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So N, Price K, O'Mara P, Rodrigues MA. The importance of cultural humility and cultural safety in health care. Med J Aust 2024; 220:12-13. [PMID: 38049948 DOI: 10.5694/mja2.52182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/18/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Neda So
- Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Karen Price
- Monash University, Melbourne, VIC
- Moorabbin Medical Clinic, Melbourne, VIC
| | | | - Michelle A Rodrigues
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
- Chroma Dermatology, Melbourne, VIC
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Ebner DK, Evans JM, Christensen B, Breinholt J, Gamez ME, Lester SC, Routman DM, Ma DJ, Price K, Dong H, Park SS, Chintakuntlawar AV, Neben-Wittich MA, McGee LA, Garces Y, Patel SH, Foote RL, Evans JD. Unique T-cell Sub-Population Shifts after SBPT and Nivolumab in Platinum Refractory HNC: Biomarker Correlates from ROR1771. Int J Radiat Oncol Biol Phys 2023; 117:e580. [PMID: 37785763 DOI: 10.1016/j.ijrobp.2023.06.1920] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) ROR1771 was a clinical trial investigating the use of stereotactic body proton radiotherapy (SBPT) and nivolumab in recurrent platinum refractory head and neck squamous cell carcinoma (HNSCC). The planned analysis of T-cell subpopulation and biomarker response is herein presented. MATERIALS/METHODS Patients with metastatic histologically confirmed HNSCC from any primary site received 2 cycles of nivolumab followed by SBPT to 1-2 selected target lesion(s) (hilar/lung: 8 of 12 patients), followed by maintenance nivolumab. Peripheral blood mononuclear cells were isolated pre-/post-treatment. Flow cytometry identified T-cell subpopulations. Single Cell 5' Gene Expression (GEX) and V(D)J T Cell Receptor libraries were prepared using Single Cell Immune Profiling. Seurat (v4.1.1) was used to identify cell type clusters, and differential expression post-filtration was evaluated using the Wilcoxon Rank Sum test. RESULTS A total of 12 patients were eligible for analysis, with one alive at time of analysis, 52 months from start of treatment. Median overall survival here was 12.5 months vs. 7.5-months on CheckMate 141. SBPT ranged from 35-50 Gy. Sequential changes in T-cell populations from baseline were noted with initiation of nivolumab, driving decrease in tumor-reactive (TTR; CD11ahighPD1+CD8+), central memory (TCM; CCR7+CD45RA-), and effector T-cells (TEF; CCR7-CD45RA-). TTR and TCM increased following SBPT, with greatest increase (3.5x TTR and 5.2x TCM) in the surviving patient. An average of 68 genes with significant differential expression between timepoints (p<0.0001) demonstrated RNA gene expression changes across all cell subtypes, including ribosomal (RPL and RPS) genes, ACTB, FTL, MALAT1, and others. This averaged 113 genes across all timepoints in the surviving patient, with peak following nivolumab induction. On T-cell receptor (TCR) analysis of this patient, the predominant clonotype diversity changed substantially following nivolumab. Following SBPT, clonotype diversity again changed to include a milieu seen neither at baseline nor with nivolumab alone. These TCRs persisted for approximately 2 weeks following SBPT before returning to resemble the nivolumab-induced TCR diversity alone, coinciding with disease recurrence. CONCLUSION ROR1771 demonstrated overall survival favorably comparable to CheckMate 141. Biomarker analysis of peripheral blood samples demonstrated significant shifts in T-cell subpopulations and underlying gene expression to nivolumab and then to SBPT administration. SBPT to a target lesion changed TCR clonotypes within the peripheral blood beyond those seen with nivolumab administration, with fading of these TCR clonotypes coinciding with recurrence. SBPT in combination with nivolumab may drive systemic immunologic change above that induced by nivolumab alone and warrants further investigation.
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Affiliation(s)
- D K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J M Evans
- Intermountain Precision Genomics, St George, UT
| | | | - J Breinholt
- Intermountain Precision Genomics, St George, UT
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
| | - H Dong
- Department of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - S S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - L A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Y Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J D Evans
- Department of Radiation Oncology, Intermountain Healthcare, Murray, UT
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Dharan NJ, Jin F, Vaccher S, Bavinton B, Yeung B, Guy R, Carr A, Zablotska I, Amin J, Read P, Templeton DJ, Ooi C, Martin SJ, Ryder N, Smith DE, McNulty A, Brown K, Price K, Holden J, Grulich AE. Characteristics of Human Immunodeficiency Virus (HIV) Seroconversions in a Large Prospective Implementation Cohort Study of Oral HIV Preexposure Prophylaxis in Men Who Have Sex with Men (EPIC-NSW). Clin Infect Dis 2023; 76:e622-e628. [PMID: 35982613 DOI: 10.1093/cid/ciac660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia. METHODS Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in individuals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as <4 PrEP doses per week. RESULTS A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018; 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25-38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347-656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis. CONCLUSIONS Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in individuals who subsequently acquire HIV is critical to improving PrEP effectiveness.
