - Constantino Fondevila
- Department of Surgery, Division of Hepatobiliary and General Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lara Orts
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Filipe Nery
- Liver Unit, Centro Hospitalar do Porto, Hospital Sto Antonio, Porto, Portugal
| | - Akash Shukla
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Hélène Larrue
- Department of Hepatology, Rangueil Hospital, CHU Toulouse, University Paul Sabatier of Toulouse, Toulouse, France
| | - Yiliam Fundora
- Department of Surgery, Division of Hepatobiliary and General Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Helena Degroote
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Victoria Aguilera
- Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
- CIBERehd (Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Valencia Spain), Instituto de Salud Carlos III
| | - Elba LLop
- Liver Unit, Hospital U, Puerta de Hierro, Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain
| | - Laura Turco
- Department of Gastroenterology and Hepatology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federica Indulti
- Department of Gastroenterology and Hepatology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefania Gioia
- Department of Gastroenterology and Hepatology, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Tosetti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A.M.and A.Miglaivacca" Center for Liver Disease, Milan, Italy
| | - Niccolò Bitto
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A.M.and A.Miglaivacca" Center for Liver Disease, Milan, Italy
| | - Chiara Becchetti
- Hepatology Group, Swiss Liver Center, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Edilmar Alvarado
- Liver Unit, Department of Gastroenterology Hospital Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Cristina Roig
- Liver Unit, Department of Gastroenterology Hospital Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Raquel Diaz
- Department of Gastroenterology and Hepatology, University Gregorio Marañón Hospital, liSGM, CIBERehd, Barcelona, Spain
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Anna-Lena Konicek
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Guillem Soy
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Pol Olivas
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - José Ignacio Fortea
- Liver Unit, Digestive Disease Department, Marqués de Valdecilla University Hospital, Santander, Cantabria University, Cantabria, Spain
| | - Helena Masnou
- Liver Unit, University Hospital Germans Trias i Pujol, Badalona, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd)
| | - Ángela Puente
- Liver Unit, Digestive Disease Department, Marqués de Valdecilla University Hospital, Santander, Cantabria University, Cantabria, Spain
| | - Alba Ardèvol
- Liver Unit, University Hospital Germans Trias i Pujol, Badalona, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd)
| | - Carmen Álvarez-Navascués
- Liver Unit, Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Marta Romero
- Liver Unit, Department of Gastroenterology, Hospital Virgen de la Salud, Toledo, Spain
| | - Bernhard Scheiner
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Georg Semmler
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Filipe Damião
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Anna Baiges
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Fanny Turon
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Macarena Simón-Talero
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERehd, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos González-Alayón
- Liver Unit, Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Alba Díaz
- Department of Histopathology, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ángeles García-Criado
- Department of Radiology, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Andrea de Gottardi
- Servizio di Gastroenterología e Epatologia, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
| | - Enric Reverter
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Liver ICU, Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
| | - Annabel Blasi
- Anesthesiology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Joan Genescà
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERehd, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olivier Roux
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - Claire Francoz
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - Carlos Noronha Ferreira
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Manuel Rodríguez
- Liver Unit, Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Rosa María Morillas
- Liver Unit, University Hospital Germans Trias i Pujol, Badalona, Spain
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd)
| | - Javier Crespo
- Liver Unit, Digestive Disease Department, Marqués de Valdecilla University Hospital, Santander, Cantabria University, Cantabria, Spain
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
- European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
| | - Rafael Bañares
- Department of Gastroenterology and Hepatology, University Gregorio Marañón Hospital, liSGM, CIBERehd, Barcelona, Spain
| | - Càndid Villanueva
- Liver Unit, Department of Gastroenterology Hospital Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Annalisa Berzigotti
- Hepatology Group, Swiss Liver Center, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Massimo Primignani
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A.M.and A.Miglaivacca" Center for Liver Disease, Milan, Italy
| | - Vincenzo La Mura
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A.M.and A.Miglaivacca" Center for Liver Disease, Milan, Italy
| | - Oliviero Riggio
- Department of Gastroenterology and Hepatology, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy
| | - Filippo Schepis
- Department of Gastroenterology and Hepatology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Bogdan Procopet
- Regional Institute of Gastroenterology and Hepatology "Octavian Fodor," Hepatology Department and "Iuliu Hatieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania
| | - Xavier Verhelst
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - José Luis Calleja
- Liver Unit, Hospital U, Puerta de Hierro, Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain
| | - Christophe Bureau
- Department of Hepatology, Rangueil Hospital, CHU Toulouse, University Paul Sabatier of Toulouse, Toulouse, France
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERehd, Universidad de Alcalá, Madrid, Spain
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospital KU Leuven, Leuven, Belgium
| | - Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Dhiraj Tripathi
- The Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Pierre-Emmanuel Rautou
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - François Durand
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - Juan Carlos García-Pagán
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| |
Collapse
|
11
|
Escorsell A, Garcia-Pagán JC, Alvarado-Tapia E, Aracil C, Masnou H, Villanueva C, Bosch J. Pre-emptive TIPS for the treatment of bleeding from gastric fundal varices: Results of a randomised controlled trial. JHEP Rep 2023; 5:100717. [PMID: 37284139 PMCID: PMC10240269 DOI: 10.1016/j.jhepr.2023.100717] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 06/08/2023] Open
Abstract
Background & Aims Bleeding from gastric fundal varices (isolated gastric varices type 1/gastroesophageal varices type 2) represents a major problem because of a high incidence of rebleeding and death with standard-of-care therapy (endoscopic obliteration with tissue adhesives plus pharmacological therapy). Transjugular intrahepatic portosystemic shunts (TIPSs) are recommended as a rescue therapy. Pre-emptive 'early' TIPS (pTIPS) significantly improves control of bleeding and survival in patients at high-risk of dying or rebleeding from esophageal varices. Methods This randomised controlled trial investigate whether the use of pTIPS improves rebleeding-free survival in patients with gastric fundal varices (isolated gastric varices type 1 and/or gastroesophageal varices type 2) compared with standard therapy. Results The study did not achieve the predefined sample size because of low recruitment. Nevertheless, pTIPS (n = 11) was more effective compared with combined endoscopic and pharmacological therapy (n = 10) in improving rebleeding-free survival (per protocol analysis: 100 vs. 28%; p = 0.017). This was mainly because of a better outcome in patients with Child-Pugh B or C scores. There were no differences in serious adverse events or in the incidence of hepatic encephalopathy among the different cohorts. Conclusion The use of pTIPS should be considered in patients with Child-Pugh B or C scores bleeding from gastric fundal varices. Impact and implications The first-line treatment of gastric fundal varices (GOV2 and/or IGV1) is the combination of pharmacological therapy and endoscopic obliteration with glue. TIPS is considered the main rescue therapy. Recent data suggest that, in patients at high-risk of dying or rebleeding (Child-Pugh C or B scores + active bleeding at endoscopy) from esophageal varices, the use of pTIPS, performed during the first 72 h from admission, results in an increased rate of control of bleeding and survival compared with combined endoscopic and pharmacological therapy. Herein, we present a randomised controlled trial comparing pTIPS with combined endoscopic (injection of glue) and pharmacological therapy (first, somatostatin or terlipressin; carvedilol after discharge) in the treatment of patients bleeding from GOV2 and/or IGV1. Although we were not able to include the calculated sample size because of the scarcity of these patients, our results show that the use of pTIPS is associated with a significantly higher actuarial rebleeding-free survival when analysed as per protocol. This is because of the greater efficacy of this treatment in patients with Child-Pugh B or C scores.
Collapse
Affiliation(s)
- Angels Escorsell
- Digestive Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
| | - Juan C. Garcia-Pagán
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
| | - Edilmar Alvarado-Tapia
- Digestive Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
| | - Carles Aracil
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
- Digestive Diseases Unit, Hospital Arnau de Vilanova, Lleida, Spain
| | - Helena Masnou
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
- Digestive Diseases Unit, Hospital General Universitari Germans Trias i Pujol, Badalona, Spain
| | - Càndid Villanueva
- Digestive Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
| | - Jaume Bosch
- CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Madrid, Spain
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
12
|
Rudler M, Hernández-Gea V, Procopet BD, Giráldez A, Amitrano L, Villanueva C, Ibañez L, Silva-Junior G, Genesca J, Bureau C, Trebicka J, Bañares R, Krag A, Llop E, Laleman W, Palazon JM, Castellote J, Rodrigues S, Gluud LL, Noronha Ferreira C, Canete N, Rodríguez M, Ferlitsch A, Mundi JL, Gronbaek H, Hernandez-Guerra M, Sassatelli R, Dell'era A, Senzolo M, Abraldes JG, Romero-Gómez M, Zipprich A, Casas M, Masnou H, Larrue H, Primignani M, Nevens F, Calleja JL, Schwarzer R, Jansen C, Robic MA, Conejo I, Martínez Gonzalez J, Catalina MV, Albillos A, Alvarado E, Guardascione MA, Mallet M, Tripon S, Casanovas G, Bosch J, Garcia-Pagan JC, Thabut D. Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding. Gut 2023; 72:749-758. [PMID: 36328772 DOI: 10.1136/gutjnl-2022-326975] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/27/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown. We aimed to (1) assess the prevalence of HE in patients with AVB; (2) evaluate the outcome of patients presenting HE at admission after pTIPS; and (3) determine if HE at admission is a risk factor for death and post-TIPS HE. PATIENTS AND METHODS This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation. RESULTS 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients. CONCLUSION pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.
