1
|
Hofherr A, Schumi J, Rekić D, Knöchel J, Nilsson C, Rudvik A, Hurt-Camejo E, Wernevik L, Rydén-Bergsten T, Koren M, Carlsson B. ETESIAN: A phase 2B study of the efficacy, safety and tolerability of AZD8233, a PCSK9-targeted antisense oligonucleotide, in patients with dyslipidemia. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
2
|
Ericson E, Bergenholm L, Andréasson AC, Dix CI, Knöchel J, Hansson SF, Lee R, Schumi J, Antonsson M, Fjellström O, Nasr P, Liljeblad M, Carlsson B, Kechagias S, Lindén D, Ekstedt M. Hepatic patatin-like phospholipase domain-containing 3 levels are increased in I148M risk allele carriers and correlate with NAFLD in humans. Hepatol Commun 2022; 6:2689-2701. [PMID: 35833455 PMCID: PMC9512469 DOI: 10.1002/hep4.2032] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
In nonalcoholic fatty liver disease (NAFLD) the patatin‐like phospholipase domain‐containing 3 (PNPLA3) rs738409 variant is a contributor. In mice, the Pnpla3 148M variant accumulates on lipid droplets and probably leads to sequestration of a lipase cofactor leading to impaired mobilization of triglycerides. To advance our understanding of the localization and abundance of PNPLA3 protein in humans, we used liver biopsies from patients with NAFLD to investigate the link to NAFLD and the PNPLA3 148M genotype. We experimentally qualified an antibody against human PNPLA3. Hepatic PNPLA3 protein fractional area and localization were determined by immunohistochemistry in biopsies from a well‐characterized NAFLD cohort of 67 patients. Potential differences in hepatic PNPLA3 protein levels among patients related to degree of steatosis, lobular inflammation, ballooning, and fibrosis, and PNPLA3 I148M gene variants were assessed. Immunohistochemistry staining in biopsies from patients with NAFLD showed that hepatic PNPLA3 protein was predominantly localized to the membranes of small and large lipid droplets in hepatocytes. PNPLA3 protein levels correlated strongly with steatosis grade (p = 0.000027) and were also significantly higher in patients with lobular inflammation (p = 0.009), ballooning (p = 0.022), and significant fibrosis (stage 2–4, p = 0.014). In addition, PNPLA3 levels were higher in PNPLA3 rs738409 148M (CG, GG) risk allele carriers compared to 148I (CC) nonrisk allele carriers (p = 0.0029). Conclusion: PNPLA3 protein levels were associated with increased hepatic lipid content and disease severity in patients with NAFLD and were higher in PNPLA3 rs738409 (148M) risk allele carriers. Our hypothesis that increased hepatic levels of PNPLA3 may be part of the pathophysiological mechanism of NAFLD is supported.
Collapse
Affiliation(s)
- Elke Ericson
- Genome Engineering, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Linnéa Bergenholm
- Drug Metabolism and Pharmacokinetics, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anne-Christine Andréasson
- Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Carly I Dix
- Affinity Reagents Generation, Biologics Engineering and Oncology Tumor-Targeted Delivery, AstraZeneca, Cambridge, UK
| | - Jane Knöchel
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Sara F Hansson
- Translational Science and Experimental Medicine, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Richard Lee
- Antisense Drug Discovery, Ionis Pharmaceuticals, Carlsbad, California, USA.,Preclinical Pharmacology and Translational Medicine, Verve Therapeutics, Cambridge, Massachusetts, USA
| | - Jennifer Schumi
- Early Biometrics and Statistical Innovation, Data Science and Artificial Intelligence, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Madeleine Antonsson
- Drug Metabolism and Pharmacokinetics, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ola Fjellström
- Projects, Cardiovascular, Renal, and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Patrik Nasr
- Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathias Liljeblad
- Translational Science and Experimental Medicine, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Björn Carlsson
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stergios Kechagias
- Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Daniel Lindén