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Affiliation(s)
- Nila J Dharan
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Stefanie Vaccher
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Barbara Yeung
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Andrew Carr
- St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, New South Wales, Australia.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Janaki Amin
- Department Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Philip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - David J Templeton
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Sexual Health Medicine, Sydney Local Health District, Camperdown, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Catriona Ooi
- Clinic 16, St Leonards, New South Wales, Australia.,Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Martin
- Canberra Sexual Health Centre, Canberra Health Services, Woden, Australia Capital Territory, Australia.,The Australian National University Medical School, Canberra, Australia Capital Territory, Australia
| | - Nathan Ryder
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Don E Smith
- Albion Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Anna McNulty
- School of Population Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Katherine Brown
- Illawarra Sexual Health, Warrawong, New South Wales, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, New South Wales, Australia
| | - Jo Holden
- New South Wales Health, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Chew KW, Moser C, Daar ES, Wohl DA, Li JZ, Coombs RW, Ritz J, Giganti M, Javan AC, Li Y, Choudhary MC, Deo R, Malvestutto C, Klekotka P, Price K, Nirula A, Fischer W, Bala V, Ribeiro RM, Perelson AS, Fletcher CV, Eron JJ, Currier JS, Hughes MD, Smith DM. Publisher Correction: Antiviral and clinical activity of bamlanivimab in a randomized trial of non-hospitalized adults with COVID-19. Nat Commun 2023; 14:333. [PMID: 36658128 PMCID: PMC9851732 DOI: 10.1038/s41467-023-35835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Kara W Chew
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Coombs
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Justin Ritz
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark Giganti
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yijia Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manish C Choudhary
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rinki Deo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - William Fischer
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Veenu Bala
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE, USA
- Clinical Pharmacology & Pharmacometrics, Jounce Therapeutics, Cambridge, MA, USA
| | - Ruy M Ribeiro
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Alan S Perelson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Courtney V Fletcher
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Judith S Currier
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Davey M Smith
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Ebner D, Lester S, Gamez M, Routman D, Ma D, Price K, Dong H, Park S, Chintakuntlawar A, Neben-Wittich M, McGee L, Garces Y, Patel S, Foote R, Evans J. A Prospective Observational Study of Proton Stereotactic Body Radiation Therapy and Immunotherapy for Recurrent Metastatic Head and Neck Cancer: Initial Report of MC ROR1771 Survival Analysis and Toxicity. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1299] [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]
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6
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Gao R, Routman D, Harmsen W, Ebrahimi S, Foote R, Ma D, Neben-Wittich M, McGee L, Patel S, Moore E, Choby G, Tasche K, Price K, Gamez M, Lester S. Adenoid Cystic Carcinoma of the Head and Neck: Patterns of Recurrence and Implications for Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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7
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Kamdem Talom B, Weiskittle T, Abdel-Halim C, Kowalchuk R, Ebner D, Breen W, Sharifzadeh Y, Ma D, Price K, Lester S, Van Abel K, Routman D, Waddle M. Reliability of Cancer Recurrence Data: Institution Cancer Registry vs. Trained Chart Abstraction. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1475] [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: 11/24/2022]
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Chew KW, Moser C, Daar ES, Wohl DA, Li JZ, Coombs RW, Ritz J, Giganti M, Javan AC, Li Y, Choudhary MC, Deo R, Malvestutto C, Klekotka P, Price K, Nirula A, Fischer W, Bala V, Ribeiro RM, Perelson AS, Fletcher CV, Eron JJ, Currier JS, Hughes MD, Smith DM. Antiviral and clinical activity of bamlanivimab in a randomized trial of non-hospitalized adults with COVID-19. Nat Commun 2022; 13:4931. [PMID: 35995785 PMCID: PMC9395368 DOI: 10.1038/s41467-022-32551-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023] Open
Abstract
Anti-SARS-CoV-2 monoclonal antibodies are mainstay COVID-19 therapeutics. Safety, antiviral, and clinical efficacy of bamlanivimab were evaluated in the randomized controlled trial ACTIV-2/A5401. Non-hospitalized adults were randomized 1:1 within 10 days of COVID-19 symptoms to bamlanivimab or blinded-placebo in two dose-cohorts (7000 mg, n = 94; 700 mg, n = 223). No differences in bamlanivimab vs placebo were observed in the primary outcomes: proportion with undetectable nasopharyngeal SARS-CoV-2 RNA at days 3, 7, 14, 21, and 28 (risk ratio = 0.82-1.05 for 7000 mg [p(overall) = 0.88] and 0.81-1.21 for 700 mg [p(overall) = 0.49]), time to symptom improvement (median 21 vs 18.5 days [p = 0.97], 7000 mg; 24 vs 20.5 days [p = 0.08], 700 mg), or grade 3+ adverse events. However, bamlanivimab was associated with lower day 3 nasopharyngeal viral levels and faster reductions in inflammatory markers and viral decay by modeling. This study provides evidence of faster reductions in nasopharyngeal SARS-CoV-2 RNA levels but not shorter symptom durations in non-hospitalized adults with early variants of SARS-CoV-2.