Collapse
Affiliation(s)
- Marika Rudler
- Hepatology and gastroenterology, Unité de Soins Intensifs d'Hépato-Gastro-Entérologie, Groupement Hospitalier APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France, Paris, France
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), APHP-Sorbonne Université, Paris, France
| | - Virginia Hernández-Gea
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Bogdan Dumitru Procopet
- Gastroenterology, Regional Institute of Gastroenterology and Hepatology 'Octavian Fodor', Cluj-Napoca, Romania
- Gastroenterology, University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - Alvaro Giráldez
- Hepatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Càndid Villanueva
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Luis Ibañez
- Gastroenterology and Hepatology, Hospital Universitario Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Gilberto Silva-Junior
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Joan Genesca
- Internal Medicine-Liver Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Rafael Bañares
- Gastroenterology, IRYCIS, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aleksander Krag
- Department of Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Elba Llop
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERehd, Barcelona, Spain
| | - Wim Laleman
- Division of Liver and Biliopancreatic Disorders, KU Leuven, University of Leuven, Leuven, Belgium
| | | | - Jose Castellote
- Digestive Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Susana Rodrigues
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Lise Lotte Gluud
- Gastrounit, Medical Division, University Hospital of Hvidovre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Nouria Canete
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Rodríguez
- Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain
| | - Arnulf Ferlitsch
- Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Jose Luis Mundi
- Department of Gastroenterology, University Hospital San Cecilio, Grenada, Spain
| | - Henning Gronbaek
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Alessandra Dell'era
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milano, Italy
- UOC Gastroenterologia ed Endoscopia, Aziende Socio Sanitarie Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Marco Senzolo
- Department of Surgical and Gastroenterological Sciences, Multivisceral Transplant Unit, University of Padova, Padova, Italy
| | - Juan G Abraldes
- Cirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel Romero-Gómez
- Unit for The Clinical Management of Digestive Diseases and CIBERehd, Hospital Universitario de Valme, Sevilla, Spain
| | - Alexander Zipprich
- First Department of Internal Medicine, Martin-Luther-University, Halle, Germany
| | - Meritxell Casas
- Liver Unit, Department of Gastroenterology, Corporación Sanitaria Parc Taulí, Sabadell, Spain
| | - Helena Masnou
- Hospital Universitari Germans Trias i Pujol, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Hélène Larrue
- Service D'hepato-Gastro-Enterologie, CHU Purpan, Toulouse, France
| | - Massimo Primignani
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | | | - Jose Luis Calleja
- Gastroenterology and Hepatology, IDIPHISA, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- (CIBERehd), Instituto de Salud Carlos III, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Madrid, Spain
| | - Remy Schwarzer
- Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | | | | | - Irene Conejo
- Liver Unit, Hospital Universitario Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona and CIBERehd, Barcelona, Spain
| | - Javier Martínez Gonzalez
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, Madrid, Spain
| | - Maria Vega Catalina
- Servicio de Medicina de Aparato Digestivo Gregorio Marañón, Hospital General Universitario Gregorio Marañón, CIBERehd, Barcelona, Spain
| | - Agustín Albillos
- Hepatology, Hospital Ramon y Cajal, Madrid, Spain
- Universidad de Alcala de Henares, Madrid, Spain
| | - Edilmar Alvarado
- Gastroenterology, Hospital de la Santa Creu i Sant Pau Institut de Recerca, Barcelona, Spain
| | | | - Maxime Mallet
- Hepatology and gastroenterology, Unité de Soins Intensifs d'Hépato-Gastro-Entérologie, Groupement Hospitalier APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France, Paris, France
| | - Simona Tripon
- Hepatology and gastroenterology, Unité de Soins Intensifs d'Hépato-Gastro-Entérologie, Groupement Hospitalier APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France, Paris, France
| | - Georgina Casanovas
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Jaume Bosch
- Department of Biomedical Research, Bern University, Hepatology, Inselspital, Bern, Switzerland
| | - Juan-Carlos Garcia-Pagan
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Dominique Thabut
- Hepatology and gastroenterology, Unité de Soins Intensifs d'Hépato-Gastro-Entérologie, Groupement Hospitalier APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France, Paris, France
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), APHP-Sorbonne Université, Paris, France
| |
Collapse
|
13
|
Reiniš J, Petrenko O, Simbrunner B, Hofer BS, Schepis F, Scoppettuolo M, Saltini D, Indulti F, Guasconi T, Albillos A, Téllez L, Villanueva C, Brujats A, Garcia-Pagan JC, Perez-Campuzano V, Hernández-Gea V, Rautou PE, Moga L, Vanwolleghem T, Kwanten WJ, Francque S, Trebicka J, Gu W, Ferstl PG, Gluud LL, Bendtsen F, Møller S, Kubicek S, Mandorfer M, Reiberger T. Assessment of portal hypertension severity using machine learning models in patients with compensated cirrhosis. J Hepatol 2023; 78:390-400. [PMID: 36152767 DOI: 10.1016/j.jhep.2022.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND & AIMS In individuals with compensated advanced chronic liver disease (cACLD), the severity of portal hypertension (PH) determines the risk of decompensation. Invasive measurement of the hepatic venous pressure gradient (HVPG) is the diagnostic gold standard for PH. We evaluated the utility of machine learning models (MLMs) based on standard laboratory parameters to predict the severity of PH in individuals with cACLD. METHODS A detailed laboratory workup of individuals with cACLD recruited from the Vienna cohort (NCT03267615) was utilised to predict clinically significant portal hypertension (CSPH, i.e., HVPG ≥10 mmHg) and severe PH (i.e., HVPG ≥16 mmHg). The MLMs were then evaluated in individual external datasets and optimised in the merged cohort. RESULTS Among 1,232 participants with cACLD, the prevalence of CSPH/severe PH was similar in the Vienna (n = 163, 67.4%/35.0%) and validation (n = 1,069, 70.3%/34.7%) cohorts. The MLMs were based on 3 (3P: platelet count, bilirubin, international normalised ratio) or 5 (5P: +cholinesterase, +gamma-glutamyl transferase, +activated partial thromboplastin time replacing international normalised ratio) laboratory parameters. The MLMs performed robustly in the Vienna cohort. 5P-MLM had the best AUCs for CSPH (0.813) and severe PH (0.887) and compared favourably to liver stiffness measurement (AUC: 0.808). Their performance in external validation datasets was heterogeneous (AUCs: 0.589-0.887). Training on the merged cohort optimised model performance for CSPH (AUCs for 3P and 5P: 0.775 and 0.789, respectively) and severe PH (0.737 and 0.828, respectively). CONCLUSIONS Internally trained MLMs reliably predicted PH severity in the Vienna cACLD cohort but exhibited heterogeneous results on external validation. The proposed 3P/5P online tool can reliably identify individuals with CSPH or severe PH, who are thus at risk of hepatic decompensation. IMPACT AND IMPLICATIONS We used machine learning models based on widely available laboratory parameters to develop a non-invasive model to predict the severity of portal hypertension in individuals with compensated cirrhosis, who currently require invasive measurement of hepatic venous pressure gradient. We validated our findings in a large multicentre cohort of individuals with advanced chronic liver disease (cACLD) of any cause. Finally, we provide a readily available online calculator, based on 3 (platelet count, bilirubin, international normalised ratio) or 5 (platelet count, bilirubin, activated partial thromboplastin time, gamma-glutamyltransferase, choline-esterase) widely available laboratory parameters, that clinicians can use to predict the likelihood of their patients with cACLD having clinically significant or severe portal hypertension.
Collapse
Affiliation(s)
- Jiří Reiniš
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Oleksandr Petrenko
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria; Vienna Hepatic Hemodynamic Lab (HEPEX), Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Benedikt Simbrunner
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria; Vienna Hepatic Hemodynamic Lab (HEPEX), Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Benedikt S Hofer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria; Vienna Hepatic Hemodynamic Lab (HEPEX), Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Filippo Schepis
- Unit of Gastroenterology, Hepatic Hemodynamic Laboratory, Università degli Studi di Modena e Reggio Emilia (UNIMORE), Modena, Italy
| | - Marco Scoppettuolo
- Unit of Gastroenterology, Hepatic Hemodynamic Laboratory, Università degli Studi di Modena e Reggio Emilia (UNIMORE), Modena, Italy
| | - Dario Saltini
- Unit of Gastroenterology, Hepatic Hemodynamic Laboratory, Università degli Studi di Modena e Reggio Emilia (UNIMORE), Modena, Italy
| | - Federica Indulti
- Unit of Gastroenterology, Hepatic Hemodynamic Laboratory, Università degli Studi di Modena e Reggio Emilia (UNIMORE), Modena, Italy
| | - Tomas Guasconi
- Unit of Gastroenterology, Hepatic Hemodynamic Laboratory, Università degli Studi di Modena e Reggio Emilia (UNIMORE), Modena, Italy
| | - Agustin Albillos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Luis Téllez
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Brujats
- Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Garcia-Pagan
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona; CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders, Barcelona, Spain
| | - Valeria Perez-Campuzano
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona; CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders, Barcelona, Spain
| | - Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona; CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders, Barcelona, Spain
| | - Pierre-Emmanuel Rautou
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Lucile Moga
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP) - Gastroenterology & Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wilhelmus J Kwanten
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP) - Gastroenterology & Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP) - Gastroenterology & Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jonel Trebicka
- Department of Internal Medicine I, Goethe University Clinic, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, EFCLIF, Barcelona, Spain; Department of Internal Medicine B, WWU Münster, Münster, Germany
| | - Wenyi Gu
- Department of Internal Medicine I, Goethe University Clinic, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, EFCLIF, Barcelona, Spain
| | - Philip G Ferstl
- Department of Internal Medicine I, Goethe University Clinic, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, EFCLIF, Barcelona, Spain
| | - Lise Lotte Gluud
- Gastro Unit, Medical Section, Hvidovre Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Section, Hvidovre Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab (HEPEX), Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria; Vienna Hepatic Hemodynamic Lab (HEPEX), Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
14
|
Pivot X, Manikhas A, Shamrai V, Dzagnidze G, Soo H, Kaewkangsadan V, Petrelli F, Villanueva C, Kim J, Pradhan S, Jaison L, Feyaerts P, Kaufman L, Derde MP, Deforce F, Cox D. 2MO Final analysis of the phase III randomized clinical trial, comparing HD201 vs referent trastuzumab in patients with ERBB2-positive breast cancer treated in the neoadjuvant setting. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.009] [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: 12/07/2022] Open
|
15
|
Villanueva C, Torres F, Sarin SK, Shah HA, Tripathi D, Brujats A, Rodrigues SG, Bhardwaj A, Azam Z, Hayes PC, Jindal A, Abid S, Alvarado E, Bosch J. Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis. J Hepatol 2022; 77:1014-1025. [PMID: 35661713 DOI: 10.1016/j.jhep.2022.05.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Whether non-selective β-blockers can prevent decompensation of cirrhosis warrants clarification. Carvedilol might be particularly effective since its intrinsic vasodilatory activity may ameliorate hepatic vascular resistance, a major mechanism of portal hypertension in early cirrhosis. We assessed whether carvedilol may prevent decompensation and improve survival in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH). METHODS By systematic review we identified randomized-controlled trials (RCTs) comparing carvedilol vs. control therapy (no-active treatment or endoscopic variceal ligation [EVL]) in patients with cirrhosis and CSPH without previous bleeding. We performed a competing-risk time-to-event meta-analysis using individual patient data (IPD) obtained from principal investigators of RCTs. Only compensated patients were included. Primary outcomes were prevention of decompensation (liver transplantation and death were competing events) and death (liver transplantation was a competing event). Models were adjusted using propensity scores for baseline covariates with the inverse probability of treatment weighting (IPTW) approach. RESULTS Among 125 full-text studies evaluated, 4 RCTs were eligible. The 4 provided IPD and were included, comprising 352 patients with compensated cirrhosis, 181 treated with carvedilol and 171 controls (79 received EVL and 92 placebo). Baseline characteristics were similar between groups. Standardized differences were <10% by IPTW. The risk of developing decompensation of cirrhosis was lower with carvedilol than in controls (subdistribution hazard ratio [SHR] 0.506; 95% CI 0.289-0.887; p = 0.017; I2 = 0.0%, Q-statistic-p = 0.880), mainly due to a reduced risk of ascites (SHR 0.491; 95% CI 0.247-0.974; p = 0.042; I2 = 0.0%, Q-statistic-p = 0.384). The risk of death was also lower with carvedilol (SHR 0.417; 95% CI 0.194-0.896; p = 0.025; I2 = 0.0%, Q-statistic-p = 0.989). CONCLUSIONS Long-term carvedilol therapy reduced decompensation of cirrhosis and significantly improved survival in compensated patients with CSPH. This suggests that screening patients with compensated cirrhosis for CSPH to enable the prompt initiation of carvedilol could improve outcomes. PROSPERO REGISTRATION NUMBER CRD42019144786. LAY SUMMARY The transition from compensated cirrhosis to decompensated cirrhosis is associated with markedly reduced life expectancy. Therefore, preventing decompensation in patients with compensated cirrhosis would be associated with greatly improved patient outcomes. There has been controversy regarding the use of non-selective β-blockers (portal pressure-lowering medications) in patients with cirrhosis and elevated portal blood pressure (portal hypertension). Herein, using a competing-risk meta-analysis to optimize sample size and properly investigate cirrhosis as a multistate disease and outcomes as time-dependent events, we show that carvedilol (a non-selective β-blocker) is associated with a reduced risk of decompensating events and improved survival in patients with cirrhosis and portal hypertension.