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.,Division of Endocrinology, Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Ekstedt
- Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
Koren MJ, Hofherr A, Schumi J, Rekic D, Knochel J, Nilsson CA, Rudvik A, Wernevik L, Ryden-Bergsten T, Carlsson BC. ETESIAN: A PHASE 2B STUDY OF THE EFFICACY, SAFETY AND TOLERABILITY OF AZD8233, A PCSK9-TARGETED ANTISENSE OLIGONUCLEOTIDE, IN PATIENTS WITH DYSLIPIDEMIA. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02466-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
4
|
Wessels AM, Tariot PN, Zimmer JA, Selzler KJ, Bragg SM, Andersen SW, Landry J, Krull JH, Downing AM, Willis BA, Shcherbinin S, Mullen J, Barker P, Schumi J, Shering C, Matthews BR, Stern RA, Vellas B, Cohen S, MacSweeney E, Boada M, Sims JR. Efficacy and Safety of Lanabecestat for Treatment of Early and Mild Alzheimer Disease: The AMARANTH and DAYBREAK-ALZ Randomized Clinical Trials. JAMA Neurol 2020; 77:199-209. [PMID: 31764959 PMCID: PMC6902191 DOI: 10.1001/jamaneurol.2019.3988] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Alzheimer disease (AD) is a neurodegenerative disorder characterized by cognitive deterioration and impaired activities of daily living. Current treatments provide only minor symptomatic improvements with limited benefit duration. Lanabecestat, a brain-permeable inhibitor of human beta-site amyloid precursor protein-cleaving enzyme 1 (BACE1/β-secretase), was developed to modify the clinical course of AD by slowing disease progression. Objective To assess whether lanabecestat slows the progression of AD compared with placebo in patients with early AD (mild cognitive impairment) and mild AD dementia. Design, Setting, and Participants AMARANTH (first patient visit on September 30, 2014; last patient visit on October 4, 2018) and DAYBREAK-ALZ (first patient visit on July 1, 2016; last patient visit on September 28, 2018) were randomized, placebo-controlled, phase 2/3 and phase 3 clinical trials lasting 104 weeks and 78 weeks, respectively. AMARANTH and DAYBREAK-ALZ were multicenter, global, double-blind studies conducted at 257 and 251 centers, respectively, located in 15 and 18 countries or territories, respectively. A population-based sample of men and women aged 55 to 85 years who met National Institute on Aging-Alzheimer's Association criteria for early AD or mild AD dementia was screened using cognitive assessments, and the presence of amyloid was confirmed. Patients were excluded for unstable medical conditions or medication use, significant cerebrovascular pathologic findings, or a history of vitiligo and/or current evidence of postinflammatory hypopigmentation. AMARANTH screened 6871 patients; 2218 (32.3%) were randomized, and 539 patients completed the study. DAYBREAK-ALZ screened 5706 patients; 1722 (30.2%) were randomized, and 76 patients completed the study. Interventions Patients were randomized (1:1:1) to once-daily oral doses of lanabecestat (20 mg), lanabecestat (50 mg), or placebo. Main Outcomes and Measures The primary outcome measure was change from baseline on the 13-item Alzheimer Disease Assessment Scale-cognitive subscale. Secondary outcomes included Alzheimer's Disease Cooperative Study-Instrumental Activities of Daily Living Inventory, Clinical Dementia Rating, Functional Activities Questionnaire, Mini-Mental State Examination, and Neuropsychiatric Inventory. Efficacy analyses were conducted on the intent-to-treat population. Results Among 2218 AMARANTH patients, the mean (SD) age was 71.3 (7.1) years, and 1177 of 2218 (53.1%) were women. Among 1722 DAYBREAK-ALZ patients, the mean (SD) age was 72.3 (7.0) years, and 1023 of 1722 (59.4%) were women. Both studies were terminated early after futility analysis. There were no consistent, reproducible dose-related findings on primary or secondary efficacy measures. Psychiatric adverse events, weight loss, and hair color changes were reported in a higher percentage of patients receiving lanabecestat than placebo. Conclusions and Relevance Treatment with lanabecestat was well tolerated and did not slow cognitive or functional decline. Trial Registration ClinicalTrials.gov identifiers: NCT02245737 and NCT02783573.
