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Ackermann DM, Hersch JK, Janda M, Bracken K, Turner RM, Bell KJL. Using the Behaviour Change Wheel to identify barriers and targeted strategies to improve adherence in randomised clinical trials: The example of MEL-SELF trial of patient-led surveillance for melanoma. Contemp Clin Trials 2024; 140:107513. [PMID: 38537902 DOI: 10.1016/j.cct.2024.107513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Adherence to self-management interventions is critical in both clinical settings and trials to ensure maximal effectiveness. This study reports how the Behaviour Change Wheel may be used to assess barriers to self-management behaviours and develop strategies to maximise adherence in a trial setting (the MEL-SELF trial of patient-led melanoma surveillance). METHODS The Behaviour Change Wheel was applied by (i) using the Capability, Opportunity, Motivation-Behaviour (COMB) model informed by empirical and review data to identify adherence barriers, (ii) mapping identified barriers to corresponding intervention functions, and (iii) identifying appropriate behaviour change techniques and developing potential solutions using the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) criteria. RESULTS The target adherence behaviour was defined as conducting a thorough skin self-examination and submitting images for teledermatology review. Key barriers identified included: non-engaged skin check partners, inadequate planning, time constraints, low self-efficacy, and technological difficulties. Participants' motivation was positively influenced by perceived health benefits and negatively impacted by emotional states such as anxiety and depression. We identified the following feasible interventions to support adherence: education, training, environmental restructuring, enablement, persuasion, and incentivisation. Proposed solutions included action planning, calendar scheduling, alternative dermatoscopes, optimised communication, educational resources in various formats to boost self-efficacy and motivation and optimised reminders (which will be evaluated in a Study Within A Trial (SWAT)). CONCLUSION The Behaviour Change Wheel may be used to improve adherence in clinical trials by identifying barriers to self-management behaviours and guiding development of targeted strategies.
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Affiliation(s)
- Deonna M Ackermann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Jolyn K Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Karen Bracken
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
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Grossmann M, Robledo KP, Daniel M, Handelsman DJ, Inder WJ, Stuckey BGA, Yeap BB, Ng Tang Fui M, Bracken K, Allan CA, Jesudason D, Zajac JD, Wittert GA. Testosterone treatment, weight loss and health-related quality of life and psychosocial function in men: a two-year RCT. J Clin Endocrinol Metab 2024:dgae085. [PMID: 38335137 DOI: 10.1210/clinem/dgae085] [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: 12/15/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To determine the effect of testosterone vs placebo treatment on health-related quality of life (HR-QOL) and psychosocial function in men without pathologic hypogonadism in the context of a lifestyle intervention. DESIGN, SETTING, PARTICIPANTS Secondary analysis of a 2-year, randomised controlled, testosterone therapy trial for prevention, or reversal of newly diagnosed, type 2 diabetes, enrolling men > 50 years at high risk for type 2 diabetes from six Australian centers. INTERVENTIONS Injectable testosterone undecanoate or matching placebo on the background of a community-based lifestyle program. MAIN OUTCOMES Self-reported measures of HR-QOL/psychosocial function. RESULTS Of 1007 participants randomised into T4DM, 648 (64%) had complete data available for all HR-QOL/psychosocial function assessments at baseline and two years. Over 24 months, while most measures were not different between treatment arms, testosterone treatment, compared with placebo, improved subjective social status and sense of coherence. Baseline HR-QOL/psychosocial function measures did not predict the effect of testosterone treatment on glycemic outcomes, primary endpoints of T4DM. Irrespective of treatment allocation, larger decreases in body weight were associated with improved mental quality of life, mastery, and subjective social status. Men with better baseline physical function, greater sense of coherence, and less depressive symptoms experienced greater associated decreases in body weight, with similar effects on waist circumference. CONCLUSIONS In this diabetes prevention trial, weight loss induced by a lifestyle intervention improved HR-QOL and psychosocial function in more domains than testosterone treatment. The magnitude of weight and waist circumference reduction were predicted by baseline physical function, depressive symptomology, and sense of coherence.
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Affiliation(s)
- Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Mark Daniel
- Department of Population Health, Dasman Diabetes Institute, Kuwait
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney New South Wales, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and the University of Queensland, Queensland, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Western Australia, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Mark Ng Tang Fui
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Carolyn A Allan
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, School of Clinical Sciences at Monash Health, and Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - David Jesudason
- University of Adelaide, Adelaide, South Australia, Australia, and The Queen Elizabeth Hospital, South Australia, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia, and The Queen Elizabeth Hospital, South Australia, Australia
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Fahridin S, Agarwal N, Bracken K, Law S, Morton RL. The use of linked administrative data in Australian randomised controlled trials: A scoping review. Clin Trials 2024:17407745231225618. [PMID: 38305216 DOI: 10.1177/17407745231225618] [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: 02/03/2024]
Abstract
BACKGROUND/AIMS The demand for simplified data collection within trials to increase efficiency and reduce costs has led to broader interest in repurposing routinely collected administrative data for use in clinical trials research. The aim of this scoping review is to describe how and why administrative data have been used in Australian randomised controlled trial conduct and analyses, specifically the advantages and limitations of their use as well as barriers and enablers to accessing administrative data for use alongside randomised controlled trials. METHODS Databases were searched to November 2022. Randomised controlled trials were included if they accessed one or more Australian administrative data sets, where some or all trial participants were enrolled in Australia, and where the article was published between January 2000 and November 2022. Titles and abstracts were independently screened by two reviewers, and the full texts of selected studies were assessed against the eligibility criteria by two independent reviewers. Data were extracted from included articles by two reviewers using a data extraction tool. RESULTS Forty-one articles from 36 randomised controlled trials were included. Trial characteristics, including the sample size, disease area, population, and intervention, were varied; however, randomised controlled trials most commonly linked to government reimbursed claims data sets, hospital admissions data sets and birth/death registries, and the most common reason for linkage was to ascertain disease outcomes or survival status, and to track health service use. The majority of randomised controlled trials were able to achieve linkage in over 90% of trial participants; however, consent and participant withdrawals were common limitations to participant linkage. Reported advantages were the reliability and accuracy of the data, the ease of long term follow-up, and the use of established data linkage units. Common reported limitations were locating participants who had moved outside the jurisdictional area, missing data where consent was not provided, and unavailability of certain healthcare data. CONCLUSIONS As linked administrative data are not intended for research purposes, detailed knowledge of the data sets is required by researchers, and the time delay in receiving the data is viewed as a barrier to its use. The lack of access to primary care data sets is viewed as a barrier to administrative data use; however, work to expand the number of healthcare data sets that can be linked has made it easier for researchers to access and use these data, which may have implications on how randomised controlled trials will be run in future.