Collapse
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, 08025, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Hasnain Ali Shah
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Dhiraj Tripathi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK; Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anna Brujats
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, 08025, Spain
| | - Susana G Rodrigues
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of BioMedical Research, Visceral Surgery and Medicine, University of Bern, Switzerland
| | - Ankit Bhardwaj
- Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Zahid Azam
- National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Peter C Hayes
- Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Shahab Abid
- Section of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Edilmar Alvarado
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, 08025, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Jaume Bosch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of BioMedical Research, Visceral Surgery and Medicine, University of Bern, Switzerland
| |
Collapse
|
16
|
Ventura-Cots M, Argemi J, Jones PD, Lackner C, El Hag M, Abraldes JG, Alvarado E, Clemente A, Ravi S, Alves A, Alboraie M, Altamirano J, Barace S, Bosques F, Brown R, Caballeria J, Cabezas J, Carvalhana S, Cortez-Pinto H, Costa A, Degré D, Fernandez-Carrillo C, Ganne-Carrie N, Garcia-Tsao G, Genesca J, Koskinas J, Lanthier N, Louvet A, Lozano JJ, Lucey MR, Masson S, Mathurin P, Mendez-Sanchez N, Miquel R, Moreno C, Mounajjed T, Odena G, Kim W, Sancho-Bru P, Warren Sands R, Szafranska J, Verset L, Schnabl B, Sempoux C, Shah V, Shawcross DL, Stauber RE, Straub BK, Verna E, Tiniakos D, Trépo E, Vargas V, Villanueva C, Woosley JT, Ziol M, Mueller S, Stärkel P, Bataller R. Clinical, histological and molecular profiling of different stages of alcohol-related liver disease. Gut 2022; 71:1856-1866. [PMID: 34992134 PMCID: PMC11034788 DOI: 10.1136/gutjnl-2021-324295] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 02/01/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Alcohol-related liver disease (ALD) ranges from never-decompensated ALD (ndALD) to the life-threatening decompensated phenotype, known as alcohol-related hepatitis (AH). A multidimensional study of the clinical, histological and molecular features of these subtypes is lacking. DESIGN Two large cohorts of patients were recruited in an international, observational multicentre study: a retrospective cohort of patients with ndALD (n=110) and a prospective cohort of patients with AH (n=225). Clinical, analytical, immunohistochemistry and hepatic RNA microarray analysis of both disease phenotypes were performed. RESULTS Age and mean alcohol intake were similar in both groups. AH patients had greater aspartate amino transferase/alanine amino transferase ratio and lower gamma-glutamyl transferase levels than in ndALD patients. Patients with AH demonstrated profound liver failure and increased mortality. One-year mortality was 10% in ndALD and 50% in AH. Histologically, steatosis grade, ballooning and pericellular fibrosis were similar in both groups, while advanced fibrosis, Mallory-Denk bodies, bilirubinostasis, severe neutrophil infiltration and ductular reaction were more frequent among AH patients. Transcriptome analysis revealed a profound gene dysregulation within both phenotypes when compare to controls. While ndALD was characterised by deregulated expression of genes involved in matrisome and immune response, the development of AH resulted in a marked deregulation of genes involved in hepatocyte reprogramming and bile acid metabolism. CONCLUSIONS Despite comparable alcohol intake, AH patients presented with worse liver function compared with ndALD patients. Bilirubinostasis, severe fibrosis and ductular reaction were prominent features of AH. AH patients exhibited a more profound deregulation of gene expression compared with ndALD patients.
Collapse
Affiliation(s)
- Meritxell Ventura-Cots
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josepmaria Argemi
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Liver Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - Patricia D Jones
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carolin Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Mohamed El Hag
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Juan G Abraldes
- Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Edilmar Alvarado
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Gastroenterology, Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ana Clemente
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañon, Madrid, Spain
| | - Samhita Ravi
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Antonio Alves
- Departament of Pathology, Hospital Prof. Doutor Fernando Fonseca. Instituto de Anatomia Patologica, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Jose Altamirano
- Internal Medicine, Hospital Quironsalud Barcelona, Barcelona, Spain
| | - Sergio Barace
- Centro de investigación Médica Aplicada (CIMA), Universidad de Navarra, Hepatology Program, Pamplona, Spain
| | - Francisco Bosques
- Hospital Sant José Tecnológico de Monterrey, Universidad Autonoma de Nuevo Leon, Monterrey, Monterrey, Mexico
| | - Robert Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Juan Caballeria
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Liver Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Joaquin Cabezas
- Gastroenterology and Hepatology Department Marques de Valdecilla University Hospital, Valdecilla Research Institute - IDIVAL, Santander, Santander, Spain
| | - Sofia Carvalhana
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Adilia Costa
- Department of Pathology, Hospital Santa Maria, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Delphine Degré
- Centre de ressources biologiques (BB-0033-00027) Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Brussels, Belgium
| | - Carlos Fernandez-Carrillo
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), Madrid, Spain
| | - Nathalie Ganne-Carrie
- Liver Unit, INSERM UMR 1162, Hôpitaux Universitaires Paris Seine Saint-Denis, APHP, Université paris 13 Sorbonne Paris Cité, Paris, France
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University, New Haven, Connecticut. Department of Veterans Affairs Connecticut Healthcare, New Haven, Connecticut, USA
| | - Joan Genesca
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - John Koskinas
- 2nd Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nicolas Lanthier
- Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium
- Laboratory of Hepatogastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Alexandre Louvet
- University of Lille, Inserm, CHU Lille, U1286-INFINITI-Institute for Translational Research in Inflammation, F-590000, Lille, France
| | - Juan José Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Michael R Lucey
- Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Steven Masson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Philippe Mathurin
- University of Lille, Inserm, CHU Lille, U1286-INFINITI-Institute for Translational Research in Inflammation, F-590000, Lille, France
| | - Nahum Mendez-Sanchez
- Liver Research Unit, Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosa Miquel
- Liver Histopathology Laboratory, Institute of Liver Studies, Kings College London, London, UK
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme and Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Taofic Mounajjed
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gemma Odena
- Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Won Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
| | - Pau Sancho-Bru
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - R Warren Sands
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Justyna Szafranska
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Laurine Verset
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Bern Schnabl
- Medicine, University of California San Diego, La Jolla, California, USA
| | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Vijay Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Debbie Lindsay Shawcross
- Liver Sciences, James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Rudolf E Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Beate K Straub
- Institute of Pathology, Universities of Mainz and Heidelberg, Mainz, Germany
| | - Elizabeth Verna
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Dina Tiniakos
- Institute of Cellular Medicine, Translational and Clinical Research Institute, Newcastle Univsersity, Newcastle upon Tyne, UK
- Department of Pathology, Aretaieion Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Eric Trépo
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme and Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Victor Vargas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Càndid Villanueva
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Autonomous University, Barcelona, Spain
| | - John T Woosley
- Pathology Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marianne Ziol
- Centre de ressources biologiques (BB-0033-00027) Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Sebastian Mueller
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Peter Stärkel
- Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Ramon Bataller
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
17
|
Ziegelmann M, Winkelman A, Holler J, Breyer B, Herndon A, Villanueva C, Kern N. Adult Patient's Opinions on Surgical Correction of Congenital Penile Curvature. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.083] [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: 10/18/2022]
|
18
|
Abstract
Traumatic tricuspid valve injury is rare, accounting for 0.02% of traumatic injuries. The majority of cases result from blunt force trauma to the chest, however penetrating injuries have been documented in literature. Patients' can be in the full spectrum of disease, from asymptomatic to cardiogenic shock. Indications for surgery include right heart failure or evidence of right heart volume overload in the setting of significant tricuspid regurgitation. Early surgical repair is warranted to preserve right ventricular function. Surgery also needs to be planned in conjunction with the patients' other injuries. In some cases, it may be beneficial for surgery to be delayed whilst the patient is closely observed, in order for the patient to recover from concomitant injuries. We report two cases of tricuspid regurgitation in the context of blunt trauma, and our approach to the management of these patients.
Collapse
|
19
|
Castets S, Villanueva C, Vergier J, Brue T, Saveanu A, Reynaud R. Clinical, radiological, and molecular diagnosis of congenital pituitary diseases causing short stature. Arch Pediatr 2022; 28:8S33-8S38. [PMID: 37870532 DOI: 10.1016/s0929-693x(22)00041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Short stature in children can be caused by congenital pituitary disorders involving at least one form of growth hormone deficiency. Clinical and radiological evaluations of the index case and family history assessments are essential to guide genetic diagnostic testing and interpret results. The first-line approach is panel testing of genes involved in pituitary development with variants known to be pathogenic in this context. It identifies a genetic cause in less than 10% of cases, however. Whole-exome and whole-genome sequencing techniques may provide original information but also raise new questions regarding the pathophysiological role of identified variants. These new tools can make genetic counselling more complex. The role of clinicians in these interpretations is therefore important. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
Collapse
Affiliation(s)
- S Castets
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France.
| | - C Villanueva
- Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), Service d'Endocrinologie pédiatrique, Bron, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France
| | - J Vergier
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France
| | - T Brue
- Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), Service d'Endocrinologie pédiatrique, Bron, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Endocrinologie, Hôpital de la Conception, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - A Saveanu
- Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), U 1251, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France; Assistance Publique-Hôpitaux de Marseille (AP-HM), Laboratoire de Biologie Moléculaire, Hôpital de la Conception, Marseille, France
| | - R Reynaud
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), U 1251, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| |
Collapse
|
20
|
Villanueva C, Bosch J. Reply to: "First things first! Can bacterial infections be considered as decompensating events per se?". J Hepatol 2021; 75:1242-1243. [PMID: 34358568 DOI: 10.1016/j.jhep.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Jaume Bosch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University, Switzerland
| | | |
Collapse
|
21
|
Garcia Garcia de Paredes A, Villanueva C, Blanco C, Genescà J, Manicardi N, Garcia-Pagan JC, Calleja JL, Aracil C, Morillas RM, Poca M, Peñas B, Augustin S, Abraldes JG, Alvarado E, Royo F, Garcia-Bermejo ML, Falcon-Perez JM, Bañares R, Bosch J, Gracia-Sancho J, Albillos A. Serum miR-181b-5p predicts ascites onset in patients with compensated cirrhosis. JHEP Rep 2021; 3:100368. [PMID: 34712934 PMCID: PMC8531668 DOI: 10.1016/j.jhepr.2021.100368] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/19/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background & Aims Treatment with non-selective beta-blockers (NSBBs) reduces the risk of ascites, which is the most common decompensating event in cirrhosis. This study aimed to assess the ability of a serum microRNA (miRNA) signature to predict ascites formation and the hemodynamic response to NSBBs in compensated cirrhosis. Methods Serum levels of miR-452-5p, miR-429, miR-885-5p, miR-181b-5p, and miR-122-5p were analyzed in patients with compensated cirrhosis (N = 105). Hepatic venous pressure gradient (HVPG) was measured at baseline, after intravenous propranolol, and 1 year after randomization to NSBBs (n = 52) or placebo (n = 53) (PREDESCI trial). miRNAs were analyzed at baseline and at 1 year. Results Nineteen patients (18%) developed ascites, of whom 17 developed ascites after 1 year. miR-181b-5p levels at 1 year, but not at baseline, were higher in patients that developed ascites. The AUC of miR-181b-5p at 1 year to predict ascites was 0.7 (95% CI 0.59–0.78). miR-429 levels were lower at baseline in acute HVPG responders to NSBBs (AUC 0.65; 95% CI, 0.53–0.76), but levels at baseline and at 1 year were not associated with the HVPG response to NSBBs at 1 year. Conclusions Serum miR-181b-5p is a promising non-invasive biomarker to identify patients with compensated cirrhosis at risk of ascites development. Lay summary Ascites marks the transition from the compensated to decompensated stage in cirrhosis and indicates a worsening in prognosis. There are currently no easily accessible tools to identify patients with compensated cirrhosis at risk of developing ascites. We evaluated the levels of novel molecules termed microRNAs in the blood of patients with compensated cirrhosis and observed that miR-181b-5p can predict which patients are going to develop ascites. miR-181b-5p appears to be a useful serum biomarker to anticipate ascites onset. Low serum miR-181b-5p indicates low risk of ascites in compensated cirrhosis. Low serum miR-429 reflects acute hemodynamic response to non-selective beta-blockers.