Collapse
Affiliation(s)
| | - Pierre N Tariot
- Banner Alzheimer's Institute, University of Arizona College of Medicine, Phoenix
| | | | | | | | | | - John Landry
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | | | - Jamie Mullen
- AstraZeneca, Waltham, Massachusetts, and Gaithersburg, Maryland.,Now retired
| | - Peter Barker
- AstraZeneca, Waltham, Massachusetts, and Gaithersburg, Maryland
| | - Jennifer Schumi
- AstraZeneca, Waltham, Massachusetts, and Gaithersburg, Maryland
| | - Craig Shering
- AstraZeneca, Waltham, Massachusetts, and Gaithersburg, Maryland
| | | | - Robert A Stern
- Alzheimer's Disease Center, Boston University School of Medicine, Boston, Massachusetts
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Unités Mixtes de Recherche Institut National de la Santé et de la Recherche Médicale 1027, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Sharon Cohen
- Toronto Memory Program, Toronto, Ontario, Canada
| | | | - Mercè Boada
- Research Center and Memory Clinic, Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - John R Sims
- Eli Lilly and Company, Indianapolis, Indiana
| |
Collapse
|
5
|
Liu-Seifert H, Schumi J, Miao X, Tian Y, Rabbia M, Andersen SW, Wilson S, Li W, Entsuah R. Disease Modification in Alzheimer's Disease: Current Thinking. Ther Innov Regul Sci 2020; 54:396-403. [PMID: 32072596 DOI: 10.1007/s43441-019-00068-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/25/2019] [Indexed: 11/25/2022]
Abstract
Alzheimer's disease (AD) has increasingly been recognized as a huge unmet medical need. Currently, there is no approved drug to cure, prevent, or even slow down the disease. It is imperative to develop disease-modifying treatments for AD to alter the underlying disease progression. This paper reviews the most up-to-date regulatory guidance on how to demonstrate disease modification and provides an overview of available methodologies and applications to clinical trials. The intent is to assist the field with future clinical trials designed to demonstrate disease-modifying effect in AD. The methodologies may be generalizable to broader neurodegenerative diseases.
Collapse
Affiliation(s)
- Hong Liu-Seifert
- Lilly Research Laboratories, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA.
| | - Jennifer Schumi
- Advanced Analytics Centre, Biometrics and Information Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - Xiaopeng Miao
- Department of Biostatistics, Biogen, Cambridge, MA, USA
| | - Ying Tian
- Department of Biostatistics, Biogen, Cambridge, MA, USA
| | - Michael Rabbia
- Product Development Biostatistics, Genentech, Inc, South San Francisco, CA, USA
| | - Scott W Andersen
- Neuroscience Statistics, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Wen Li
- Biostatistics and Research Decision Sciences, Merck Research Laboratories (MRL), Merck & Co, Inc, Kenilworth, NJ, USA
| | - Richard Entsuah
- Biostatistics and Research Decision Sciences, Merck Research Laboratories (MRL), Merck & Co, Inc, Kenilworth, NJ, USA
| |
Collapse
|
6
|
Liu-Seifert H, Schumi J, Miao X, Tian Y, Rabbia M, Andersen SW, Wilson S, Li W, Entsuah R. Disease Modification in Alzheimer’s Disease: Current Thinking. Ther Innov Regul Sci 2019. [DOI: 10.1177/2168479019841894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hong Liu-Seifert
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Jennifer Schumi
- Advanced Analytics Centre, Biometrics and Information Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - Xiaopeng Miao
- Department of Biostatistics, Biogen, Cambridge, MA, USA
| | - Ying Tian
- Department of Biostatistics, Biogen, Cambridge, MA, USA
| | - Michael Rabbia
- Product Development Biostatistics, Genentech, Inc, South San Francisco, CA, USA
| | - Scott W. Andersen
- Neuroscience Statistics, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Wen Li
- Biostatistics and Research Decision Sciences, Merck Research Laboratories (MRL), Merck & Co, Inc, Kenilworth, NJ, USA
| | - Richard Entsuah
- Biostatistics and Research Decision Sciences, Merck Research Laboratories (MRL), Merck & Co, Inc, Kenilworth, NJ, USA
| |
Collapse
|
7
|
Sims JR, Selzler KJ, Downing AM, Willis BA, Aluise CD, Zimmer J, Bragg S, Andersen S, Ayan-Oshodi M, Liffick E, Eads J, Wessels AM, Monk S, Schumi J, Mullen J. Development Review of the BACE1 Inhibitor Lanabecestat (AZD3293/LY3314814). J Prev Alzheimers Dis 2018; 5:214-215. [PMID: 29181490 DOI: 10.14283/jpad.2017.38] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Several ongoing clinical development programs are investigating potential disease-modifying treatments for Alzheimer's disease (AD), including lanabecestat (AZD3293/LY3314814). Lanabecestat is a brain-permeable oral inhibitor of human beta-site amyloid (Aβ) precursor protein-cleaving enzyme 1 (BACE1) that reduces Aβ production. As a potent BACE1 inhibitor, lanabecestat significantly reduced soluble Aβ species and soluble amyloid precursor proteins (sAPPβ) in mouse, guinea pig, and dog in a time- and dose-dependent manner. Significant reductions in plasma and cerebrospinal fluid (CSF) Aβ1-40 and Aβ1-42 were observed in Phase 1 studies of healthy subjects and AD patients treated with lanabecestat. Three lanabecestat trials are ongoing and intended to support registration in Early AD: (1) Phase 2/3 study in patients with mild cognitive impairment (MCI) due to AD and mild AD dementia (AMARANTH, NCT02245737); (2) Delayed-start extension study (AMARANTH-EXTENSION, NCT02972658) for patients who have completed treatment in the AMARANTH Study; and (3) Phase 3 study in mild AD dementia (DAYBREAK-ALZ, NCT02783573). This review will discuss the development of lanabecestat, results from the completed nonclinical and clinical studies, as well as describe the ongoing Phase 3 clinical trials.