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Affiliation(s)
- Salma Fahridin
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Neeru Agarwal
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Law
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Handelsman DJ, Grossmann M, Yeap BB, Stuckey BGA, Shankara-Narayana N, Conway AJ, Inder WJ, McLachlan RI, Allan C, Jenkins AJ, Jesudason D, Bracken K, Wittert GA. Long-term Outcomes of Testosterone Treatment in Men: A T4DM Postrandomization Observational Follow-up Study. J Clin Endocrinol Metab 2023; 109:e25-e31. [PMID: 37623257 DOI: 10.1210/clinem/dgad485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT The T4DM study randomized 1007 men with impaired glucose tolerance or newly diagnosed diabetes to testosterone undecanoate (TU, 1000 mg) or matching placebo (P) injections every 12 weeks for 24 months with a lifestyle program with testosterone (T) treatment reducing diabetes diagnosis by 40%. BACKGROUND The long-term effects on new diagnosis of diabetes, cardiovascular and prostate disease, sleep apnea, weight maintenance trajectory and androgen dependence were not yet described. METHODS A follow-up email survey after a median of 5.1 years since last injection obtained 599 (59%) completed surveys (316 T, 283 P), with participants in the follow-up survey compared with nonparticipants in 23 anthropometric and demographic variables. RESULTS Randomization to was TU associated with stronger belief in study benefits during (64% vs 49%, P < .001) but not after the study (44% vs 40%, P = .07); there is high interest in future studies. At T4DM entry, 25% had sleep apnea with a new diagnosis more frequent on TU (3.0% vs 0.4%, P = .03) during, but not after, the study. Poststudy, resuming prescribed T treatment was more frequent among TU-treated men (6% vs 2.8%, P = .03). Five years after cessation of TU treatment there was no difference in self-reported rates of new diagnosis of diabetes, and prostate or cardiovascular disease, nor change in weight maintenance or weight loss behaviors. CONCLUSION We conclude that randomized T treatment for 24 months in men with impaired glucose tolerance or new diabetes but without pathological hypogonadism was associated with higher levels of self-reported benefits and diagnosis of sleep apnea during, but not after, the study as well as more frequent prescribed poststudy T treatment consistent with androgen dependence in some men receiving prolonged injectable TU.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Mathis Grossmann
- Department of Medicine Austin Health, The University of Melbourne and Department of Endocrinology, Austin Health, Heidelberg, VIC 3084, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA 6150, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Nandini Shankara-Narayana
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, and PA-Southside Clinical Unit, Medical School, the University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Alicia J Jenkins
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Karen Bracken
- Kolling Institute, University of Sydney, Sydney, NSW 2064, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA 506, Australia
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Robledo KP, Marschner IC, Handelsman DJ, Bracken K, Stuckey BGA, Yeap BB, Inder W, Grossmann M, Jesudason D, Allan CA, Wittert G. Mediation analysis of the testosterone treatment effect to prevent type 2 diabetes in the T4DM trial. Eur J Endocrinol 2023:lvad074. [PMID: 37406250 DOI: 10.1093/ejendo/lvad074] [Citation(s) in RCA: 2] [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: 03/16/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To determine if testosterone treatment effect on glycaemia is mediated through changes in total fat mass, abdominal fat mass, skeletal muscle mass, non-dominant handgrip, oestradiol (E2), and sex hormone-binding globulin (SHBG). DESIGN Mediation analysis of a randomised placebo-controlled trial of testosterone. METHODS Six Australian tertiary care centres recruited 1007 males, aged 50-74 years, with waist circumference ≥ 95 cm, serum total testosterone ≤ 14 nmol/L (immunoassay) and either impaired glucose tolerance or newly diagnosed type 2 diabetes on an oral glucose tolerance test (OGTT). Participants were enrolled in a lifestyle program and randomised 1:1 to 3 monthly injections of 1000 mg testosterone undecanoate or placebo for 2 years. Complete data were available for 709 participants (70%). Mediation analyses for the primary outcomes of type 2 diabetes at 2-years (OGTT ≥ 11.1 mmol/L and change in 2-hour glucose from baseline), incorporating potential mediators: changes in fat mass, % abdominal fat, skeletal muscle mass, non-dominant hand-grip strength, E2, and SHBG was performed. RESULTS For type 2 diabetes at 2-years, the unadjusted OR for treatment was 0.53 (95% CI:0.35-0.79), which became 0.48 (95% CI:0.30-0.76) after adjustment for covariates. Including potential mediators attenuated the treatment effect (OR 0.77; 95% CI:0.44-1.35; direct effect) with 65% mediated. Only fat mass remained prognostic in the full model (OR: 1.23; 95% CI: 1.09-1.39; p < 0.001). CONCLUSION At least part of the testosterone treatment effect was found to be mediated by changes in fat mass, abdominal fat, skeletal muscle mass, grip strength, SHBG, and E2, but predominantly by changes in fat mass.
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Affiliation(s)
- Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney; Locked bag 77, Camperdown NSW 1450, Australia
| | | | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Andrology Department, Concord Hospital
| | | | - Bronwyn G A Stuckey
- Medical School, University of Western Australia, Keogh Institute for Medical Research, and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands WA 6009, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch WA 6150, Australia
| | - Warrick Inder
- Princess Alexandra Hospital and University of Queensland
| | | | | | - Carolyn A Allan
- Hudson Research Institute and Monash University, Clayton Victoria, Australia
| | - Gary Wittert
- Freemasons Centre for Male health and Wellbeing, South Australian Health Medical Research Institute and University of Adelaide, Adelaide, Australia
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Williams ADN, Hood K, Bracken K, Shorter GW. The importance of NOT being Other: Time to address the invisibility of nuanced gender and sexuality in clinical trials. Trials 2023; 24:242. [PMID: 36998055 PMCID: PMC10064725 DOI: 10.1186/s13063-023-07278-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Representation of all members of society within research, especially those typically underserved, is needed to ensure that trial evidence applies to the relevant population, and that effective interventions are available to all. The lack of appropriate and representative options in demographic questions around sex, gender and sexuality may result in the exclusion of LGBTQIA + people from health research. MAIN BODY Sex and gender are not the same, yet this is rarely recognised in trial data collection, with the terms sex and gender often being used interchangeably. Sex or gender is often used as a stratification factor at randomisation and/or to define sub-groups at the time of data analysis, so correct data collection is essential for producing high-quality science. Sexuality also suffers from 'othering' with identities not being acknowledged but simply provided as an alternative to the perceived main identities. When collecting sexuality information, it is important to consider the purposes of collecting this data. CONCLUSION We call on those involved in trials to consider how sex, gender and sexuality data are collected, with an active consideration of inclusivity. Through the description of all non-straight, non-cisgender people as 'other' you may be ignoring the needs of these populations and doing science, yourself, and them a disservice. Inclusivity may require small but important changes to ensure your research findings are inclusive and develop the evidence base for often overlooked populations.