Collapse
Affiliation(s)
- Ana Garcia Garcia de Paredes
- Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Universidad de Alcala, Madrid, Spain
| | - Càndid Villanueva
- Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau) Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
| | - Carolina Blanco
- Biomarkers and Therapeutic Targets Group, Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
| | - Joan Genescà
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Nicolo Manicardi
- Liver Vascular Biology Research Group, IDIBAPS Biomedical Research Institute, Barcelona, Spain
| | - Juan Carlos Garcia-Pagan
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Barcelona Hepatic Haemodynamic Laboratory, Liver Unit, Institute of Digestive and Metabolic Diseases, August Pi i Sunyer Institute of Biomedical Research, Hospital Clínic, Barcelona, Spain
| | - Jose Luis Calleja
- Gastroenterology and Hepatology Department, Hospital Universitario Puerta de Hierro, Puerta de Hierro Hospital Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Carlos Aracil
- Institute of Biomedical Research, Arnau de Vilanova University Hospital (IRB Lleida), Lleida, Spain
| | - Rosa M Morillas
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Liver Section, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona, Spain.,Universitat Autònoma de Barcelona, Spain
| | - Maria Poca
- Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau) Barcelona, Spain
| | - Beatriz Peñas
- Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Universidad de Alcala, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan G Abraldes
- Barcelona Hepatic Haemodynamic Laboratory, Liver Unit, Institute of Digestive and Metabolic Diseases, August Pi i Sunyer Institute of Biomedical Research, Hospital Clínic, Barcelona, Spain.,Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Eldimar Alvarado
- Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau) Barcelona, Spain
| | - Félix Royo
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Exosomes Laboratory, Center for Cooperative Research in Biosciencies (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, 48160, Spain
| | - Maria Laura Garcia-Bermejo
- Biomarkers and Therapeutic Targets Group, Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
| | - Juan Manuel Falcon-Perez
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Exosomes Laboratory, Center for Cooperative Research in Biosciencies (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, 48160, Spain
| | - Rafael Bañares
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Gastroenterology and Hepatology Department, Hospital Universitario Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Jaime Bosch
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Barcelona Hepatic Haemodynamic Laboratory, Liver Unit, Institute of Digestive and Metabolic Diseases, August Pi i Sunyer Institute of Biomedical Research, Hospital Clínic, Barcelona, Spain.,Department of Biomedical Research and University Clinic for Visceral Medicine and Surgery, Inselspital, Bern, Switzerland
| | - Jordi Gracia-Sancho
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain.,Liver Vascular Biology Research Group, IDIBAPS Biomedical Research Institute, Barcelona, Spain
| | - Agustin Albillos
- Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Universidad de Alcala, Madrid, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
| |
Collapse
|
22
|
Alvarado-Tapias E, Vilades D, Brujats A, Villanueva C. Reply to: "Non-selective beta blockers and mortality in decompensated cirrhosis: Is cirrhotic cardiomyopathy the missing link?". J Hepatol 2021; 75:993-994. [PMID: 34224780 DOI: 10.1016/j.jhep.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Edilmar Alvarado-Tapias
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - David Vilades
- Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Cardiac imaging Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Brujats
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Càndid Villanueva
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| |
Collapse
|
23
|
Villanueva C, Albillos A, Genescà J, Garcia-Pagan JC, Brujats A, Calleja JL, Aracil C, Bañares R, Morillas RM, Poca M, Peñas B, Augustin S, Abraldes JG, Alvarado E, Torres F, Bosch J. Bacterial infections adversely influence the risk of decompensation and survival in compensated cirrhosis. J Hepatol 2021; 75:589-599. [PMID: 33905794 DOI: 10.1016/j.jhep.2021.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The prognosis of compensated cirrhosis is good until decompensation. In decompensated cirrhosis, bacterial infections (BIs) are common and increase the risk of death. The incidence and prognostic implications of BIs in compensated cirrhosis are less-well characterized. This study aimed to assess whether BIs influence the risk of decompensation and survival in patients with compensated cirrhosis. METHODS This is a cohort study nested to the PREDESCI study, a double-blind, multicenter, randomized controlled trial designed to assess whether β-blockers could prevent decompensation of cirrhosis. Patients with compensated cirrhosis and hepatic venous pressure gradient ≥10 mmHg were included. Development of BIs during follow-up was prospectively registered. Using a competing-risk time-dependent regression analysis, we investigated whether BIs affect the risk of decompensation and survival. Decompensation was defined as development of ascites, bleeding or overt encephalopathy. RESULTS A total of 201 patients were randomized and followed for a median of 36 months (IQR 24-47 months); 34 patients (17%) developed BIs, which occurred before decompensation in 33 cases, and 29 (14%) developed ascites. Respiratory and urinary tract infections were the most frequent BIs. Decompensation occurred in 26% patients with BIs vs. 16% without BIs. Patients with BIs were at higher risk of decompensation (subdistribution hazard ratio [SHR] 2.93; 95% CI 1.02-8.42; p = 0.047) and of developing ascites (SHR 3.55; 95% CI 1.21-10.47; p = 0.022) than those without BIs. Risk of death was also higher in patients with BIs (subdistribution HR 6.93; 95% CI 2.64-18.18; p <0.001), although decompensation occurred before death in 71% of such cases. CONCLUSIONS BIs have a marked impact on the natural history of compensated cirrhosis, significantly increasing the risk of decompensation, mainly that of ascites, and increasing the risk of death, which usually occurs after decompensation. Our results suggest that BIs may constitute a target to prevent decompensation. LAY SUMMARY It is widely known that bacterial infections are common and increase the mortality risk in patients with decompensated cirrhosis. However, the relevance of bacterial infections in compensated cirrhosis has not been well studied. This study shows that in patients with compensated cirrhosis and clinically significant portal hypertension, bacterial infections occur as frequently as the development of ascites, which is the most frequent decompensating event. Bacterial infections increase the risk of progression to decompensation, mainly by increasing the risk of ascites, and also increase the risk of death, which usually occurs after decompensation. CLINICALTRIALS. GOV IDENTIFIER NCT01059396.
Collapse
Affiliation(s)
- Càndid Villanueva
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, 08025, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| | - Agustín Albillos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Joan Genescà
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Unit, Department of Internal Medicine, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Spain
| | - Joan C Garcia-Pagan
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain(‡)
| | - Anna Brujats
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, 08025, Barcelona, Spain
| | - José L Calleja
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitario Puerta de Hierro, IDIPHIM, Universidad Autónoma de Madird, Madrid, Spain
| | - Carles Aracil
- Hospital Universitari Arnau de Vilanova, Lleida, Institut de Recerca Biomèdica (IRBLleida), Spain
| | - Rafael Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital General Universitario Gregorio Marañón, IISGM, Universidad Complutense, Madrid, Spain
| | - Rosa M Morillas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Section, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - María Poca
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, 08025, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Beatriz Peñas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Salvador Augustin
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Unit, Department of Internal Medicine, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Spain
| | - Juan G Abraldes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain(‡); Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada
| | - Edilmar Alvarado
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, 08025, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Bosch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain(‡); University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University, Switzerland
| | | |
Collapse
|
24
|
Massey V, Parrish A, Argemi J, Moreno M, Mello A, García-Rocha M, Altamirano J, Odena G, Dubuquoy L, Louvet A, Martinez C, Adrover A, Affò S, Morales-Ibanez O, Sancho-Bru P, Millán C, Alvarado-Tapias E, Morales-Arraez D, Caballería J, Mann J, Cao S, Sun Z, Shah V, Cameron A, Mathurin P, Snider N, Villanueva C, Morgan TR, Guinovart J, Vadigepalli R, Bataller R. Integrated Multiomics Reveals Glucose Use Reprogramming and Identifies a Novel Hexokinase in Alcoholic Hepatitis. Gastroenterology 2021; 160:1725-1740.e2. [PMID: 33309778 PMCID: PMC8613537 DOI: 10.1053/j.gastro.2020.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 02/23/2020] [Revised: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND & AIMS We recently showed that alcoholic hepatitis (AH) is characterized by dedifferentiation of hepatocytes and loss of mature functions. Glucose metabolism is tightly regulated in healthy hepatocytes. We hypothesize that AH may lead to metabolic reprogramming of the liver, including dysregulation of glucose metabolism. METHODS We performed integrated metabolomic and transcriptomic analyses of liver tissue from patients with AH or alcoholic cirrhosis or normal liver tissue from hepatic resection. Focused analyses of chromatin immunoprecipitation coupled to DNA sequencing was performed. Functional in vitro studies were performed in primary rat and human hepatocytes and HepG2 cells. RESULTS Patients with AH exhibited specific changes in the levels of intermediates of glycolysis/gluconeogenesis, the tricarboxylic acid cycle, and monosaccharide and disaccharide metabolism. Integrated analysis of the transcriptome and metabolome showed the used of alternate energetic pathways, metabolite sinks and bottlenecks, and dysregulated glucose storage in patients with AH. Among genes involved in glucose metabolism, hexokinase domain containing 1 (HKDC1) was identified as the most up-regulated kinase in patients with AH. Histone active promoter and enhancer markers were increased in the HKDC1 genomic region. High HKDC1 levels were associated with the development of acute kidney injury and decreased survival. Increased HKDC1 activity contributed to the accumulation of glucose-6-P and glycogen in primary rat hepatocytes. CONCLUSIONS Altered metabolite levels and messenger RNA expression of metabolic enzymes suggest the existence of extensive reprogramming of glucose metabolism in AH. Increased HKDC1 expression may contribute to dysregulated glucose metabolism and represents a novel biomarker and therapeutic target for AH.