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Affiliation(s)
- Kara W Chew
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Coombs
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Justin Ritz
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark Giganti
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yijia Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manish C Choudhary
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rinki Deo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - William Fischer
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Veenu Bala
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE, USA
- Clinical Pharmacology & Pharmacometrics, Jounce Therapeutics, Cambridge, MA, USA
| | - Ruy M Ribeiro
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Alan S Perelson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Courtney V Fletcher
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Judith S Currier
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Davey M Smith
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Ma D, Price K, Moore E, Patel S, Hinni M, Fruth B, Foster N, Van Abel K, Yin L, Neben-Wittich M, Garces Y, McGee L, Rwigema J, Routman D, Lester S, Price D, Janus J, Chintakuntlawar A, Savvides P, Foote R. Non-Inferiority Margin and Nodal Analysis of De-Escalated Adjuvant Radiation Therapy (DART) for HPV-Related Oropharyngeal Squamous Cell Carcinoma (OPSCC): A Preplanned Pooled Analysis of MC1273 & MC1675. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McGarrah P, Routman D, Ma D, Van Abel K, Moore E, Patel S, Hinni M, Fruth B, Foster N, Yin L, Neben-Wittich M, Garces Y, McGee L, Rwigema J, Price D, Janus J, Chintakuntlawar A, Savvides P, Foote R, Price K. Analysis of Outcomes by Smoking Status in a Phase III Trial of De-Escalated Adjuvant Chemoradiation Therapy in Human Papillomavirus (HPV(+)) Oropharyngeal Squamous Cell Carcinoma (OPSCC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.033] [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: 11/26/2022]
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Wood L, Chintakuntlawar A, Price K, Kaczmar J, Conn G, Bedu-Addo F, Weiss J. Preliminary Safety of PDS0101 (Versamune +HPVmix) and Pembrolizumab Combination Therapy in Subjects with Recurrent/Metastatic Human Papillomavirus-16 Positive Oropharyngeal Squamous Cell Carcinoma (OPSCC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Chew KW, Moser C, Daar ES, Wohl DA, Li JZ, Coombs R, Ritz J, Giganti M, Javan AC, Li Y, Malvestutto C, Klekotka P, Price K, Nirula A, Fischer W, Bala V, Ribeiro RM, Perelson AS, Fletcher CV, Eron JJ, Currier JS, Hughes MD, Smith DM. Bamlanivimab reduces nasopharyngeal SARS-CoV-2 RNA levels but not symptom duration in non-hospitalized adults with COVID-19: A Phase 2 Randomized Clinical Trial. medRxiv 2021:2021.12.17.21268009. [PMID: 34981077 PMCID: PMC8722620 DOI: 10.1101/2021.12.17.21268009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The antiviral activity and efficacy of anti-SARS-CoV-2 monoclonal antibody (mAb) therapies to accelerate recovery from COVID-19 is important to define. Objective To determine safety and efficacy of the mAb bamlanivimab to reduce nasopharyngeal (NP) SARS-CoV-2 RNA levels and symptom duration. Design ACTIV-2/A5401 is a randomized, blinded, placebo-controlled platform trial. Two dose cohorts were enrolled between August 19 and November 17, 2020 for phase 2 evaluation: in the first, participants were randomized 1:1 to bamlanivimab 7000 mg versus placebo, and in the second to bamlanivimab 700 mg versus placebo. Randomization was stratified by time from symptom onset (≤ or >5 days) and risk of progression to severe COVID-19 ("higher" vs "lower"). Setting Multicenter trial conducted at U.S. sites. Participants Non-hospitalized adults ≥18 years of age with positive SARS-CoV-2 antigen or nucleic acid test within 7 days, ≤10 days of COVID-19 symptoms, and with oxygen saturation ≥92% within 48 hours prior to study entry. Intervention Single infusion of bamlanivimab (7000 or 700 mg) or placebo. Main Outcomes and Measures Detection of NP SARS-CoV-2 RNA at days 3, 7, 14, 21, and 28, time to improvement of all of 13 targeted COVID-19 symptoms by daily self-assessment through day 