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Affiliation(s)
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, Wales, UK
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Gillian W Shorter
- Drug and Alcohol Research Network, Queen's University Belfast, Belfast, Northern Ireland, UK
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Ackermann DM, Bracken K, Janda M, Turner RM, Hersch JK, Drabarek D, Bell KJL. Strategies to Improve Adherence to Skin Self-examination and Other Self-management Practices in People at High Risk of Melanoma: A Scoping Review of Randomized Clinical Trials. JAMA Dermatol 2023; 159:432-440. [PMID: 36857048 DOI: 10.1001/jamadermatol.2022.6478] [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: 03/02/2023]
Abstract
Importance Adherence, both in research trials and in clinical practice, is crucial to the success of interventions. There is limited guidance on strategies to increase adherence and the measurement and reporting of adherence in trials of melanoma self-management practices. Objective This scoping review aimed to describe (1) strategies to improve adherence to self-management practices in randomized clinical trials of people at high risk of melanoma and (2) measurement and reporting of adherence data in these trials. Evidence Review Four databases, including MEDLINE, Embase, CENTRAL, and CINAHL, were searched from inception to July 2022. Eligible studies were randomized clinical trials of self-monitoring interventions for early detection of melanoma in people at increased risk due to personal history (eg, melanoma, transplant, dysplastic naevus syndrome), family history of melanoma, or as determined by a risk assessment tool or clinical judgment. Findings From 939 records screened, 18 eligible randomized clinical trials were identified, ranging in size from 40 to 724 participants, using a range of adherence strategies but with sparse evidence on effectiveness of the strategies. Strategies were classified as trial design (n = 15); social and economic support (n = 5); intervention design (n = 18); intervention and condition support (n = 10); and participant support (n = 18). No strategies were reported for supporting underserved groups (eg, people who are socioeconomically disadvantaged, have low health literacy, non-English speakers, or older adults) to adhere to self-monitoring practices, and few trials targeted provider (referring to both clinicians and researchers) adherence (n = 5). Behavioral support tools included reminders (n = 8), priority-setting guidance (n = 5), and clinician feedback (n = 5). Measurement of adherence was usually by participant report of skin self-examination practice with some recent trials of digital interventions also directly measuring adherence to the intervention through website or application analytic data. Reporting of adherence data was limited, and fewer than half of all reports mentioned adherence in their discussion. Conclusions and Relevance Using an adaptation of the World Health Organization framework for clinical adherence, this scoping review of randomized clinical trials identified key concepts as well as gaps in the way adherence is approached in design, conduct, and reporting of trials for skin self-examination and other self-management practices in people at high risk of melanoma. These findings may usefully guide future trials and clinical practice; evaluation of adherence strategies may be possible using a Study Within A Trial (SWAT) framework within host trials.
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Affiliation(s)
- Deonna M Ackermann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Bracken
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Jolyn K Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Niazi T, McBride SM, Williams S, Davis ID, Stockler MR, Martin AJ, Bracken K, Roncolato F, Horvath L, Sengupta S, Martin J, Lim T, Hughes S, McDermott RS, Catto JW, Kelly PJ, Parulekar WR, Morgan SC, Rendon RA, Sweeney C. DASL-HiCaP: Darolutamide augments standard therapy for localized very high-risk cancer of the prostate (ANZUP1801)—A randomized phase 3, double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps5103] [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: 11/20/2022] Open
Abstract
TPS5103 Background: Radiation therapy (RT), plus androgen deprivation therapy (ADT) with a luteinizing hormone releasing hormone analog (LHRHA), is standard of care for men with very high-risk localized prostate cancer (PC), or with very high-risk features and persistent PSA after radical prostatectomy (RP). Despite this, incurable distant metastases develop within 5 years in 15% of men with very high-risk features. Darolutamide is a structurally distinct oral androgen receptor antagonist with low blood-brain-barrier penetration, a demonstrated favorable safety profile, and low potential for drug-drug interactions. Our aim is to determine the efficacy of adding darolutamide to ADT and RT in the setting of either primary definitive therapy, or salvage therapy for very high-risk PC. Methods: This study is a randomized (1:1), phase 3, placebo-controlled, double-blind trial for men planned for RT who have very high-risk localized PC on conventional imaging; or very high-risk features with PSA persistence or rise within one year following RP. The trial is stratified by: RP; use of adjuvant docetaxel; pelvic nodal involvement. 1100 participants will be randomized to darolutamide 600 mg or placebo twice daily for 96 weeks. Participants will receive LHRHA for 96 weeks, plus RT starting week 8-24 from randomization. Participants are allowed nonsteroidal antiandrogen in addition to LHRHA for up to 90 days prior to randomization. Early treatment with up to 6 cycles of docetaxel completed at least 4 weeks prior to RT is permitted. The primary endpoint is metastasis-free survival (ICECaP-validated), with secondary endpoints overall survival, PC-specific survival, PSA-progression free survival, time to subsequent hormonal therapy, time to castration-resistance, frequency and severity of adverse events, health related quality of life, fear of recurrence. Tertiary endpoints include incremental cost-effectiveness, and identification of prognostic and/or predictive biomarkers of treatment response, safety, and resistance to study treatment. Clinical trial information: NCT04136353.
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Affiliation(s)
- Tamim Niazi
- Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | - Scott Williams
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Ian D. Davis
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Felicia Roncolato
- NHMRC Clinical Trials Center, University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Tee Lim
- Fiona Stanley Hospital, Murdoch, Australia
| | - Simon Hughes
- Guy's Cancer, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - James W.F. Catto
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, United Kingdom
| | | | | | | | - Ricardo A. Rendon
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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McBride SM, Niazi T, Williams S, Davis ID, Stockler MR, Martin AJ, Bracken K, Roncolato FT, Horvath L, Sengupta S, Martin J, Lim T, Hughes S, McDermott RS, Catto JW, Kelly PJ, Parulekar WR, Morgan SC, Rendon RA, Sweeney C. DASL-HiCaP: Darolutamide augments standard therapy for localized very high-risk cancer of the prostate (ANZUP1801). a randomized phase 3 double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.tps284] [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: 11/20/2022] Open
Abstract
TPS284 Background: Radiation therapy (RT), plus androgen deprivation therapy (ADT) with a luteinizing hormone releasing hormone analog (LHRHA), is standard of care for men with very high-risk localized prostate cancer (PC), or with very high-risk features and persistent PSA after radical prostatectomy (RP). Despite this, incurable distant metastases develop within 5 years in 15% of men with very high-risk features. Darolutamide is a structurally distinct oral androgen receptor antagonist with low blood-brain-barrier penetration, a demonstrated favorable safety profile, and low potential for drug-drug interactions. Our aim is to determine the efficacy of adding darolutamide to ADT and RT in the setting of either primary definitive therapy, or salvage therapy for very high-risk PC. Methods: This study is a randomized (1:1), phase 3, placebo-controlled, double-blind international trial for men planned for RT who have very high-risk localized PC on conventional imaging; or very high-risk features with PSA persistence or rise within one year following RP. The trial is stratified by: RP; use of adjuvant docetaxel; pelvic nodal involvement. 1100 participants will be randomized to darolutamide 600 mg or placebo twice daily for 96 weeks in combination with SOC: LHRHA for 96 weeks, plus RT starting week 8-24 from randomization. Participants are allowed nonsteroidal antiandrogen in addition to LHRHA for up to 90 days prior to randomization. Early treatment with up to 6 cycles of docetaxel completed at least 4 weeks prior to RT is permitted. The primary endpoint is metastasis-free survival (ICECaP-validated), with secondary endpoints overall survival, PC-specific survival, PSA-progression free survival, time to subsequent hormonal therapy, time to castration-resistance, frequency and severity of adverse events, health related quality of life, fear of recurrence. Tertiary endpoints include incremental cost-effectiveness, and identification of prognostic and/or predictive biomarkers of treatment response, safety, and resistance to study treatment. Clinical trial information: NCT04136353.