Collapse
Affiliation(s)
- Veronica Massey
- Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, North Carolina
| | - Austin Parrish
- Daniel Baugh Institute, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Josepmaria Argemi
- Department of Gastroenterology and Hepatology, Division of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Liver Unit, Clinica Universidad de Navarra. Hepatology Program, Center for Applied Medical Research, IdisNA, Pamplona, Spain
| | - Montserrat Moreno
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Aline Mello
- Department of Gastroenterology and Hepatology, Division of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mar García-Rocha
- Institute for Research in Biomedicine, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Jose Altamirano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | - Gemma Odena
- Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, North Carolina
| | - Laurent Dubuquoy
- Service des Maladies de l'appareil digestif, CHU Lille, Inserm LIRIC-UMR995, University of Lille, Lille, France
| | - Alexandre Louvet
- Service des Maladies de l'appareil digestif, CHU Lille, Inserm LIRIC-UMR995, University of Lille, Lille, France
| | - Carlos Martinez
- Institute for Research in Biomedicine, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Anna Adrover
- Institute for Research in Biomedicine, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Silvia Affò
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Pau Sancho-Bru
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Cristina Millán
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Edilmar Alvarado-Tapias
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Dalia Morales-Arraez
- Department of Gastroenterology and Hepatology, Division of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Caballería
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Liver Unit, Hospital Clínic, CIBER de Enfermedades Hepáticas y Digestivas, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Jelena Mann
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Sheng Cao
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Zhaoli Sun
- Johns Hopkins School of Medicine, Department of Surgery and Transplant Biology Research Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vijay Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Andrew Cameron
- Johns Hopkins School of Medicine, Department of Surgery and Transplant Biology Research Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Phillipe Mathurin
- Service des Maladies de l'appareil digestif, CHU Lille, Inserm LIRIC-UMR995, University of Lille, Lille, France
| | - Natasha Snider
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina
| | - Càndid Villanueva
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Timothy R Morgan
- Gastroenterology Services, VA Long Beach Healthcare, VA Long Beach Healthcare System, Long Beach, California
| | - Joan Guinovart
- Institute for Research in Biomedicine, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Rajanikanth Vadigepalli
- Daniel Baugh Institute, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ramon Bataller
- Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, North Carolina; Department of Gastroenterology and Hepatology, Division of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
25
|
Alvarado-Tapias E, Ardevol A, Garcia-Guix M, Montañés R, Pavel O, Cuyas B, Graupera I, Brujats A, Vilades D, Colomo A, Poca M, Torras X, Guarner C, Concepción M, Aracil C, Torres F, Villanueva C. Short-term hemodynamic effects of β-blockers influence survival of patients with decompensated cirrhosis. J Hepatol 2020; 73:829-841. [PMID: 32298768 DOI: 10.1016/j.jhep.2020.03.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Whether the effect of β-blockers on arterial pressure and/or cardiac function may offset the benefit of reducing portal pressure in advanced cirrhosis is controversial. Herein, we aimed to evaluate the systemic and splanchnic hemodynamic effects of β-blockers in decompensated vs. compensated cirrhosis and to investigate the influence of systemic hemodynamic changes on survival times in decompensated cirrhosis. METHODS Patients with cirrhosis and high-risk esophageal varices, without previous bleeding, were consecutively included and grouped according to the presence or absence of decompensation (ascites with or without overt encephalopathy). Systemic and hepatic hemodynamic measurements were performed before starting β-blockers and again after 1 to 3 months of treatment (short-term). RESULTS Four hundred and three patients were included (190 decompensated and 213 compensated). At baseline, decompensated patients had higher portal pressure than compensated patients and were more hyperdynamic, with higher cardiac output (CO) and lower arterial pressure. Under β-blockers, decompensated patients had lower portal pressure decrease (10 ± 18% vs. 15 ± 12%; p <0.05) and had greater reductions in heart rate (p <0.001) and CO (17 ± 15% vs. 10 ± 21%; p <0.01). Among patients with decompensated cirrhosis, those who died had a greater decrease in CO with β-blockers than survivors (21 ± 14% vs. 15 ± 16%; p <0.05) and CO under β-blockers independently predicted death by competing-risk regression analysis, with good diagnostic accuracy (C-index 0.74; 95% CI 0.66-0.83). Death risk was higher in decompensated patients with CO <5 L/min vs. CO ≥5 L/min (subdistribution hazard ratio 0.44; 95% CI 0.25-0.77; p = 0.004). CONCLUSIONS In patients with high-risk varices treated to prevent first bleeding, the systemic hemodynamic response to β-blockers is greater and the portal pressure decrease is smaller in those with decompensated cirrhosis. The short-term effect of β-blockers on CO might adversely influence survival in decompensated cirrhosis. LAY SUMMARY β-blockers are often used to reduce the risk of variceal bleeding in patients with cirrhosis. However, it is not known whether the effect of β-blockers on arterial pressure and/or cardiac function may offset the benefit of reducing portal pressure. Herein, we show that in patients with decompensated cirrhosis the potentially detrimental systemic effects of β-blockers are greater than in compensated patients, while the beneficial pressure lowering effects are reduced. The short-term effect of β-blockers on cardiac output may adversely influence survival in patients with decompensated cirrhosis.
Collapse
Affiliation(s)
- Edilmar Alvarado-Tapias
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Alba Ardevol
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Marta Garcia-Guix
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rosa Montañés
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oana Pavel
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Berta Cuyas
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Graupera
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Brujats
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Vilades
- Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Cardiac imaging unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alan Colomo
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Poca
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Torras
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Carlos Guarner
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Mar Concepción
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carles Aracil
- Hospital Universitari Arnau de Vilanova, Lleida, Institut de Recerca Biomèdica (IRBLleida)
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona; and Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Càndid Villanueva
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| |
Collapse
|
26
|
Ardevol A, Alvarado-Tapias E, Garcia-Guix M, Brujats A, Gonzalez L, Hernández-Gea V, Aracil C, Pavel O, Cuyas B, Graupera I, Colomo A, Poca M, Torras X, Concepción M, Villanueva C. Early rebleeding increases mortality of variecal bleeders on secondary prophylaxis with β-blockers and ligation. Dig Liver Dis 2020; 52:1017-1025. [PMID: 32653417 DOI: 10.1016/j.dld.2020.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Despite secondary-prophylaxis with β-blockers and endoscopic-variceal-ligation rebleeding is frequent, particularly within the first-6-weeks. Early-rebleeding may have greater impact on death-risk than late rebleeding, which may affect therapy. We assessed whether the influence of rebleeding on long-term survival of patients on secondary-prophylaxis is greater in patients with early-rebleeding. METHODS 369 patients with cirrhosis were consecutively included once recovered from first variceal-bleeding. The impact of rebleeding on survival was investigated according to whether it occurred within 6-weeks (early-rebleeding) or later (late-rebleeding). RESULTS During 46-months of follow-up (IQR: 14-61), 45 patients (12%) had early-rebleeding, 74(20%) had late-rebleeding and 250(68%) had not rebleeding. Mortality risk was higher in early-rebleeding group vs. late-rebleeding (HR = 0.476, 95%CI = 0.318-0.712, p < 0.001) and was similar in late-rebleeding group vs. no-rebleeding (HR = 0.902, 95%CI = 0.749-1.086, p = 0.271). Adjusting for baseline risk-factors, early-rebleeding was independently associated with mortality-risk (HR = 1.58, 95%CI = 1.02-2.45; p = 0.04). Child-Pugh&MELD scores improved at 3rd-4th-week only in patients without early-rebleeding (p < 0.05). Presence of ascites or encephalopathy, MELD-score>12 and HVPG>20 mmHg identified patients at risk of early-rebleeding. CONCLUSIONS Patients with early-rebleeding have higher risk of death than patients without rebleeding and even than those rebleeding later. Our results suggest that patients at risk of early rebleeding might benefit from preemptive therapies such as early-TIPS.
Collapse
Affiliation(s)
- Alba Ardevol
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edilmar Alvarado-Tapias
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Garcia-Guix
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Brujats
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Gonzalez
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Virginia Hernández-Gea
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Carles Aracil
- Hospital Arnau de Vilanova,(IRBLleida), Lleida, Spain
| | - Oana Pavel
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Berta Cuyas
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Graupera
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Alan Colomo
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Poca
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Xavier Torras
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Concepción
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Càndid Villanueva
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
27
|
Santos-García D, de Deus Fonticoba T, Suárez Castro E, Aneiros Díaz A, McAfee D, Catalán MJ, Alonso-Frech F, Villanueva C, Jesús S, Mir P, Aguilar M, Pastor P, García Caldentey J, Esltelrich Peyret E, Planellas LL, Martí MJ, Caballol N, Hernández Vara J, Martí Andrés G, Cabo I, Ávila Rivera MA, López Manzanares L, Redondo N, Martinez-Martin P, McAfee D. Non-motor symptom burden is strongly correlated to motor complications in patients with Parkinson's disease. Eur J Neurol 2020; 27:1210-1223. [PMID: 32181979 DOI: 10.1111/ene.14221] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to analyze the relationship between motor complications and non-motor symptom (NMS) burden in a population of patients with Parkinson's disease (PD) and also in a subgroup of patients with early PD. METHODS Patients with PD from the COPPADIS cohort were included in this cross-sectional study. NMS burden was defined according to the Non-Motor Symptoms Scale (NMSS) total score. Unified Parkinson's Disease Rating Scale (UPDRS) part IV was used to establish motor complication types and their severity. Patients with ≤5 years of symptoms from onset were included as patients with early PD. RESULTS Of 690 patients with PD (62.6 ± 8.9 years old, 60.1% males), 33.9% and 18.1% presented motor fluctuations and dyskinesia, respectively. The NMS total score was higher in patients with motor fluctuations (59.2 ± 43.1 vs. 38.3 ± 33.1; P < 0.0001) and dyskinesia (63.5 ± 40.7 vs. 41.4 ± 36.3; P < 0.0001). In a multiple linear regression model and after adjustment for age, sex, disease duration, Hoehn & Yahr stage, UPDRS-III score and levodopa equivalent daily dose, UPDRS-IV score was significantly related to a higher NMSS total score (β = 0.27; 95% confidence intervals, 2.81-5.61; P < 0.0001), as it was in a logistic regression model on dichotomous NMSS total score (≤40, mild or moderate vs. >40, severe or very severe) (odds ratio, 1.31; 95% confidence intervals, 1.17-1.47; P < 0.0001). In the subgroup of patients with early PD (n = 396; mean disease duration 2.7 ± 1.5 years), motor fluctuations were frequent (18.1%) and similar results were obtained. CONCLUSIONS Motor complications were frequent and were associated with a greater NMS burden in patients with PD even during the first 5 years of disease duration.
Collapse
Affiliation(s)
- D Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - T de Deus Fonticoba
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - E Suárez Castro
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - A Aneiros Díaz
- Hospital Arquitecto Marcide y Hospital Naval, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - D McAfee
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - S Jesús
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/CSIC, Sevilla, Spain
| | - P Mir
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/CSIC, Sevilla, Spain
| | - M Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - P Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | - L L Planellas
- Hospital Clínic de Barcelona, Fundació Clínic, IDIBAPS, CIBERNED, Barcelona, Spain
| | - M J Martí
- Hospital Clínic de Barcelona, Fundació Clínic, IDIBAPS, CIBERNED, Barcelona, Spain
| | - N Caballol
- Hospital de Sant Joan Despí Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | | | | | - I Cabo
- Hospital de Pontevedra, Pontevedra, Spain
| | - M A Ávila Rivera
- Hospital General de l'Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - N Redondo
- Hospital Universitario de la Princesa, Madrid, Spain
| | - P Martinez-Martin
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | | | | |
Collapse
|
28
|
Bazan F, Dobi E, Royer B, Curtit E, Mansi L, Menneveau N, Paillard MJ, Meynard G, Villanueva C, Pivot X, Chaigneau L. Systemic high-dose intravenous methotrexate in patients with central nervous system metastatic breast cancer. BMC Cancer 2019; 19:1029. [PMID: 31675937 PMCID: PMC6823971 DOI: 10.1186/s12885-019-6228-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 01/06/2023] Open
Abstract
Background Infusion of high-dose intravenous methotrexate (MTX) has been demonstrating to penetrate the blood-brain barrier. The aim of this present study was to assess the efficacy and safety of high dose MTX in patients with central nervous system (CNS) metastases of breast cancer. Methods Twenty-two patients with CNS metastases treated by MTX (3 g/m2) between April 2004 and October 2009 were enrolled. Clinical response rate, time to progression (TTP), overall survival (OS), and safety were assessed. Results In terms of brain metastases, 2 patients (9%) achieved a partial response, 10 patients (45%) had disease stabilization, and 10 patients (45%) had disease progression. In others metastatic sites, 7 patients (39%) achieved a disease stabilization, and 11 patients (61%) had disease progression. TTP and OS were 2.1 (95%CI 1.4–2.9) and 6.3 (95%CI 1.8–10) months, respectively. Conclusion High-dose MTX demonstrated a moderate activity at 3 g/m2. Nonetheless, the favorable toxicity profile should suggest the possibility to increase the dosage and further study are planned.