Collapse
Affiliation(s)
- J R Sims
- John R. Sims, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, , +1-317-209-6229
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Sims JR, Downing AM, Andersen SW, Wessels AM, Zimmer JA, Mullen J, Schumi J, Stern RA, Vellas B, Boada M, Cohen S, MacSweeney E, Tariot PN. DT‐01‐04: LANABECESTAT: BASELINE CHARACTERISTICS OF PARTICIPANTS RANDOMIZED IN THE PHASE 2/3 AMARANTH STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.006] [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: 10/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mercè Boada
- Fundació ACE. Barcelona Alzheimer Treatment and Research CenterBarcelonaSpain
| | | | | | | |
Collapse
|
9
|
Wang AC, Stellmacher U, Schumi J, Tu N, Reimitz PE. Assessment of the Cardiovascular Risk of Olmesartan Medoxomil-Based Treatment: Meta-Analysis of Individual Patient Data. Am J Cardiovasc Drugs 2016; 16:427-437. [PMID: 27565974 DOI: 10.1007/s40256-016-0182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Results from two long-term studies (ROADMAP and ORIENT) indicated a numerical imbalance in the number of cardiovascular deaths between the olmesartan medoxomil (OM) and placebo groups. OBJECTIVE Our objective was to conduct an individual patient data meta-analysis to provide more complete information regarding OM-associated cardiovascular risks and/or benefits. METHODS We created an integrated database based on 191 clinical trials from the OM development program. Events were identified and adjudicated by an independent, blinded clinical events committee. The incidence of major cardiovascular events and total mortality for OM versus placebo/active control were evaluated, and the effect of OM on cardiovascular mortality (main endpoint of interest) and morbidity was calculated using a two-stage approach (Tian method). RESULTS A total of 46 studies (~27,000 patients) met the US FDA-specified inclusion criteria (phase II-IV randomized, double-blind, placebo- or active-controlled studies [OM-based monotherapy or combination, double-blind period ≥28 days] and adult patients). The incidence of known adjudicated endpoints in the analysis of all studies combined was low among OM (0.11-0.53 %) and placebo/active control (0.08-0.76 %) groups. For cardiovascular mortality, the estimated risk difference (OM vs. control) was 0.00070 (95 % confidence interval [CI] -0.0011 to 0.0024; p = 0.60); the risk difference for each endpoint was <1/1000, with no statistically significant difference between groups. Results were similar with and without ROADMAP and ORIENT. DISCUSSION The results from this meta-analysis did not show a clinically meaningful or statistically significant difference in cardiovascular risk between OM and the placebo/active control groups, and thus did not corroborate the numerical imbalance observed in ROADMAP and ORIENT.
Collapse
Affiliation(s)
- Antonia C Wang
- Biostatistics, Daiichi Sankyo Pharma Development, 399 Thornall Street, Edison, NJ, 08837, USA.
| | | | | | - Nora Tu
- Biostatistics, Daiichi Sankyo Pharma Development, 399 Thornall Street, Edison, NJ, 08837, USA
| | | |
Collapse
|
10
|
Abstract
Non-inferiority trials test whether a new product is not unacceptably worse than a product already in use. This paper introduces concepts related to non-inferiority, and discusses the regulatory views of both the European Medicines Agency and the United States Food and Drug Administration.