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Affiliation(s)
| | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Scott Williams
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Ian D. Davis
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Center, University of Sydney, Sydney, NSW, Australia
| | | | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Lisa Horvath
- Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | | | | | - Tee Lim
- Fiona Stanley Hospital, Murdoch, Australia
| | - Simon Hughes
- Guy's Cancer, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - James W.F. Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Paul J. Kelly
- Bon Secours Radiotherapy Cork, in partnership with UPMC Hillman Cancer Centre, Cork, Ireland
| | | | | | - Ricardo A. Rendon
- Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
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10
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Handelsman DJ, Desai R, Conway AJ, Shankara-Narayana N, Stuckey BGA, Inder WJ, Grossmann M, Yeap BB, Jesudason D, Ly LP, Bracken K, Wittert GA. Recovery of male reproductive endocrine function after ceasing prolonged testosterone undecanoate injections. Eur J Endocrinol 2022; 186:307-318. [PMID: 35000898 DOI: 10.1530/eje-21-0608] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 06/07/2021] [Accepted: 01/06/2022] [Indexed: 11/08/2022]
Abstract
CONTEXT The time course of male reproductive hormone recovery after stopping injectable testosterone undecanoate (TU) treatment is not known. OBJECTIVE The aim of this study was to investigate the rate, extent, and determinants of reproductive hormone recovery over 12 months after stopping TU injections. MATERIALS AND METHODS Men (n = 303) with glucose intolerance but without pathologic hypogonadism who completed a 2-year placebo (P)-controlled randomized clinical trial of TU treatment were recruited for further 12 months while remaining blinded to treatment. Sex steroids (testosterone (T), dihydrotestosterone, oestradiol, oestrone) by liquid chromatography-mass sprectometry, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) by immunoassays and sexual function questionnaires (Psychosexual Diary Questionnaire, International Index of Erectile Function, and short form survey (SF-12)) were measured at entry (3 months after the last injection) and 6, 12, 18, 24, 40, and 52 weeks later. RESULTS In the nested cohort of TU-treated men, serum T was initially higher but declined at 12 weeks remaining stable thereafter with serum T and SHBG at 11 and 13%, respectively, lower than P-treated men. Similarly, both questionnaires showed initial carry-over higher scores in T-treated men but after 18 weeks showed no difference between T- and P-treated men. Initially, fully suppressed serum LH and FSH recovered slowly towards the participant's own pre-treatment baseline over 12 months since the last injection. CONCLUSIONS After stopping 2 years of 1000 mg injectable TU treatment, full reproductive hormone recovery is slow and progressive over 15 months since the last testosterone injection but may take longer than 12 months to be complete. Persistent proportionate reduction in serum SHBG and T reflects lasting exogenous T effects on hepatic SHBG secretion rather than androgen deficiency.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Andrology, Concord Hospital, Concord, Australia
| | - Reena Desai
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Andrology, Concord Hospital, Concord, Australia
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Andrology, Concord Hospital, Concord, Australia
| | - Nandini Shankara-Narayana
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Andrology, Concord Hospital, Concord, Australia
| | - Bronwyn G A Stuckey
- Department of Endocrinology and Diabetes, Keogh Institute for Medical Research, Sir Charles Gairdner Hospital and University of Western Australia, Western Australia, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and the University of Queensland, Queensland, Australia
| | - Mathis Grossmann
- The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Bu Beng Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - David Jesudason
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
| | - Lam P Ly
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Andrology, Concord Hospital, Concord, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Gary Allen Wittert
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
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11
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Ng Tang Fui M, Hoermann R, Bracken K, Handelsman DJ, Inder WJ, Stuckey BGA, Yeap BB, Ghasem-Zadeh A, Robledo KP, Jesudason D, Zajac JD, Wittert GA, Grossmann M. Effect of Testosterone Treatment on Bone Microarchitecture and Bone Mineral Density in Men: A 2-Year RCT. J Clin Endocrinol Metab 2021; 106:e3143-e3158. [PMID: 33693907 DOI: 10.1210/clinem/dgab149] [Citation(s) in RCA: 21] [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: 12/20/2020] [Indexed: 01/16/2023]
Abstract
CONTEXT Testosterone treatment increases bone mineral density (BMD) in hypogonadal men. Effects on bone microarchitecture, a determinant of fracture risk, are unknown. OBJECTIVE We aimed to determine the effect of testosterone treatment on bone microarchitecture using high resolution-peripheral quantitative computed tomography (HR-pQCT). METHODS Men ≥ 50 years of age were recruited from 6 Australian centers and were randomized to receive injectable testosterone undecanoate or placebo over 2 years on the background of a community-based lifestyle program. The primary endpoint was cortical volumetric BMD (vBMD) at the distal tibia, measured using HR-pQCT in 177 men (1 center). Secondary endpoints included other HR-pQCT parameters and bone remodeling markers. Areal BMD (aBMD) was measured by dual-energy x-ray absorptiometry (DXA) in 601 men (5 centers). Using a linear mixed model for repeated measures, the mean adjusted differences (95% CI) at 12 and 24 months between groups are reported as treatment effect. RESULTS Over 24 months, testosterone treatment, versus placebo, increased tibial cortical vBMD, 9.33 mg hydroxyapatite (HA)/cm3) (3.96, 14.71), P < 0.001 or 3.1% (1.2, 5.0); radial cortical vBMD, 8.96 mg HA/cm3 (3.30, 14.62), P = 0.005 or 2.9% (1.0, 4.9); total tibial vBMD, 4.16 mg HA/cm3 (2.14, 6.19), P < 0.001 or 1.3% (0.6, 1.9); and total radial vBMD, 4.42 mg HA/cm3 (1.67, 7.16), P = 0.002 or 1.8% (0.4, 2.0). Testosterone also significantly increased cortical area and thickness at both sites. Effects on trabecular architecture were minor. Testosterone reduced bone remodeling markers CTX, -48.1 ng/L [-81.1, -15.1], P < 0.001 and P1NP, -6.8 μg/L[-10.9, -2.7], P < 0.001. Testosterone significantly increased aBMD at the lumbar spine, 0.04 g/cm2 (0.03, 0.05), P < 0.001 and the total hip, 0.01 g/cm2 (0.01, 0.02), P < 0.001. CONCLUSION In men ≥ 50 years of age, testosterone treatment for 2 years increased volumetric bone density, predominantly via effects on cortical bone. Implications for fracture risk reduction require further study.
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Affiliation(s)
- Mark Ng Tang Fui
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Rudolf Hoermann
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, 2050, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney New South Wales, 2139, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and the University of Queensland, Queensland, 4102, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital and University of Western Australia, Western Australia, 6009, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia and Department of Endocrinology and Diabetes, Freemantle & Fiona Stanley Hospital, Perth, Western Australia, 6150, Australia
| | - Ali Ghasem-Zadeh
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, 2050, Australia
| | - David Jesudason
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia, and The Queen Elizabeth Hospital, South Australia, 5000, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia, and The Queen Elizabeth Hospital, South Australia, 5000, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, 3084, Australia
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12
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Shankara-Narayana N, Desai R, Conway A, Stuckey BGA, Inder WJ, Grossmann M, Yeap BB, McLachlan RI, Lam LP, Bracken K, Wittert GA, Handelsman DJ. Recovery of Male Reproductive Endocrine Function Following Prolonged Injectable Testosterone Undecanoate Treatment. J Endocr Soc 2021. [PMCID: PMC8265856 DOI: 10.1210/jendso/bvab048.1478] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Exogenous androgen treatment suppresses the hypothalamo-pituitary testicular (HPT) axis causing reduced serum LH, FSH and testosterone (T). Recovery of male reproductive endocrine function in past androgen abusers takes 9-18 months with persistent mild lowering of serum T. The natural history of recovery of HPT axis following prolonged injectable testosterone undecanoate (TU) treatment at standard dose is not known. Therefore, the Runoff Study investigated the rate and extent of reproductive hormone recovery over 12 months following cessation of 2 years of TU treatment in the Testosterone for Diabetes Mellitus (T4DM) Study, while men remain blinded to treatment allocation. Methods: T4DM participants without pathological hypogonadism (n=1007) were randomised to TU or Placebo (P) injections every 3 months for 2 years with 303 subsequently volunteering to enter the Runoff study at 12 weeks after last injection. Before T4DM study unblinding, they provided blood samples and validated sexual function questionnaires (PDQ, IIEF-15) at entry (3 months after last injection), 6, 12, 18, 24, 40 and 52 weeks later. Serum steroid profile (T, DHT, E2, E1) was measured batchwise by LCMS and serum LH, FSH and SHBG by immunoassays. Results: Runoff study participants in both groups were similar and did not differ from all T4DM participants. As expected, at entry to Runoff serum T was higher in TU-treated men but at all timepoints from 12 weeks onwards serum T and SHBG remained consistently 11% and 13%, respectively, lower in TU-treated than in P-treated men. Similarly, at entry sexual function scores were higher in TU-treated men but subsequently no different from P-treated men. Serum LH and FSH recovered slowly with the median time to reach their own pre-treatment baseline of serum LH was 51.1 weeks [95% CI 50.4 – 53.0 weeks] and for serum FSH was 52.7 weeks [51.0 – 60.9 weeks]. Conclusion: After stopping 2 years of standard dose injectable TU treatment in men without pathological hypogonadism, recovery of testicular endocrine function is eventually complete but slow with serum gonadotropin recovery taking on 12 months since the last dose. Persistent mild, proportionate reduction in serum SHBG and T reflects lasting exogenous T effects on hepatic SHBG secretion rather than signifying androgen deficiency. This suggests that recovery from androgen-induced HPT axis suppression depends primarily on time since cessation rather than dose or duration of androgen exposure.