Collapse
Affiliation(s)
- F Bazan
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - E Dobi
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - B Royer
- Department of Clinical Pharmacology and Toxicology, University Hospital of Besancon, Besancon, France
| | - E Curtit
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - L Mansi
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - N Menneveau
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - M J Paillard
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - G Meynard
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France
| | - C Villanueva
- Centre de Cancérologie du grand Montpellier, Montpellier, France
| | - X Pivot
- Centre Paul Strauss, Porte de l'Hopital Strasbourg, Strasbourg, France
| | - L Chaigneau
- Department of Medical Oncology, University Hospital of Besancon, Besancon, France. .,Department of Medical Oncology, University Hospital Jean Minjoz, Boulevard Alexandre Fleming, F-25000, Besancon, France.
| |
Collapse
|
29
|
Santos García D, Jesús S, Aguilar M, Planellas LL, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Catalán MJ, López Díaz L, Puente V, García Moreno JM, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Menéndez González M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, Fábregues‐Boixar O, González Ardura J, Prieto Jurczynska C, Martinez‐Martin P, Mir P, Adarmes Astrid D, Almeria M, Alonso Cánovas A, Alonso Frech F, Aneiros Díaz A, Arnáiz S, Arribas S, Ascunce Vidondo A, Bernardo Lambrich N, Bejr‐Kasem H, Blázquez Estrada M, Botí M, Cabello González C, Cámara Lorenzo A, Carrillo F, Casas E, Clavero P, Cortina Fernández A, Cots Foraster A, Crespo Cuevas A, de Deus Fonticoba T, Díez‐Fairen M, Erro E, Estelrich Peyret E, Fernández Guillán N, Gámez P, Gallego M, García Campos C, Gómez Garre MP, González Aloy J, González García B, González Palmás MJ, González Toledo GR, Golpe Díaz A, Grau Solá M, Guardia G, Horta‐Barba A, Infante J, Labandeira C, Labrador MA, Lacruz F, Lage Castro M, López Seoane B, Macías Y, Mata M, Martí Andres G, Martí MJ, McAfee D, Meitín MT, Méndez del Barrio C, Miranda Santiago J, Morales Casado MI, Moreno Diéguez A, Nogueira V, Novo Amado A, Novo Ponte S, Ordás C, Pagonabarraga J, Pareés I, Pascual‐Sedano B, Pastor P, Pérez Fuertes A, Pérez Noguera R, Prats MA, Pueyo Morlans M, Redondo Rafales N, Rodríguez Méndez L, Rodríguez Pérez AB, Roldán F, Ruíz De Arcos M, Sánchez‐Carpintero M, Sánchez Díez G, Sánchez Rodríguez A, Santacruz P, Segundo Rodríguez JC, Serarols A, Sierra Peña M, Suárez Castro E, Tartari JP, Vargas L, Vázquez Gómez R, Villanueva C, Vives B, Villar MD. COPPADIS
‐2015 (
CO
hort of Patients with PArkinson's
DI
sease in Spain, 2015): an ongoing global Parkinson's disease project about disease progression with more than 1000 subjects included. Results from the baseline evaluation. Eur J Neurol 2019; 26:1399-1407. [DOI: 10.1111/ene.14008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 01/03/2023]
Affiliation(s)
- D. Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña A CoruñaSpain
| | - S. Jesús
- Hospital Universitario Virgen del Rocío SevillaSpain
| | - M. Aguilar
- Hospital Universitari Mutua de Terrassa Terrassa Barcelona Spain
| | | | | | - N. Caballol
- Consorci Sanitari Integral Hospital Moisés Broggi Sant Joan Despí Barcelona Spain
| | - I. Legarda
- Hospital Universitario Son Espases Palma de MallorcaSpain
| | | | - I. Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP) PontevedraSpain
| | | | | | - M. A. Ávila Rivera
- Consorci Sanitari Integral Hospital General de L'Hospitalet, L'Hospitalet de Llobregat Barcelona Spain
| | - M. J. Catalán
- Hospital Universitario Clínico San Carlos Madrid Spain
| | - L. López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO) Orense Spain
| | | | | | | | - B. Solano Vila
- Institut d'Assistència Sanitària (IAS) – Institut Català de la Salut Girona Spain
| | | | - L. Vela
- Fundación Hospital de Alcorcón MadridSpain
| | - S. Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC) Tortosa Tarragona Spain
| | - E. Cubo
- Complejo Asistencial Universitario de Burgos Burgos Spain
| | - F. Carrillo Padilla
- Hospital Universitario de Canarias San Cristóbal de la LagunaSanta Cruz de Tenerife Spain
| | | | | | - M. G. Alonso Losada
- Hospital Álvaro Cunqueiro Complejo Hospitalario Universitario de Vigo (CHUVI) Vigo Spain
| | | | - I. Gastón
- Complejo Hospitalario de Navarra Pamplona Spain
| | | | | | - M. Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP) PontevedraSpain
| | | | - C. Valero
- Hospital Arnau de Vilanova Valencia Spain
| | - M. Kurtis
- Hospital Ruber Internacional Madrid Spain
| | | | | | | | - P. Martinez‐Martin
- Centro Nacional de Epidemiología y CIBERNED Instituto de Salud Carlos III Madrid Spain
| | - P. Mir
- Hospital Universitario Virgen del Rocío SevillaSpain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Villanueva C, Albillos A, Genescà J, Garcia-Pagan JC, Calleja JL, Aracil C, Bañares R, Morillas RM, Poca M, Peñas B, Augustin S, Abraldes JG, Alvarado E, Torres F, Bosch J. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2019; 393:1597-1608. [PMID: 30910320 DOI: 10.1016/s0140-6736(18)31875-0] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [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: 05/10/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical decompensation of cirrhosis is associated with poor prognosis. Clinically significant portal hypertension (CSPH), defined by a hepatic venous pressure gradient (HVPG) ≥10 mm Hg, is the strongest predictor of decompensation. This study aimed at assessing whether lowering HVPG with β blockers could decrease the risk of decompensation or death in compensated cirrhosis with CSPH. METHODS This study on β blockers to prevent decompensation of cirrhosis with portal hypertension (PREDESCI) was an investigator-initiated, double-blind, randomised controlled trial done in eight hospitals in Spain. We enrolled patients with compensated cirrhosis and CSPH without high-risk varices. All participants had HVPG measurements with assessment of acute HVPG-response to intravenous propranolol. Responders (HVPG-decrease ≥10%) were randomly assigned to propranolol (up to 160 mg twice a day) versus placebo and non-responders to carvedilol (≤25 mg/day) versus placebo. Doses were individually determined during an open-label titration period after which randomisation was done with 1:1 allocation by a centralised web-based system. The primary endpoint was incidence of cirrhosis decompensation (defined as development of ascites, bleeding, or overt encephalopathy) or death. Since death in compensated cirrhosis is usually unrelated to the liver, an intention-to-treat analysis considering deaths unrelated to the liver as competing events was done. This study is registered with ClinicalTrials.gov, number NCT01059396. The trial is now completed. FINDINGS Between Jan 18, 2010, and July 31, 2013, 631 patients were evaluated and 201 were randomly assigned. 101 patients received placebo and 100 received active treatment (67 propranolol and 33 carvedilol). The primary endpoint occurred in 16 (16%) of 100 patients in the β blockers group versus 27 (27%) of 101 in the placebo group (hazard ratio [HR] 0·51, 95% CI 0·26-0·97, p=0·041). The difference was due to a reduced incidence of ascites (HR=0·44, 95%CI=0·20-0·97, p=0·0297). The overall incidence of adverse events was similar in both groups. Six patients (four in the β blockers group) had severe adverse events. INTERPRETATION Long-term treatment with β blockers could increase decompensation-free survival in patients with compensated cirrhosis and CSPH, mainly by reducing the incidence of ascites. FUNDING Spanish Ministries of Health and Economy.
Collapse
Affiliation(s)
- Càndid Villanueva
- Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau) Barcelona, Spain; Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain.
| | - Agustín Albillos
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Ramón y Cajal University Hospital, Ramón y Cajal Institute of Health Research (IRYCIS), University of Alcalá, Madrid, Spain
| | - Joan Genescà
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHRI), Autonomous University of Barcelona, Barcelona, Spain
| | - Joan C Garcia-Pagan
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Barcelona Hepatic Haemodynamic Laboratory, Liver Unit, Institute of Digestive and Metabolic Diseases, August Pi i Sunyer Institute of Biomedical Research, Hospital Clínic, Barcelona, Spain
| | - José L Calleja
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Puerta de Hierro University Hospital, Puerta de Hierro Hospital Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Carles Aracil
- Institute of Biomedical Research, Arnau de Vilanova University Hospital (IRBLleida), Lleida, Spain
| | - Rafael Bañares
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Gregorio Marañón University General Hospital, Gregorio Marañón Sanitary Research Institute, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Rosa M Morillas
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; University Hospital Germans Trias i Pujol, Badalona, Spain
| | - María Poca
- Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau) Barcelona, Spain; Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain
| | - Beatriz Peñas
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Ramón y Cajal University Hospital, Ramón y Cajal Institute of Health Research (IRYCIS), University of Alcalá, Madrid, Spain
| | - Salvador Augustin
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHRI), Autonomous University of Barcelona, Barcelona, Spain
| | - Juan G Abraldes
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Barcelona Hepatic Haemodynamic Laboratory, Liver Unit, Institute of Digestive and Metabolic Diseases, August Pi i Sunyer Institute of Biomedical Research, Hospital Clínic, Barcelona, Spain; University of Alberta, Edmonton, Canada
| | - Edilmar Alvarado
- Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Hospital Sant Pau Biomedical Research Institute (IIB Sant Pau) Barcelona, Spain; Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, August Pi i Sunyer Biomedical Research Institute, Hospital Clinic, Barcelona; Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Bosch
- Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), University of Alcalá, Madrid, Spain; Barcelona Hepatic Haemodynamic Laboratory, Liver Unit, Institute of Digestive and Metabolic Diseases, August Pi i Sunyer Institute of Biomedical Research, Hospital Clínic, Barcelona, Spain; Inselspital, Bern University, Switzerland
| |
Collapse
|
31
|
Villanueva C, Doyle M, Parikh R, Manganas C. Patient Safety and Current Practice During Chest Drain Insertion. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.012] [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: 10/26/2022]
|
32
|
Villanueva C, Yazbek G, Beuzeboc P, Viel E, Dohollou N, Luporsi E, Eymard JC, Levy E, Mouret-Reynier MA, Dourthe LM, Malaurie E, Madelenat M, Denden A, Antoine EC. Breast cancer (BC) treatment (tx) with everolimus (EVE) and exemestane (EXE) in hormone receptor positive (HR+)/ HER2-negative (HER2−) postmenopausal women: Final analysis of the French observational TANGO study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.325] [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: 11/14/2022] Open
|
33
|
Curtit E, Bazan F, Chaigneau L, Mouillet G, Dobi E, Mansi L, Meneveau N, Paillard MJ, Meynard G, Klajer E, Villanueva C, Montcuquet P, Pivot X, Cals L. Prolonged overall survival for patients with bone-only metastases at presentation of metastatic breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Klajer E, Paget-Bailly S, Meynard G, Meurisse A, Bazan F, Chaigneau L, Dobi E, Meneveau N, Montcuquet P, Villanueva C, Thiery-Vuillemin A, Kalbacher E, Populaire C, Collonge-Rame MA, Gligorov J, Curtit E, Pivot X, Mansi L. Impact of BRCA status on outcomes and survival in high-risk early breast cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.207] [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: 11/13/2022] Open
|
35
|
Alvarado E, Garcia-Guix M, Mirabet S, Villanueva C. The relationship of hyperdynamic circulation and cardiodynamic states in cirrhosis. J Hepatol 2018; 69:746-747. [PMID: 29784565 DOI: 10.1016/j.jhep.2018.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Edilmar Alvarado
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Garcia-Guix
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Mirabet
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Càndid Villanueva
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| |
Collapse
|
36
|
Hortobagyi GN, Stemmer S, Campone M, Sonke GS, Arteaga CL, Paluch-Shimon S, Petrakova K, Villanueva C, Nusch A, Grischke EM, Chan A, Jakobsen E, Marschner N, Hart LL, Alba E, Ohnstand HO, Blau S, Yardley DA, Solovieff N, Su F, Germa C, Yap YS. Abstract PD4-06: First-line ribociclib + letrozole in hormone receptor-positive, HER2-negative advanced breast cancer: Efficacy by baseline circulating tumor DNA alterations in MONALEESA-2. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd4-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The addition of first-line ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) to letrozole (LET) significantly improved progression-free survival (PFS) compared with placebo (PBO) + LET in patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC) in the Phase III MONALEESA-2 study. Identifying biomarkers that predict response to treatment remains a key challenge in pts with HR+ ABC. Here we analyze results from MONALEESA-2 by molecular alterations detected in circulating tumor DNA (ctDNA) at baseline, including PIK3CA mutations and other alterations considered to be important in HR+ ABC.