28, and grade 3 or higher treatment emergent adverse events (TEAEs) through day 28. Secondary measures included quantitative NP SARS-CoV-2 RNA, all-cause hospitalizations and deaths (composite), area under the curve of symptom scores from day 0 through day 28, plasma bamlanivimab concentrations, plasma and serum inflammatory biomarkers, and safety through week 24. Results Ninety-four participants were enrolled to the 7000 mg cohort and 223 to the 700 mg cohort and initiated study intervention. The proportion meeting protocol criteria for "higher" risk for COVID-19 progression was 42% and 51% for the 7000 and 700 mg cohort, respectively. Median time from symptom onset at study entry for both cohorts was 6 days. There was no difference in the proportion with undetectable NP SARS-CoV-2 RNA at any post-treatment timepoints (risk ratio compared to placebo, 0.82-1.05 for 7000 mg dose [overall p=0.88] and 0.81-1.21 for 700 mg dose [overall p=0.49]), time to symptom improvement (median of 21 vs 18.5 days, p=0.97, for 7000 mg bamlanivimab vs placebo and 24 vs 20.5 days, p=0.08, for 700 mg bamlanivimab vs placebo), or grade 3+ TEAEs with either dose compared to placebo. Median NP SARS-CoV-2 RNA levels were lower at day 3 and C-reactive protein, ferritin, and fibrinogen levels significantly reduced at days 7 and 14 for bamlanivimab 700 mg compared to placebo, with similar trends observed for bamlanivimab 7000 mg. Viral decay modeling supported more rapid decay with bamlanivimab compared to placebo. Conclusions and Relevance Treatment with bamlanivimab 7000 mg and 700 mg was safe and compared to placebo led to more rapid reductions in NP SARS-CoV-2 RNA and inflammatory biomarkers, but did not decrease time to symptom improvement. The clinical utility of mAbs for outcomes other than hospitalizations and deaths is uncertain. Trial Registration ClinicalTrials.gov Identifier: NCT04518410.
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Affiliation(s)
- Kara W Chew
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Eric S Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Robert Coombs
- Departments of Laboratory Medicine and and Pathology; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Justin Ritz
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark Giganti
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yijia Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | | | | | - Karen Price
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - William Fischer
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC, USA
| | - Veenu Bala
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ruy M Ribeiro
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Alan S Perelson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Courtney V Fletcher
- UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC, USA
| | - Judith S Currier
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Davey M Smith
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Ma D, Price K, Moore E, Patel S, Hinni M, Fruth B, Foster N, Van Abel K, Yin L, Neben-Wittich M, McGee L, Rwigema J, Routman D, Lester S, Price D, Janus J, Kasperbauer J, Nagel T, Chintakuntlawar A, Savvides P, Garcia J, Foote R. MC1675, a Phase III Evaluation of De-Escalated Adjuvant Radiation Therapy (DART) vs. Standard Adjuvant Treatment for Human Papillomavirus Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ebrahimi S, Patel S, McGee L, Garcia J, Ma D, Foote R, Garces Y, Neben Wittich M, Price K, Schmitt A, Zhai Q, May B, Nagel T, Hinni M, Routman D, Chintakuntlawar A, Rwigema J. Clinical Outcomes of Histologically Verified Salivary Ductal Carcinomas: Retrospective Analysis of 89 Patients Treated Over 47 Years. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Ma D, Price K, Eric M, Patel S, Hinni M, Ginos B, Fruth B, Foster N, Chintakuntlawar A, Neben-Wittich M, Garces Y, Van Abel K, Price D, Kasperbauer J, Janus J, Nagel T, Garcia J, Foote R. Long-Term Results for MC1273, A Phase II Evaluation of De-Escalated Adjuvant Radiation Therapy for Human Papillomavirus Associated Oropharyngeal Squamous Cell Carcinoma (HPV+ OPSCC). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jin F, Amin J, Guy R, Vaccher S, Selvey C, Zablotska I, Holden J, Price K, Yeung B, Ogilvie E, Quichua GC, Clackett S, McNulty A, Smith D, Templeton DJ, Bavinton B, Grulich AE. Adherence to daily HIV pre-exposure prophylaxis in a large-scale implementation study in New South Wales, Australia. AIDS 2021; 35:1987-1996. [PMID: 34101630 DOI: 10.1097/qad.0000000000002970] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/14/2023]