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Affiliation(s)
| | | | - Ann Conway
- Concord Repatriation General Hospital, Sydney, Australia
| | | | | | - Mathis Grossmann
- University of Melbourne/Austin Health, Heidelberg, VIC, Australia
| | - Bu Beng Yeap
- University of Western Australia, Crawley, Australia
| | | | - Ly P Lam
- ANZAC Research Institute, Sydney, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
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13
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Niazi T, Williams S, Davis ID, Stockler MR, Martin AJ, Bracken K, Roncolato F, Horvath L, Martin J, Lim TS, Hughes S, McDermott RS, Catto JWF, Kelly PJ, McBride SM, Parulekar WR, Morgan SC, Rendon RA, Sweeney C. DASL-HiCaP: Darolutamide augments standard therapy for localized very high-risk cancer of the prostate (ANZUP1801)—A randomized phase III double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.tps266] [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: 11/20/2022] Open
Abstract
TPS266 Background: Radiation therapy (RT), plus androgen deprivation therapy (ADT) with a luteinizing hormone releasing hormone analogue (LHRHA), is standard of care for men with very high-risk localized prostate cancer (PC), or with very high- risk features and persistent PSA after radical prostatectomy (RP). Despite this, incurable distant metastases develop within 5 years in 15% of men with very high-risk features. Darolutamide is a structurally distinct oral androgen receptor antagonist with low blood-brain-barrier penetration, a demonstrated favorable safety profile and low potential for drug-drug interactions. Our aim is to determine the efficacy of adding darolutamide to ADT and RT in the setting of either primary definitive therapy, or adjuvant therapy for very high-risk PC. Methods: This study is a randomized (1:1) phase III placebo-controlled, double-blind trial for men planned for RT who have very high-risk localized PC; or very high-risk features with PSA persistence or rise within one year following RP. The trial will be stratified by: RP; use of adjuvant docetaxel; pelvic nodal involvement. 1100 participants will be randomized to darolutamide 600 mg or placebo twice daily for 96 weeks. Participants will receive LHRHA for 96 weeks, plus RT starting week 8-24 from randomisation. Participants are allowed nonsteroidal antiandrogen (up to 90 days) in addition to LHRHA up until randomisation. Early treatment with up to 6 cycles of docetaxel completed at least 4 weeks prior to RT is permitted. The primary endpoint is metastasis-free survival (ICECaP-validated), with secondary endpoints overall survival, PC-specific survival, PSA-progression free survival, time to subsequent hormonal therapy, time to castration-resistance, frequency and severity of adverse events, health related quality of life, fear of recurrence. Tertiary endpoints include incremental cost-effectiveness, and identification of prognostic and/or predictive biomarkers of treatment response, safety and resistance to study treatment. Clinical trial information: NCT04136353.
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Affiliation(s)
- Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Ian D. Davis
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Center, University of Sydney, Sydney, NSW, Australia
| | | | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Felicia Roncolato
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Lisa Horvath
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | | | - Tee Sin Lim
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Simon Hughes
- Guy's Cancer, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - James WF Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Paul J. Kelly
- Bon Secours Radiotherapy Cork, in partnership with UPMC Hillman Cancer Centre, Cork, Ireland
| | | | | | | | - Ricardo A. Rendon
- Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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14
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Wittert G, Bracken K, Robledo KP, Grossmann M, Yeap BB, Handelsman DJ, Stuckey B, Conway A, Inder W, McLachlan R, Allan C, Jesudason D, Fui MNT, Hague W, Jenkins A, Daniel M, Gebski V, Keech A. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol 2021; 9:32-45. [PMID: 33338415 DOI: 10.1016/s2213-8587(20)30367-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [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] [Received: 06/27/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Men who are overweight or obese frequently have low serum testosterone concentrations, which are associated with increased risk of type 2 diabetes. We aimed to determine whether testosterone treatment prevents progression to or reverses early type 2 diabetes, beyond the effects of a community-based lifestyle programme. METHODS T4DM was a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial done at six Australian tertiary care centres. Men aged 50-74 years, with a waist circumference of 95 cm or higher, a serum testosterone concentration of 14·0 nmol/L or lower but without pathological hypogonadism, and impaired glucose tolerance (oral glucose tolerance test [OGTT] 2-h glucose 7·8-11·0 mmol/L) or newly diagnosed type 2 diabetes (provided OGTT 2-h glucose ≤15·0 mmol/L) were enrolled in a lifestyle programme and randomly assigned (1:1) to receive an intramuscular injection of testosterone undecanoate (1000 mg) or placebo at baseline, 6 weeks, and then every 3 months for 2 years. Randomisation was done centrally, including stratification by centre, age group, waist circumference, 2-h OGTT glucose, smoking, and first-degree family history of type 2 diabetes. The primary outcomes at 2 years were type 2 diabetes (2-h OGTT glucose ≥11·1 mmol/L) and mean change from baseline in 2-h OGTT glucose, assessed by intention to treat. For safety assessment, we did a masked monitoring of haematocrit and prostate-specific antigen, and analysed prespecified serious adverse events. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12612000287831. FINDINGS Between Feb 5, 2013, and Feb 27, 2017, of 19 022 men who were pre-screened, 1007 (5%) were randomly assigned to the placebo (n=503) and testosterone (n=504) groups. At 2 years, 2-h glucose of 11·1 mmol/L or higher on OGTT was reported in 87 (21%) of 413 participants with available data in the placebo group and 55 (12%) of 443 participants in the testosterone group (relative risk 0·59, 95% CI 0·43 to 0·80; p=0·0007). The mean change from baseline 2-h glucose was -0·95 mmol/L (SD 2·78) in the placebo group and -1·70 mmol/L (SD 2·47) in the testosterone group (mean difference -0·75 mmol/L, -1·10 to -0·40; p<0·0001). The treatment effect was independent of baseline serum testosterone. A safety trigger for haematocrit greater than 54% occurred in six (1%) of 484 participants in the placebo group and 106 (22%) of 491 participants in the testosterone group, and a trigger for an increase of 0·75 μg/mL or more in prostate-specific antigen occurred in 87 (19%) of 468 participants in the placebo group and 109 (23%) of 480 participants in the testosterone group. Prespecified serious adverse events occurred in 37 (7·4%, 95% CI 5·4 to 10·0) of 503 patients in the placebo group and 55 (10·9%, 8·5 to 13·9) of 504 patients in the testosterone group. There were two deaths in each group. INTERPRETATION Testosterone treatment for 2 years reduced the proportion of participants with type 2 diabetes beyond the effects of a lifestyle programme. Increases in haematocrit might be treatment limiting. Longer-term durability, safety, and cardiovascular effects of the intervention remain to be further investigated. FUNDING Australian National Health and Medical Research Council, Bayer, Eli Lilly, University of Adelaide, and WW (formerly Weight Watchers).