Methods: Postmenopausal women (N=668) with HR+, HER2– ABC who had not received any prior therapy for ABC were randomized 1:1 to RIB (600 mg/day; 3-weeks-on/1-week-off) + LET (2.5 mg/day; continuous) or PBO + LET. The primary endpoint was PFS. Biomarker analysis of the ctDNA mutation profile was an exploratory endpoint. Plasma samples for ctDNA analysis were collected at baseline and end of treatment. ctDNA was analyzed using next-generation sequencing with a targeted panel of ˜550 genes.
Results: Baseline ctDNA was successfully sequenced in 494 pts (RIB + LET: n=212; PBO + LET: n=215); 67 (14%) of 494 pts were removed from the analysis due to limited tumor DNA in circulation. 427 (86%) pts had ≥1 alteration, including 1,573 mutations, 513 short insertions/deletions, 166 amplifications, and 8 translocations. Alterations (frequency) were commonly observed in the following genes: PIK3CA (33%), TP53 (12%), ZNF703/FGFR1 (5%), and ESR1 (4%), and in genes involved in receptor tyrosine kinase (RTK) signaling (12%). RIB + LET treatment benefit was consistent in pts with wild-type (WT) and altered PIK3CA, and in pts with WT and altered TP53 (Table). RIB + LET improved PFS regardless of RTK or ZNF703/FGFR1 alterations. However, there was a weak trend for increased benefit in pts with WT vs altered RTK genes and in pts with WT vs altered ZNF703/FGFR1 genes. These results should be interpreted with caution due to the small number of pts with these alterations. There were too few ESR1 alterations for firm conclusions to be drawn.
Events, n/NMedian PFS, months Gene(s)RIB + LETPBO + LETRIB + LETPBO + LETHazard ratio (95% confidence interval)PIK3CAWT54/14393/14229.614.70.44 (0.31–0.62)Altered40/6955/7319.212.70.53 (0.35–0.81)TP53WT72/180129/19427.614.70.44 (0.33–0.59)Altered22/3219/2110.25.50.43 (0.23–0.83)ZNF703/FGFR1WT88/202139/20524.814.60.47 (0.36–0.62)Altered6/109/1010.611.40.73 (0.23–2.29)RTKWT81/189128/18724.814.40.46 (0.35–0.61)Altered13/2320/2821.311.40.72 (0.34–1.53)
Conclusions: Consistent RIB + LET treatment benefit was observed compared with PBO + LET, irrespective of the status of baseline ctDNA biomarkers.
Citation Format: Hortobagyi GN, Stemmer S, Campone M, Sonke GS, Arteaga CL, Paluch-Shimon S, Petrakova K, Villanueva C, Nusch A, Grischke E-M, Chan A, Jakobsen E, Marschner N, Hart LL, Alba E, Ohnstand HO, Blau S, Yardley DA, Solovieff N, Su F, Germa C, Yap Y-S. First-line ribociclib + letrozole in hormone receptor-positive, HER2-negative advanced breast cancer: Efficacy by baseline circulating tumor DNA alterations in MONALEESA-2 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD4-06.
Collapse
Affiliation(s)
- GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - S Stemmer
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - M Campone
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - GS Sonke
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - CL Arteaga
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - S Paluch-Shimon
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - K Petrakova
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - C Villanueva
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - A Nusch
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - E-M Grischke
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - A Chan
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - E Jakobsen
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - N Marschner
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - LL Hart
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - E Alba
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - HO Ohnstand
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - S Blau
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - DA Yardley
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - N Solovieff
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - F Su
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - C Germa
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| | - Y-S Yap
- The University of Texas MD Anderson Cancer Center, Houston, TX; Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nates, France; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Vanderbilt-Ingram Cancer Center, Nashville, TN; Sheba Medical Center, Ramat Gan, Israel; Masaryk Memorial Cancer Institute, Brno, Czech Republic; University Hospital of Besançon, Hospital Jean-Minjoz, Besançon, France; Onkologische Praxis Velbert, Velbert, Germany; University of Tübingen, Tübingen, Germany; Breast Cancer Research Centre–Western Australia and Curtin University, Perth, Australia; Vejle Hospital, Vejle, Denmark; Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany; Florida Cancer Specialists–Sarah Cannon Research Institute, Fort Myers, FL; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Norwegian Radium Hospital, Oslo University H
| |
Collapse
|
37
|
Affiliation(s)
- Càndid Villanueva
- Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Isabel Graupera
- Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Edilmar Alvarado
- Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| |
Collapse
|
38
|
Colan-Hernandez J, Aldana A, Concepción M, Chavez K, Gómez C, Mendez-bocanegra A, Martínez-Guillen M, Sendino O, Villanueva C, Llach J, Guarner-Argente C, Cárdenas A, Guarner C. Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers. Surg Endosc 2017; 31:3711-3717. [DOI: 10.1007/s00464-016-5410-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 12/30/2016] [Indexed: 02/05/2023]
|
39
|
Bachelot T, Royce M, Villanueva C, Melo Cruz F, Hegg R, Falkson C, Jeong J, Srimuninnimit V, Arce C, Ridolfi A, Lin C, Gradishar W, Ozguroglu M, Cardoso F, Azevedo S. Everolimus (EVE) + letrozole (LET) in patients (pts) with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC): Progression-free survival (PFS) subgroup analyses in BOLERO-4. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.007] [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: 11/14/2022] Open
|
40
|
Escorsell À, Pavel O, Cárdenas A, Morillas R, Llop E, Villanueva C, Garcia-Pagan JC, Bosch J. Reply. Hepatology 2017; 65:2121-2122. [PMID: 28105736 DOI: 10.1002/hep.29045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/09/2017] [Indexed: 12/07/2022]
Affiliation(s)
- Àngels Escorsell
- Liver Unit, Hospital Clínic, Barcelona, Spain.,CiberEHD, Madrid, Spain
| | - Oana Pavel
- CiberEHD, Madrid, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andrés Cárdenas
- CiberEHD, Madrid, Spain.,GI/Endoscopy Unit, Hospital Clínic, Barcelona, Spain
| | - Rosa Morillas
- CiberEHD, Madrid, Spain.,Hospital Germans Trias i Pujol, Badalona, Spain
| | - Elba Llop
- CiberEHD, Madrid, Spain.,Hospital Puerta de Hierro, Madrid, Spain
| | - Càndid Villanueva
- CiberEHD, Madrid, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jaime Bosch
- Liver Unit, Hospital Clínic, Barcelona, Spain.,CiberEHD, Madrid, Spain
| |
Collapse
|
41
|
Graupera I, Coll M, Pose E, Elia C, Piano S, Solà E, Blaya D, Huelin P, Solé C, Moreira R, de Prada G, Fabrellas N, Juanola A, Morales-Ruiz M, Sancho-Bru P, Villanueva C, Ginès P. Adipocyte Fatty-Acid Binding Protein is Overexpressed in Cirrhosis and Correlates with Clinical Outcomes. Sci Rep 2017; 7:1829. [PMID: 28500294 PMCID: PMC5431836 DOI: 10.1038/s41598-017-01709-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/03/2017] [Indexed: 12/20/2022] Open
Abstract
Fatty-acid-binding proteins (FABPs) are small intracellular proteins that coordinate lipid-mediated processes by targeting metabolic and immune response pathways. The aim of the study was to investigate plasma FABPs levels and their relationship with clinical outcomes in cirrhosis. Plasma levels of L-FABP1(liver and kidney), I-FABP2(intestine), and A-FABP4(adipocyte and macrophages) were measured in 274 patients with decompensated cirrhosis. Hepatic gene expression of FABPs was assessed in liver biopsies from patients with decompensated cirrhosis and in liver cell types from mice with cirrhosis. Immunohistochemistry of A-FABP4 in human liver biopsy was also performed. Plasma levels of FABPs were increased in patients with decompensated cirrhosis compared to those of healthy subjects (L-FABP1: 25 (17–39) vs 10 (9–17) ng/mL p = 0.001, I-FABP2: 1.1 (0.5–2.1) vs 0.6 (0.4–1) ng/mL p = 0.04 and A-FABP4: 37 (20–68) vs 16 (11–33) ng/mL p = 0.002), respectively. Increased A-FABP4 levels were associated with complications of cirrhosis, acute-on-chronic liver failure and poor survival. Hepatic A-FABP4 gene expression was upregulated in decompensated cirrhosis. Macrophages were the main liver cell that over-expressed A-FABP4 in experimental cirrhosis and increased A-FABP4 was found in macrophages of human biopsies by immunohistochemistry. A-FABP4 levels are increased in decompensated cirrhosis and correlate with poor outcomes. Liver macrophages appear to be the main source of A-FABP4 in decompensated cirrhosis.
Collapse
Affiliation(s)
- Isabel Graupera
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Mar Coll
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Chiara Elia
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Salvatore Piano
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Elsa Solà
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,School of Medicine and Health Sciences Center, University of Barcelona, Barcelona, Spain
| | - Delia Blaya
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Huelin
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Cristina Solé
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Rebeca Moreira
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Gloria de Prada
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,School of Medicine and Health Sciences Center, University of Barcelona, Barcelona, Spain
| | - Adrià Juanola
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Manuel Morales-Ruiz
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Biochemistry and Molecular Genetics Department. Hospital Clínic, Department of Biomedicine-Biochemistry Unit, School of Medicine University of Barcelona, Barcelona, Spain
| | - Pau Sancho-Bru
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Càndid Villanueva
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Gastroenterology department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. .,School of Medicine and Health Sciences Center, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
42
|
Campone M, Marschner N, Villanueva C, Sonke G, Alba E, Jakobsen E, Su F, He W, Germa C, André F. First-line ribociclib + letrozole in HR+, HER2– ABC: Efficacy by baseline tumor markers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
43
|
Villanueva C, Graupera I, Aracil C, Alvarado E, Miñana J, Puente Á, Hernandez-Gea V, Ardevol A, Pavel O, Colomo A, Concepción M, Poca M, Torras X, Reñe JM, Guarner C. A randomized trial to assess whether portal pressure guided therapy to prevent variceal rebleeding improves survival in cirrhosis. Hepatology 2017; 65:1693-1707. [PMID: 28100019 DOI: 10.1002/hep.29056] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/07/2016] [Accepted: 01/12/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED Monitoring the hemodynamic response of portal pressure (PP) to drug therapy accurately stratifies the risk of variceal rebleeding (VRB). We assessed whether guiding therapy with hepatic venous pressure gradient (HVPG) monitoring may improve survival by preventing VRB. Patients with cirrhosis with controlled variceal bleeding were randomized to an HVPG-guided therapy group (N = 84) or to a control group (N = 86). In both groups, HVPG and acute β-blocker response were evaluated at baseline and HVPG measurements were repeated at 2-4 weeks to determine chronic response. In the HVPG-guided group, acute responders were treated with nadolol and acute nonresponders with nadolol+nitrates. Chronic nonresponders received nadolol+prazosin and had a third HVPG study. Ligation sessions were repeated until response was achieved. The control group was treated with nadolol+nitrates+ligation. Between-group baseline characteristics were similar. During long-term follow-up (median of 24 months), mortality was lower in the HVPG-guided therapy group than in the control group (29% vs. 43%; hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.35-0.99). Rebleeding occurred in 19% versus 31% of patients, respectively (HR = 0.53; 95% CI = 0.29-0.98), and further decompensation of cirrhosis occurred in 52% versus 72% (HR = 0.68; 95% CI = 0.46-0.99). The survival probability was higher with HVPG-guided therapy than in controls, both in acute (HR = 0.59; 95% CI = 0.32-1.08) and chronic nonresponders (HR = 0.48; 95% CI = 0.23-0.99). HVPG-guided patients had a greater reduction of HVPG and a lower final value than controls (P < 0.05). CONCLUSION HVPG monitoring, by stratifying risk and targeting therapy, improves the survival achieved with currently recommended treatment to prevent VRB using β-blockers and ligation. HVPG-guided therapy achieved a greater reduction in PP, which may have contributed to reduce the risk of rebleeding and of further decompensation of cirrhosis, thus contributing to a better survival. (Hepatology 2017;65:1693-1707).