Abstract
OBJECTIVES To examine patterns of long-term pre-exposure prophylaxis (PrEP) adherence and its association with HIV seroconversion in NSW, Australia. DESIGN Population-based HIV PrEP implementation study. METHODS Expanded PrEP Implementation in Communities in New South Wales was an open-label study of daily oral PrEP which recruited participants from March 2016 to April 2018. Adherence was measured using dispensing records. PrEP discontinuation was defined as an at least 120-day period without PrEP coverage. Long-term adherence patterns were identified using group-based trajectory modelling. RESULTS Participants dispensed at least once (n = 9586) were almost all male (98.5%), identified as gay (91.3%), with a median age of 34 years (range: 18-86). Of the 6460 (67.4%) participants who had at least 9 months of follow-up since first dispensing, 1942 (30.1%) discontinued. Among these, 292 (15.0%) restarted later. Four distinct groups were identified ['Steep decline' in adherence (15.8%), 'Steady decline' (11.6%), 'Good adherence' (37.4%), and 'Excellent adherence' (35.2%)]. Older (P < 0.001) and gay-identified (P < 0.001) participants were more likely to have higher adherence, so were those living in postcodes with a higher proportion of gay-identified male residents (P < 0.001). Conversely, those who at baseline reported recent crystal methamphetamine use and had a recent diagnosis of sexually transmitted infection (STI) had lower adherence (P < 0.001). Overall HIV incidence was 0.94 per 1000 person-years (95% confidence interval: 0.49-1.81; n = 9) and was highest in the 'steep decline' group (5.45 per 1000 person-years; P = 0.001). CONCLUSION : About 15% of participants stopped PrEP during study follow-up and were at increased risk of HIV infection. They were more likely to be younger and report a recent STI or methamphetamine use prior to PrEP initiation.
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Affiliation(s)
| | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University
| | | | | | | | | | | | | | | | | | | | | | | | - David Smith
- North Coast HIV/Sexual Health Services, Lismore
| | - David J Templeton
- The Kirby Institute, UNSW Sydney
- Sexual Health Service, Sydney Local Health District Sydney and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Park JS, Page AT, Shen PH, Price K, Tennant M, Kruger E. Management of dental emergencies amongst Australian general medical practitioners - A case-vignette study. Aust Dent J 2021; 67:30-38. [PMID: 34591999 DOI: 10.1111/adj.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In Australia, because of inequity in dental service accessibility and affordability, patients can see general medical practitioners (GPs) for acute dental conditions. METHODS This cross-sectional study consisted of surveys distributed to the board registered GPs practising in Australia. The main outcome measures included statistical analysis of GPs managing different dental emergency scenarios and their confidence and expectations in managing dental emergencies. RESULTS A total of 425 GPs participated in the study. The sample primarily consisted of GPs practising in metropolitan clinics (n = 315). Most participants reported that they would refer to the dentist for mobilized tooth (n = 402). There was a negative correlation between GPs with 5-29 years of experience and traumatized tooth management (P < 0.05). GPs aged between 40 and 49 years were more inclined to treat patients with mobilized teeth [Multivariate (MV): 0.42(0.09-0.74)]. However, GPs with 0-5 years of experience were less likely to manage patients with dental abscess [MV: -0.52(-0.80 to -0.24)]. CONCLUSION Most GPs referred dental emergencies to dentists. GP management of dental emergencies were predominantly palliative. Therefore, opportunities for collaborative practice models amongst GPs and dentists may be needed to bridge the gap in the regional and remote locations.