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Affiliation(s)
- Gary Wittert
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, Australia
| | - Bronwyn Stuckey
- Medical School, University of Western Australia, Perth, WA, Australia; Keogh Institute for Medical Research, Perth, WA, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Ann Conway
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research and Monash University, Clayton, VIC, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research and Monash University, Clayton, VIC, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Mark Ng Tang Fui
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Mark Daniel
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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15
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Niazi T, Williams S, Davis I, Stockler M, Martin A, Bracken K, Roncolato F, McJannett M, Horvath L, Sengupta S, Hughes S, McDermott R, Catto J, Kelly P, Vapiwala N, Parulekar W, Morgan S, Rendon R, Sweeney C. 694TiP DASL-HiCaP: Darolutamide augments standard therapy for localised very high-risk cancer of the prostate (ANZUP1801). A randomised phase III double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2088] [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: 11/16/2022] Open
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16
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Niazi T, Williams S, Davis ID, Stockler MR, Martin AJ, Hague W, Bracken K, Gorzeman M, Roncolato F, Yip S, Horvath L, Sengupta S, Hughes S, McDermott RS, Catto JWF, Vapiwala N, Parulekar WR, Sweeney C. DASL-HiCAP (ANZUP1801): The impact of darolutamide on standard therapy for localized very high-risk cancer of the prostate—A randomized phase III double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation in very high-risk, clinically localized prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS385 Background: Radiation therapy (RT), plus androgen deprivation therapy (ADT) with a luteinising hormone releasing hormone analogue (LHRHA) for at least one year, is standard of care for men with very high-risk localised prostate cancer (PC), or with very high-risk features and persistent PSA after radical prostatectomy (RP). Despite this, incurable distant metastases develop within 5 years in 15% of men with very high risk features. Darolutamide is an androgen receptor antagonist with favourable tolerability. Our aim is to determine the efficacy of adding darolutamide to ADT and RT given in the setting of either primary definitive therapy (RP or RT), or adjuvant therapy for very high-risk PC. Methods: This study is a randomised (1:1) phase III placebo-controlled, double-blind trial for men planned for RT who have very high-risk localised PC, or very high-risk features with PSA persistence or rise within one year following RP. The trial will be stratified by: use of adjuvant docetaxel; pelvic nodal involvement; RP. 1100 participants will be randomised to darolutamide 600 mg or placebo twice daily for 96 weeks. Participants will receive LHRHA for 96 weeks, plus RT starting week 8-24 from randomisation. Participants are allowed nonsteroidal antiandrogen (up to 90 days) in addition to LHRHA up until randomisation. Early treatment with 6 cycles of docetaxel completed at least 4 weeks prior to RT is permitted. The primary endpoint is metastasis-free survival, with secondary endpoints overall survival, PC-specific survival, PSA-progression free survival, time to subsequent hormonal therapy, time to castration-resistance, frequency and severity of adverse events, health related quality of life, fear of recurrence. Tertiary endpoints include incremental cost-effectiveness, and identification of prognostic and/or predictive biomarkers of treatment response, safety and resistance to study treatment. Clinical trial information: NCT04136353.
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Affiliation(s)
- Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Ian D. Davis
- Monash University Eastern Health Clinical School, Melbourne, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Margot Gorzeman
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Sonia Yip
- Sydney Catalyst Translational Cancer Research Centre, Sydney, Australia
| | | | - Shomik Sengupta
- Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Australia
| | - Simon Hughes
- Guy's Cancer, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Raymond S. McDermott
- Adelaide and Meath Hospital (Incorporating the National Children's Hospital), Dublin, Ireland
| | - James WF Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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17
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Bracken K, Keech A, Hague W, Allan C, Conway A, Daniel M, Gebski V, Grossmann M, Handelsman DJ, Inder WJ, Jenkins A, McLachlan R, Robledo KP, Stuckey B, Yeap BB, Wittert G. A high-volume, low-cost approach to participant screening and enrolment: Experiences from the T4DM diabetes prevention trial. Clin Trials 2019; 16:589-598. [PMID: 31581816 DOI: 10.1177/1740774519872999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Participant recruitment to diabetes prevention randomised controlled trials is challenging and expensive. The T4DM study, a multicentre, Australia-based, Phase IIIb randomised controlled trial of testosterone to prevent Type 2 diabetes in men aged 50-74 years, faced the challenge of screening a large number of prospective participants at a small number of sites, with few staff, and a limited budget for screening activities. This article evaluates a high-volume, low-cost, semi-automated approach to screen and enrol T4DM study participants. METHODS We developed a sequential multi-step screening process: (1) web-based pre-screening, (2) laboratory screening through a network of third-party pathology centres, and (3) final on-site screening, using online data collection, computer-driven eligibility checking, and automated, email-based communication with prospective participants. Phone- and mail-based data collection and communication options were available to participants at their request. The screening process was administered by the central coordinating centre through a central data management system. RESULTS Screening activities required staffing of approximately 1.6 full-time equivalents over 4 years. Of 19,022 participants pre-screened, 13,108 attended a third-party pathology collection centre for laboratory screening, 1217 received final, on-site screening, and 1007 were randomised. In total, 95% of the participants opted for online pre-screening over phone-based pre-screening. Screening costs, including both direct and staffing costs, totalled AUD1,420,909 (AUD75 per subject screened and AUD1411 per randomised participant). CONCLUSION A multi-step, semi-automated screening process with web-based pre-screening facilitated low-cost, high-volume participant enrolment to this large, multicentre randomised controlled trial. Centralisation and automation of screening activities resulted in substantial savings compared to previous, similar studies. Our screening approach could be adapted to other randomised controlled trial settings to minimise the cost of screening large numbers of participants.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Ann Conway
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Mark Daniel
- University of Canberra, Canberra, ACT, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mathis Grossmann
- The Austin Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Bronwyn Stuckey