Collapse
Affiliation(s)
- Càndid Villanueva
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Lleida, Spain
| | - Isabel Graupera
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Lleida, Spain
| | - Carles Aracil
- Departmant of Gastroenterology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Edilmar Alvarado
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - Josep Miñana
- Departmant of Gastroenterology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Ángela Puente
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - Virginia Hernandez-Gea
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - Alba Ardevol
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - Oana Pavel
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Lleida, Spain
| | - Alan Colomo
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Lleida, Spain
| | - Mar Concepción
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - María Poca
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - Xavier Torras
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain
| | - Josep M Reñe
- Departmant of Gastroenterology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Carlos Guarner
- Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Autonomous University, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Lleida, Spain
| |
Collapse
|
44
|
Guyon A, Inocente C, Villanueva C, Lin J, Franco P. 0953 PREVALENCE OF METABOLIC SYNDROME AND LIVER STEATOSIS IN CHILDREN WITH IDIOPATHIC NARCOLEPSY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.952] [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: 11/14/2022] Open
|
45
|
Villanueva C, Malvestiti J, Chaigneau L, Cals L, Pivot X. Nouvelles approches thérapeutiques dans le cancer du sein HER2 positif. ONCOLOGIE 2017. [DOI: 10.1007/s10269-015-2534-z] [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: 11/28/2022]
|
46
|
O'Shaughnessy J, Petrakova K, Sonke GS, André F, Conte P, Arteaga CL, Cameron DA, Hart LL, Villanueva C, Jakobsen EH, Lindquist D, Souami F, Li X, Germa C, Hirawat S, Hortobagyi GN. Abstract P4-22-05: First-line ribociclib plus letrozole in patients with de novo HR+, HER2– advanced breast cancer (ABC): A subgroup analysis of the MONALEESA-2 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Around 15,000 US patients per year are diagnosed with de novo ABC. Due to the absence of prior systemic treatment for breast cancer, tumors of patients with de novo ABC may exhibit a different disease biology, which could result in different tumor responses compared with patients who have relapsed breast cancer. Ribociclib is an orally bioavailable cyclin-dependent kinase (CDK) 4/6 inhibitor. Results from MONALEESA-2, a double-blind, placebo-controlled, randomized Phase 3 trial (NCT01958021), demonstrated that first-line therapy with ribociclib + letrozole significantly improved progression-free survival (PFS) vs placebo + letrozole in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) ABC. Many patients with de novo ABC receive endocrine therapy in the first line and in subsequent lines; here we present results from the MONALEESA-2 study in a subpopulation of patients with de novo ABC.
Methods: Postmenopausal women (N=668) with HR+, HER2– ABC who had no prior systemic therapy for ABC were randomized 1:1 (stratified by liver and/or lung metastases) to receive ribociclib (600 mg/day; 3-weeks-on/1-week-off) + letrozole (2.5 mg/day; continuous) or placebo + letrozole. Patients with de novo ABC were eligible. Additional eligibility criteria included measurable disease or ≥1 predominantly lytic bone lesion, Eastern Cooperative Oncology Group performance status ≤1, and adequate bone marrow/organ function. Prior CDK4/6 inhibitors or systemic therapy for ABC were prohibited. Patients may have received ≤14 days of letrozole or anastrozole for ABC. The primary endpoint was locally assessed PFS; a predefined subgroup analysis evaluated PFS in patients with de novo ABC.
Results: In total, 227 patients with de novo ABC were enrolled. Patients with de novo ABC were equally distributed with 114 (34%) and 113 (34%) in the ribociclib + letrozole and placebo + letrozole arms, respectively. Median duration of exposure to study treatment in the ribociclib + letrozole vs placebo + letrozole arms was 14.1 vs 12.8 months. Treatment was discontinued in 84 (37%) patients with de novo ABC (ribociclib + letrozole vs placebo + letrozole, n [%]; 34 [30%] vs 50 [44%]). Reasons for treatment discontinuation (ribociclib + letrozole vs placebo + letrozole, n [%]) included disease progression (21 [18%] vs 41 [36%]), patient/physician decision (5 [4%] vs 6 [5%]), and adverse events (6 [5%] vs 3 [3%]). PFS was increased in patients with de novo ABC who received ribociclib + letrozole vs placebo + letrozole (hazard ratio=0.448 [95% confidence interval: 0.267–0.750]). The 12-month PFS event-free probability in patients with de novo ABC was 82% in the ribociclib + letrozole arm vs 66% in the placebo + letrozole arm.
Conclusions: The combination of ribociclib + letrozole significantly improved PFS compared with placebo + letrozole in postmenopausal women with HR+, HER2– de novo ABC at diagnosis and therefore may become an important treatment option in the de novo ABC setting.
Keywords: Advanced breast cancer; CDK4/6 inhibitor; Letrozole; Ribociclib
Citation Format: O'Shaughnessy J, Petrakova K, Sonke GS, André F, Conte P, Arteaga CL, Cameron DA, Hart LL, Villanueva C, Jakobsen EH, Lindquist D, Souami F, Li X, Germa C, Hirawat S, Hortobagyi GN. First-line ribociclib plus letrozole in patients with de novo HR+, HER2– advanced breast cancer (ABC): A subgroup analysis of the MONALEESA-2 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-05.
Collapse
Affiliation(s)
- J O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - K Petrakova
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - GS Sonke
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - F André
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - P Conte
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - CL Arteaga
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - DA Cameron
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - LL Hart
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - C Villanueva
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - EH Jakobsen
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - D Lindquist
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - F Souami
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - X Li
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - C Germa
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - S Hirawat
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - GN Hortobagyi
- Texas Oncology-Baylor Charles A. Sammons Cancer Center and US Oncology Network, Dallas, TX; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; Gustave Roussy, Villejuif, France; University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy; Vanderbilt-Ingram Cancer Center, Nashville, TN; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL; University Hospital of Besançon, Hospital Jean Minjoz, Besançon, France; Lillebaelt Hospital, Vejle, Denmark; Arizona Oncology, US Oncology Network, Sedona, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; University of Texas M.D. Anderson Cancer Center, Houston, TX
| |
Collapse
|
47
|
Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Abstract P2-11-08: Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-11-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Stomatitis is the most frequent adverse event reported in trials of mTOR-inhibitors, including EVE. In the pivotal phase 3 BOLERO-2 study, stomatitis incidence in the EVE + exemestane (EXE) arm was 59%. The BOLERO-4 study (NCT01698918) evaluated the efficacy and safety of first-line EVE + LET in postmenopausal pts with HR+, HER2− metastatic or locally advanced breast cancer (ABC). BOLERO-4 also assessed the effectiveness of an alcohol-free dexamethasone (0.5 mg/ 5ml; DEX) oral rinse for treating stomatitis in a subset of pts (USA).
Methods
Postmenopausal pts with HR+, HER2− ABC previously untreated for advanced disease received EVE (10 mg/day) + LET (2.5 mg/day).At disease progression, pts were offered EVE (10 mg/day) + EXE (25 mg/day). Pts who had at least one episode of stomatitis received oral stomatitis daily questionnaire (OSDQ), which is a 6 question pt-reported outcome (PRO) survey (Stiff et al, JCO. 2006). A subset of these pts (USA) was randomized (1:1) to receive DEX or standard of care (SOC). The primary objective of investigator-assessed progression-free survival in the first-line setting for ABC was presented previously. A secondary objective was to evaluate the effectiveness of the DEX oral rinse in reducing the severity and duration of stomatitis, using OSDQ data.
Results
Of the total 202 pts enrolled in this study, 52 pts were enrolled in USA, of which, 24 (46.2%) were randomized to receive DEX (n=11) or SOC (n=13), upon confirmation of stomatitis. The median duration of first stomatitis episode was longer per OSDQ (DEX, not estimable vs SOC, 13.7 wk) compared with physician-reported duration (DEX, 1.6 wk vs SOC, 1.9 wk). PRO OSDQ results were similar in both arms.
Among the 202 pts enrolled, 89 (44.1%) filled the OSDQ at their first stomatitis episode. The median time from treatment initiation to first stomatitis episode was 1.7 wk; median duration of stomatitis was 13.7 wk (OSDQ) vs 2.1 wk (physician reported). The majority of pts experiencing stomatitis had moderate/little/no soreness, moderate/low/no pain, and stomatitis had low/no effect on daily activities (Table 1).
Table 1. OSDQ Key Results (N=87)Questions (Score)First Day of Stomatitis Episode, n (%)End of First Stomatitis Episode, n (%)Overall healthPoor (0-4)20 (23.0)23 (26.4)Moderate (5-7)40 (46.0)32 (36.8)Perfect (8-10)27 (31.0)32 (36.8)Mouth and throat sorenessNo/a little/moderate (0-2)64 (73.6)84 (96.6)A lot or extreme (3-4)23 (26.4)3 (3.4)Mouth pain severityNo/low/moderate (0-4)51 (58.6)73 (83.9)Severe (5-7)24 (27.6)10 (11.5)Unbearable (8-10)12 (13.8)4 (4.6)Effect on daily activitiesNo/low (0-4)70 (80.5)78 (89.7)Moderate (5-7)11 (12.6)4 (4.6)High (8-10)6 (6.9)5 (5.7)
Conclusions
Overall, patient-reported median duration of stomatitis was longer than that reported by physicians, most likely due to differences in perceptions and the challenges in collecting and cleaning PRO data. Overall good health score was maintained in the majority of pts experiencing stomatitis and stomatitis had low/no effect on daily activities. However, these results, especially in the randomized subset need to be interpreted with caution owing to the small sample size, missing data and lack of commercially available DEX in most countries.
Citation Format: Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-08.
Collapse
Affiliation(s)
- C Villanueva
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - K Tsugawa
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - T Toyama
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - W Noh
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - J Jeong
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - F Cardoso
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - V Sriuranpong
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - V Srimuninnimit
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Ozguroglu
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - S Kendall
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - C Falkson
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Cianfrocca
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - C Manlius
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - JCJ Lin
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - F Ringeisen
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - A Ridolfi
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Royce
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| |
Collapse
|
48
|
Sonke G, Hart L, Campone M, Erdkamp F, Janni W, Verma S, Villanueva C, Jakobsen E, Alba E, Wist E, Favret A, Bachelot T, Hegg R, Wheatley-Price P, Souami F, Sutradhar S, Miller M, Germa C, Burris H. Efficacy and safety of ribociclib (LEE011) + letrozole in elderly patients with hormone receptor-positive (HR+), HER2-negative (HER2−) advanced breast cancer (ABC) in MONALEESA-2. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30091-6] [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: 10/20/2022]
|
49
|
Royce M, Villanueva C, Ozguroglu M, Bachelot T, Azevedo S, Melo Cruz F, Hegg R, Debled M, Gradishar W, Manlius C, Ridolfi A, Lin J, Ringeisen F, Cardoso F. BOLERO-4: Phase 2 trial of first-line everolimus (EVE) plus letrozole (LET) in estrogen receptor–positive (ER+), human epidermal growth factor receptor 2–negative (HER2-) advanced breast cancer (BC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
50
|
Moss S, Doyle M, Villanueva C. A Presentation of Single Centre Data on Aortic Valve Surgery in an Octogenarian Population Group. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.673] [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: 11/15/2022]
|