Collapse
Affiliation(s)
- Jennifer Schumi
- Statistics Collaborative, Inc., Suite 600, 1625 Massachusetts Avenue NW, Washington DC 20036, USA
| | - Janet T Wittes
- Statistics Collaborative, Inc., Suite 600, 1625 Massachusetts Avenue NW, Washington DC 20036, USA
| |
Collapse
|
11
|
Schumi J, DeGruttola V. Resampling-based analyses of the effects of combinations of HIV genetic mutations on drug susceptibility. Stat Med 2008; 27:4740-57. [DOI: 10.1002/sim.3181] [Citation(s) in RCA: 5] [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: 11/10/2022]
|
12
|
Tardif JC, McMurray JJV, Klug E, Small R, Schumi J, Choi J, Cooper J, Scott R, Lewis EF, L'Allier PL, Pfeffer MA. Effects of succinobucol (AGI-1067) after an acute coronary syndrome: a randomised, double-blind, placebo-controlled trial. Lancet 2008; 371:1761-8. [PMID: 18502300 DOI: 10.1016/s0140-6736(08)60763-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oxidative stress and inflammation are involved in the pathophysiology of atherosclerosis. Our aim was to assess the effects of the antioxidant succinobucol (AGI-1067) on cardiovascular outcomes in patients with recent acute coronary syndromes already managed with conventional treatments. METHODS After an acute coronary syndrome occurring 14-365 days before recruitment, 6144 patients were randomly assigned with a computer-generated randomisation list, stratified by study site, to receive succinobucol (n=3078) or placebo (n=3066) in addition to standard of care. Enrolment began in July, 2003; this event-driven trial was stopped in August, 2006, after the prespecified number of primary outcome events had occurred. The composite primary endpoint was time to first occurrence of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, unstable angina, or coronary revascularisation. Efficacy analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00066898. FINDINGS All randomised patients were included in the efficacy analyses. Succinobucol had no effect on the primary endpoint (530 events in succinobucol group vs 529 in placebo group; hazard ratio 1.00, 95% CI 0.89-1.13, p=0.96). The composite secondary endpoint of cardiovascular death, cardiac arrest, myocardial infarction, or stroke occurred in fewer patients in the succinobucol group than in the placebo group (207 vs 252 events; 0.81, 0.68-0.98, p=0.029). The tertiary endpoint of new-onset diabetes developed in fewer patients without diabetes at baseline in the succinobucol group than in such patients in the placebo group (30 of 1923 vs 82 of 1950 patients; 0.37, 0.24-0.56, p<0.0001). New-onset atrial fibrillation occurred more often in the succinobucol group than in the placebo group (107 of 2818 vs 55 of 2787 patients; 1.87, 1.67-2.09, p=0.0002). Although the number of patients who reported any treatment emergent adverse event was much the same in the two groups, more patients in the succinobucol group than in the placebo group reported bleeding episodes or anaemia (32 vs 18 and 37 vs ten, respectively) as serious adverse events. Relative to treatment with placebo, succinobucol increased LDL cholesterol and systolic blood pressure, and decreased HDL cholesterol and glycated haemoglobin (p<0.0001 for all). INTERPRETATION Although succinobucol had no effect on the primary endpoint, changes in the rates of other clinical outcomes-both beneficial and harmful-will need to be further assessed before succinobucol is used in patients with atherosclerosis or as an antidiabetic agent.
Collapse
|
13
|
Mello MM, Studdert DM, Schumi J, Brennan TA, Sage WM. Changes in physician supply and scope of practice during a malpractice crisis: evidence from Pennsylvania. Health Aff (Millwood) 2007; 26:w425-35. [PMID: 17456502 DOI: 10.1377/hlthaff.26.3.w425] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The extent to which liability costs cause physicians to restrict their scope of practice or cease practicing is controversial in policy debates over malpractice "crises." We used insurance department administrative data to analyze specialist physician scope-of-practice changes and exits in Pennsylvania in 1993-2002. In most specialties the proportions of high-risk specialists restricting their scope of practice did not increase during the crisis; however, the supply of obstetrician-gynecologists decreased by 8 percent in the three years following premium increases in 1999. We discuss methodological issues that could explain the disparate findings regarding physician supply effects in studies using administrative data sets and survey data.
Collapse
Affiliation(s)
- Michelle M Mello
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
| | | | | | | | | |
Collapse
|
14
|
|
15
|
|