- Keogh Institute of Medical Research and The University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Bracken K, Hague W, Keech A, Conway A, Handelsman DJ, Grossmann M, Jesudason D, Stuckey B, Yeap BB, Inder W, Allan C, McLachlan R, Robledo KP, Wittert G. Recruitment of men to a multi-centre diabetes prevention trial: an evaluation of traditional and online promotional strategies. Trials 2019; 20:366. [PMID: 31217024 PMCID: PMC6585027 DOI: 10.1186/s13063-019-3485-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Effective interventions are required to prevent the current rapid increase in the prevalence of Type 2 diabetes. Clinical trials of large-scale interventions to prevent Type 2 diabetes are essential but recruitment is challenging and expensive, and there are limited data regarding the most cost-effective and efficient approaches to recruitment. This paper aims to evaluate the cost and effectiveness of a range of promotional strategies used to recruit men to a large Type 2 diabetes prevention trial. Methods An observational study was conducted nested within the Testosterone for the Prevention of Type 2 Diabetes (T4DM) study, a large, multi-centre randomised controlled trial (RCT) of testosterone treatment for the prevention of Type 2 diabetes in men aged 50–74 years at high risk of developing diabetes. Study participation was promoted via mainstream media—television, newspaper and radio; direct marketing using mass mail-outs, publicly displayed posters and attendance at local events; digital platforms, including Facebook and Google; and online promotions by community organisations and businesses. For each strategy, the resulting number of participants and the direct cost involved were recorded. The staff effort required for each strategy was estimated based on feedback from staff. Results Of 19,022 men screened for the study, 1007 (5%) were enrolled. The most effective recruitment strategies were targeted radio advertising (accounting for 42% of participants), television news coverage (20%) and mass mail-outs (17%). Other strategies, including radio news, publicly displayed posters, attendance at local events, newspaper advertising, online promotions and Google and Facebook advertising, each accounted for no more than 4% of enrolled participants. Recruitment promotions cost an average of AU$594 per randomised participant. The most cost-effective paid strategy was mass mail-outs by a government health agency (AU$745 per participant). Other paid strategies were more expensive: mail-out by general practitioners (GPs) (AU$1104 per participant), radio advertising (AU$1081) and newspaper advertising (AU$1941). Conclusion Radio advertising, television news coverage and mass mail-outs by a government health agency were the most effective recruitment strategies. Close monitoring of recruitment outcomes and ongoing enhancement of recruitment activities played a central role in recruitment to this RCT. Trial registration ANZCTR, ID: ACTRN12612000287831. Registered on 12 March 2012. Electronic supplementary material The online version of this article (10.1186/s13063-019-3485-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Ann Conway
- Anzac Research Institute, and Andrology Department, Concord Hospital, Sydney, NSW, Australia
| | - David J Handelsman
- Anzac Research Institute, and Andrology Department, Concord Hospital, Sydney, NSW, Australia
| | - Mathis Grossmann
- Department of Medicine, the University of Melbourne, and Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | | | - Bronwyn Stuckey
- Department of Endocrinology and Diabetes, Keogh Institute of Medical Research, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Medical School, University of Western Australia and Fiona Stanley Hospital, Perth, WA, Australia
| | - Warrick Inder
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
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Bracken K, Keech A, Hague W, Kirby A, Robledo KP, Allan C, Conway A, Daniel M, Gebski V, Grossmann M, Handelsman DJ, Inder W, Jenkins A, McLachlan R, Stuckey B, Yeap BB, Wittert G. Telephone call reminders did not increase screening uptake more than SMS reminders: a recruitment study within a trial. J Clin Epidemiol 2019; 112:45-52. [PMID: 31051248 DOI: 10.1016/j.jclinepi.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/14/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to compare the response rates and costs of phone call vs. short message service (SMS) screening reminders to prospective randomized controlled trial (RCT) participants. STUDY DESIGN AND SETTING This study was a randomized evaluation within a large Australian diabetes prevention RCT. Participants were men aged 50-74 years, overweight or obese, without a previous type 2 diabetes diagnosis. Those eligible on a prescreening questionnaire who did not attend a further screening assessment within 4 weeks were randomized to receive an SMS or phone call reminder (N = 709). The primary outcome was attendance for further screening assessment within 8 weeks of prescreening. RESULTS Attendance was 18% (62/354) in the SMS reminder group, and 23% (80/355) in the phone reminder group, with no statistically significant difference in response according to reminder type (relative risk = 1.29, 95% confidence interval [CI]: 0.96-1.73, P = 0.09). The lower confidence limits for response to SMS (95% CI: 14-22%) and phone reminders (95% CI: 18-27%) did not include the 8-week attendance rate before this evaluation, 12%. Phone reminders cost substantially more than SMS reminders (AU$6.21 vs. AU$0.53 per reminder). CONCLUSION SMS reminders were as adequate a method as phone reminders to boost RCT screening uptake and were considerably more affordable.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Mathis Grossmann
- Department of Medicine, The Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Bronwyn Stuckey
- Keogh Institute of Medical Research and Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital and Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Bracken K, Askie L, Keech AC, Hague W, Wittert G. Recruitment strategies in randomised controlled trials of men aged 50 years and older: a systematic review. BMJ Open 2019; 9:e025580. [PMID: 30948584 PMCID: PMC6500287 DOI: 10.1136/bmjopen-2018-025580] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/17/2018] [Accepted: 02/13/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To identify and review evaluations of strategies to recruit men aged 50 years and over to randomised controlled trials (RCTs). DESIGN Systematic review and narrative synthesis. DATA SOURCES MEDLINE, EMBASE, CINAHL and ORRCA databases were searched to 1 December 2017. ELIGIBILITY CRITERIA Studies using quantitative methods to evaluate recruitment strategies to RCTs of men aged 50 years and older. DATA EXTRACTION AND SYNTHESIS A single reviewer extracted data (for each strategy, number of participants approached, screened and randomised, and cost). Study quality was assessed using National Heart, Lung and Blood Institute Quality Assessment Tools and considered study design, description of interventions, description and measurement of outcomes, completeness of outcome reporting, performance of statistical testing and consideration of confounders. Recruitment strategies were categorised by the recruitment stage they addressed. RESULTS Sixteen studies (n >14 000) were included: one good quality, ten fair quality and five poor quality. Studies evaluated strategies to identify prospective participants, and to improve the processes for assessing participant eligibility, providing participant information and seeking consent. In good and fair quality studies, the most effective strategies for identifying participants were referral from an affiliated health service provider (two studies), mass mailing (five studies) and media coverage (two studies). Community outreach activities such as displaying posters and attending local community events were not effective (two studies). Trial-specific training of site recruitment staff, developed using qualitative analysis of recruitment visits (two studies), and provision of study information to prospective participants at a multidisciplinary, group information session (one study) both improved recruitment. CONCLUSION Improved engagement of men aged 50 years and older in RCTs is needed. A gender-sensitised approach to RCT recruitment may help to address this need. We have identified several promising recruitment strategies that merit further evaluation. PROSPERO REGISTRATION NUMBER CRD42017060301.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Gary Wittert
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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21
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Wittert G, Atlantis E, Allan C, Bracken K, Conway A, Daniel M, Gebski V, Grossmann M, Hague W, Handelsman DJ, Inder W, Jenkins A, Keech A, McLachlan R, Robledo K, Stuckey B, Yeap BB. Testosterone therapy to prevent type 2 diabetes mellitus in at-risk men (T4DM): Design and implementation of a double-blind randomized controlled trial. Diabetes Obes Metab 2019; 21:772-780. [PMID: 30520208 DOI: 10.1111/dom.13601] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 10/18/2018] [Revised: 11/18/2018] [Accepted: 12/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). AIMS To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. STUDY POPULATION Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). SETTING, DRUG AND PROTOCOL Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. PRIMARY ENDPOINTS: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. SECONDARY ENDPOINTS Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. SAFETY Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. SUB-STUDIES: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.
