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Bissonnette R, Eichenfield LF, Simpson E, Thaçi D, Kabashima K, Thyssen JP, Guttman-Yassky E, Nunes FP, Gamalo M, Ahmad F, Kuligowski M, Sun K, Pipper C, Christensen AW, D'Angelo P, Milutinovic M, Guettner A, Silverberg JI. Estimands for atopic dermatitis clinical trials: Expert opinion on the importance of intercurrent events. J Eur Acad Dermatol Venereol 2023; 37:976-983. [PMID: 36652273 DOI: 10.1111/jdv.18881] [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] [Received: 10/07/2021] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Despite the emergence of novel targeted treatments for atopic dermatitis (AD), there is a lack of guidelines on standardizing analysis of clinical trial data. To define and estimate meaningful treatment comparisons, several factors, including intercurrent events, must be taken into account. Intercurrent events are defined as events occurring after treatment initiation that affect either the interpretation or existence of the measurements associated with clinical questions of interest. Due to the relapsing, unpredictable nature of AD, intercurrent events frequently occur in AD trials, such as use of rescue therapy for intense itch and sleep deprivation. Despite the impact of intercurrent events in AD, they are often handled in an inconsistent manner across trials, which limits results interpretation. The estimand framework is increasingly used to estimate treatment effects while accounting for intercurrent events. This review explores how guidance from the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) on the use of estimands can be applied to support AD clinical trial design and analysis. We propose that estimands are used in AD trials and defined early during trial design. The use of estimands can provide clinicians with interventional trial results that are more reflective of clinical practice, help facilitate comparisons across clinical trials, and are more informative to enable improved treatment selection for patients.
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Affiliation(s)
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, California, USA
| | - E Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - D Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - K Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - E Guttman-Yassky
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - F P Nunes
- Janssen Pharmaceutical Companies of Johnson & Johnson, Spring House, Pennsylvania, USA
| | - M Gamalo
- Pfizer Inc., Collegeville, Pennsylvania, USA
| | - F Ahmad
- Galderma Laboratories, Fort Worth, Texas, USA
| | | | - K Sun
- Incyte Corporation, Wilmington, Delaware, USA
| | - C Pipper
- LEO Pharma A/S, Ballerup, Denmark
| | | | - P D'Angelo
- Innovaderm Research, Montreal, Quebec, Canada
| | | | | | - J I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Sildorf SM, Hertel NT, Thomsen J, Fredheim S, Hastrup H, Pipper C, Hertz B, Svensson J. Treatment intensification without improved HbA1c levels in children and adolescents with Type 1 diabetes mellitus. Diabet Med 2016; 33:515-22. [PMID: 26333180 DOI: 10.1111/dme.12900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Accepted: 08/25/2015] [Indexed: 01/15/2023]
Abstract
AIMS To examine trends in diabetes treatment in Danish children and adolescents with Type 1 diabetes mellitus, comparing treatment intensity with metabolic outcomes in the population, and to describe the challenges of population-based registries in a clinical setting with rapidly changing treatment methods. METHODS This observational study is based on the Danish national population registry of childhood diabetes, which includes 99% of children diagnosed with Type 1 diabetes before the age of 15 years. We included 4527 people diagnosed between 2000 and 2012. Self-monitored blood glucose measurements, insulin injections/boluses, treatment method and metabolic control quantifications were analysed and adjusted for the effects of gender and ethnicity, the combined effect of age, visit year and duration, and for the random effects of individual and hospital settings. RESULTS Treatment was intensified via an increasing number of self-monitored blood glucose measurements and injections/boluses. More than six injections/boluses and an increased number of self-monitored blood glucose measurements were significantly associated with lower metabolic control. No reduction, however, in the overall mean HbA1c concentration was observed between 2005 [66 mmol/mol (8.2%)] and 2012 [65 mmol/mol (8.1%)]. Changed registration practices in 2009 introduced artificial jumps in data. CONCLUSIONS Intensifying treatment alone does not lead to improved metabolic control in the overall population despite the appearance of lower HbA1c in individuals with a greater number of self-monitored blood glucose measurements and injections/boluses. The contradictory results reflect difficulties in using observational studies to predict results of intervention in the individual. Data collected from population-based registries need to be adjusted continuously to reflect changes in care.
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Affiliation(s)
- S M Sildorf
- Paediatric Department, Herlev Hospital, Herlev, Denmark
| | - N T Hertel
- H.C. Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - J Thomsen
- Paediatric Department, Kolding Hospital, Kolding, Denmark
| | - S Fredheim
- Paediatric Department, Herlev Hospital, Herlev, Denmark
| | - H Hastrup
- Paediatric Department, Aalborg University Hospital, Aalborg, Denmark
| | - C Pipper
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - B Hertz
- Paediatric Department, Regionshospitalet Viborg, Viborg, Denmark
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Fredheim S, Johansen A, Thorsen SU, Kremke B, Nielsen LB, Olsen BS, Lyngsøe L, Sildorf SM, Pipper C, Mortensen HB, Johannesen J, Svensson J. Nationwide reduction in the frequency of severe hypoglycemia by half. Acta Diabetol 2015; 52:591-9. [PMID: 25528006 DOI: 10.1007/s00592-014-0697-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 10/18/2014] [Accepted: 12/05/2014] [Indexed: 12/23/2022]
Abstract
AIMS To examine contemporary rates of severe hypoglycemia (SH) and identify the effect of predictors of SH in a pediatric type 1 diabetes population. METHODS The national diabetes register provided data on children residing in Denmark from 2008 to 2013 in this register-based population study. Robust Poisson regression models were applied. RESULTS The study population [n = 2,715 (50.9 % boys), mean (SD) age at onset; 8.1 (4.0) years, diabetes duration; 5.6 (4.9) years] comprised 7,390 person-years of data and 561 events of SH. The overall incidence of SH was 7.6 per 100 person-years. The incidence rate peaked with 16.0 per 100 person-years in 2008 reaching a nadir of 4.9 in 2011. Overall, insulin pump reduced the rate of SH with 27 % compared to any pen treatment (P = 0.003). When stratifying pen treatment, premixed insulin increased the rate of SH by 1.9-fold (P = 0.0015) and NPH increased the rate by 1.6-fold (P = 0.003) versus pump treatment, whereas long-acting insulin analogues were comparable with pump treatment (P = 0.1485). We found no association of SH with glycemic control (P > 0.05). CONCLUSIONS A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.
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Affiliation(s)
- S Fredheim
- Department of Pediatrics, Herlev Hospital, Arkaden, Turkisvej 14, 2730, Herlev, Copenhagen, Denmark,
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Melbye M, Pipper C, Vestergaard H, Wohlfahrt J. 383: Aggregation and Co-Aggregation of Tonsillitis and Appendicitis within Families. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s96b] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Melbye
- Dept of Epidemiology Research, Statens Serum Institut, Denmark
| | - C Pipper
- Dept of Epidemiology Research, Statens Serum Institut, Denmark
| | - H Vestergaard
- Dept of Epidemiology Research, Statens Serum Institut, Denmark
| | - J Wohlfahrt
- Dept of Epidemiology Research, Statens Serum Institut, Denmark
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