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Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Evan Atlantis
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mathis Grossmann
- Dept. of Medicine, The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Woolloongabba, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, and Medical School, University of Western Australia, Perth, Western Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, and Medical School University of Western Australia, Perth, Western Australia
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22
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Wittert G, Atlantis E, Allan C, Bracken K, Conway A, Daniel M, Gebski V, Grossmann M, Hague W, Handelsman DJ, Inder W, Jenkins A, Keech A, McLachlan R, Robledo K, Stuckey B, Yeap BB. Testosterone therapy to prevent type 2 diabetes mellitus in at-risk men (T4DM): Design and implementation of a double-blind randomized controlled trial. Diabetes Obes Metab 2018. [PMID: 30520208 DOI: 10.1111/dom.13601.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). AIMS To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. STUDY POPULATION Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). SETTING, DRUG AND PROTOCOL Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. PRIMARY ENDPOINTS: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. SECONDARY ENDPOINTS Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. SAFETY Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. SUB-STUDIES: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.
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Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Evan Atlantis
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mathis Grossmann
- Dept. of Medicine, The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Woolloongabba, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, and Medical School, University of Western Australia, Perth, Western Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, and Medical School University of Western Australia, Perth, Western Australia
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Ho A, Chau N, Bauman J, Bible K, Chintakuntlawar A, Cabanillas M, Wong D, Braña Garcia I, Brose M, Boni V, Even C, Razaq M, Mishra V, Bracken K, Wages D, Scholz C, Gualberto A. Preliminary results from a phase II trial of tipifarnib in squamous cell carcinomas (SCCs) with HRAS mutations. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McDonald S, Pullenayegum E, Taylor V, Lutsiv O, Bracken K, Good C, Hutton E, Chen A, Hutchison R, Malott A, McDonald H, Sword W. Three-quarters of overweight and obese women are planning on exceeding the gestational weight gain recommendations. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)52180-x] [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: 10/27/2022]
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Chen D, Hackbarth C, Ni ZJ, Wu C, Wang W, Jain R, He Y, Bracken K, Weidmann B, Patel DV, Trias J, White RJ, Yuan Z. Peptide deformylase inhibitors as antibacterial agents: identification of VRC3375, a proline-3-alkylsuccinyl hydroxamate derivative, by using an integrated combinatorial and medicinal chemistry approach. Antimicrob Agents Chemother 2004; 48:250-61. [PMID: 14693547 PMCID: PMC310177 DOI: 10.1128/aac.48.1.250-261.2004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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: 11/20/2022] Open
Abstract
Peptide deformylase (PDF), a metallohydrolase essential for bacterial growth, is an attractive target for use in the discovery of novel antibiotics. Focused chelator-based chemical libraries were constructed and screened for inhibition of enzymatic activity, inhibition of Staphylococcus aureus growth, and cytotoxicity. Positive compounds were selected based on the results of all three assays. VRC3375 [N-hydroxy-3-R-butyl-3-(2-S-(tert-butoxycarbonyl)-pyrrolidin-1-ylcarbonyl)propionamide] was identified as having the most favorable properties through an integrated combinatorial and medicinal chemistry effort. This compound is a potent PDF inhibitor with a K(i) of 0.24 nM against the Escherichia coli Ni(2+) enzyme, possesses activity against gram-positive and gram-negative bacterial pathogens, and has a low cytotoxicity. Mechanistic experiments demonstrate that the compound inhibits bacterial growth through PDF inhibition. Pharmacokinetic studies of this drug in mice indicate that VRC3375 is orally bioavailable and rapidly distributed among various tissues. VRC3375 has in vivo activity against S. aureus in a murine septicemia model, with 50% effective doses of 32, 17, and 21 mg/kg of body weight after dosing by intravenous (i.v.), subcutaneous (s.c.), and oral (p.o.) administration, respectively. In murine single-dose toxicity studies, no adverse effects were observed after dosing with more than 400 mg of VRC3375 per kg by i.v., p.o., or s.c. administration. The in vivo efficacy and low toxicity of VRC3375 suggest the potential for developing this class of compounds to be used in future antibacterial drugs.
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Affiliation(s)
- D Chen
- Vicuron Pharmaceuticals, Fremont, California 94555, USA
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Horn S, Bathgate R, Lioutas C, Bracken K, Ivell R. Bovine endometrial epithelial cells as a model system to study oxytocin receptor regulation. Hum Reprod Update 1998; 4:605-14. [PMID: 10027614 DOI: 10.1093/humupd/4.5.605] [Citation(s) in RCA: 29] [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: 11/12/2022] Open
Abstract
Endometrial epithelial cell cultures were established from bovine uterine tissue collected during the oestrous cycle from commercially slaughtered animals. These cells were shown to express moderately high levels of oxytocin receptors (OTR) (up to 30000 per cell) after about one week in culture. These receptors have been characterized at the molecular, pharmacological and functional level and shown to be identical to those expressed in the bovine endometrium in vivo. Preliminary experiments to investigate the regulation of the OTR and its gene using this system, have shown that expression is to a large degree constitutive, the receptors being spontaneously upregulated during culture. Sex steroids at concentrations close to or above the serum limits observed in vivo appeared to have no effect, although the cells were shown to express mRNA for the specific steroid receptors throughout culture. Only the blastocyst product, interferon-tau, showed a significant effect, downregulating both OTR and their gene transcripts in the cultured endometrial epithelial cells. Although more extensive studies are necessary, these results support the view that the OTR gene is controlled in part at least by a combination of constitutive and inhibitory elements.
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Affiliation(s)
- S Horn
- IHF Institute for Hormone and Fertility Research, University of Hamburg, Germany
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Bracken K, Bickman J. Eyeing options for vision protection. Occup Health Saf 1997; 66:44-7. [PMID: 9314197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- K Bracken
- Arbill Industries, Philadelphia, Pa., USA
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Ockleford C, Malak T, Hubbard A, Bracken K, Burton SA, Bright N, Blakey G, Goodliffe J, Garrod D, d'Lacey C. Confocal and conventional immunofluorescence and ultrastructural localisation of intracellular strength-giving components of human amniochorion. J Anat 1993; 183 ( Pt 3):483-505. [PMID: 7507914 PMCID: PMC1259875] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Key cytoskeletal polypeptides of human fetal membranes have been localised at subcellular level using confocal and conventional indirect immunofluorescence microscopy. Correlation with electron microscope data has allowed us to examine how cellular compartments of this multilaminar tissue maintain their mechanical integrity until the time of membrane rupture at parturition. Evidence is presented for myofibroblastic characteristics of cells in both the fibroblast and reticular layers which may therefore have tension-generating, position-adjustment and wound-healing roles in the amniochorion. Desmin and vimentin are coexpressed in these cells, but a small localised population of cells in the fibroblast layer contains vimentin alone. An interaction of cytokeratin filaments with nuclei and desmosomes of amniotic epithelium in vivo is demonstrated, indicating that nuclei of cells of ectodermal origin are integrated into a mechanical structure extending throughout the tissue as a whole. Cells of the basal 1 or 2 layers of trophoblast have been shown to have a more extensive and better integrated cytoskeletal organisation than those overlying and forming the boundary with decidua. Structures within the trophoblast, identified previously as degenerate villi, contain cells with intermediate filaments with similar immunofluorescence properties to those of the neighbouring reticular layer and thus may represent papillae that prevent shearing at this interface.
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Affiliation(s)
- C Ockleford
- Department of Anatomy, University of Leicester Medical School, UK
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