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Affiliation(s)
- J S Park
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, Crawley, Western Australia, Australia.,UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia.,Monash Health Dental Services, Monash Health, Dandenong, Victoria, Australia
| | - A T Page
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.,Centre for Optimisation of Medicines, University of Western Australia, Crawley, Western Australia, Australia
| | - P-H Shen
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - K Price
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - M Tennant
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, Crawley, Western Australia, Australia
| | - E Kruger
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, Crawley, Western Australia, Australia
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18
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Shi H, Huang M, Warner W, Gill M, Price K, Levesque P. Use of human induced pluripotent stem cell-derived cardiomyocytes and multi-electrode array technology to explore the delayed onset of premature ventricular contractions in monkey. J Pharmacol Toxicol Methods 2021. [DOI: 10.1016/j.vascn.2021.107024] [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: 11/24/2022]
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19
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Chan C, Patel P, Johnson K, Vaughan M, Price K, McNulty A, Templeton DJ, Read P, Cunningham P, Grulich AE, Bavinton BR. Community-based peer-led HIV/sexually transmitted infection testing services in Sydney for gay and bisexual men captured an eighth of new HIV diagnoses in New South Wales, Australia. AIDS 2021; 35:1878-1880. [PMID: 34397488 DOI: 10.1097/qad.0000000000002982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital
- School of Population Health, UNSW Sydney
| | - David J Templeton
- Kirby Institute, UNSW Sydney
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney
| | - Phillip Read
- Kirby Institute, UNSW Sydney
- Kirketon Road Centre
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Hospital
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia
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20
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Chen P, Datta G, Grace Li Y, Chien J, Price K, Chigutsa E, Brown-Augsburger P, Poorbaugh J, Fill J, Benschop RJ, Rouphael N, Kay A, Mulligan MJ, Saxena A, Fischer WA, Dougan M, Klekotka P, Nirula A, Benson C. First-in-Human Study of Bamlanivimab in a Randomized Trial of Hospitalized Patients With COVID-19. Clin Pharmacol Ther 2021; 110:1467-1477. [PMID: 34455583 PMCID: PMC8653186 DOI: 10.1002/cpt.2405] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022]
Abstract
Therapeutics for patients hospitalized with coronavirus disease 2019 (COVID‐19) are urgently needed during the pandemic. Bamlanivimab is a potent neutralizing monoclonal antibody that blocks severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) attachment and entry into human cells, which could potentially lead to therapeutic benefit. J2W‐MC‐PYAA was a randomized, double‐blind, sponsor unblinded, placebo‐controlled, single ascending dose first‐in‐human trial (NCT04411628) in hospitalized patients with COVID‐19. A total of 24 patients received either placebo or a single dose of bamlanivimab (700 mg, 2,800 mg, or 7,000 mg). The primary objective was assessment of safety and tolerability, including adverse events and serious adverse events, with secondary objectives of pharmacokinetic (PK) and pharmacodynamic analyses. Treatment‐emergent adverse event (TEAE) rates were identical in the placebo and pooled bamlanivimab groups (66.7%). There were no apparent dose‐related increases in the number or severity of TEAEs. There were no serious adverse events or deaths during the study, and no discontinuations due to adverse events. PKs of bamlanivimab is linear and exposure increased proportionally with dose following single i.v. administration. The half‐life was ~ 17 days. These results demonstrate the favorable safety profile of bamlanivimab, and provided the initial critical evaluation of safety, tolerability, and PKs in support of the development of bamlanivimab in several ongoing clinical trials.
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Affiliation(s)
- Peter Chen
- Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gourab Datta
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Jenny Chien
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Karen Price
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Jeffrey Fill
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Ariel Kay
- Emory University, Atlanta, Georgia, USA
| | | | - Amit Saxena
- NYU Grossman School of Medicine, New York, New York, USA
| | - William A Fischer
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ajay Nirula
- Eli Lilly and Company, Indianapolis, Indiana, USA
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21
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Grulich AE, Jin F, Bavinton BR, Yeung B, Hammoud MA, Amin J, Cabrera G, Clackett S, Ogilvie E, Vaccher S, Vickers T, McNulty A, Smith DJ, Dharan NJ, Selvey C, Power C, Price K, Zablotska I, Baker DA, Bloch M, Brown K, Carmody CJ, Carr A, Chanisheff D, Doong N, Finlayson R, Lewis DA, Lusk J, Martin S, Ooi C, Read P, Ryder N, Smith D, Tuck Meng Soo C, Templeton DJ, Vlahakis E, Guy R. Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study. Lancet HIV 2021; 8:e486-e494. [PMID: 34217426 DOI: 10.1016/s2352-3018(21)00074-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Daily pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but few long-term data are available on effectiveness and adherence in real-world settings. Here, we report trends in HIV incidence over 3 years in individuals at high risk who were prescribed PrEP in New South Wales (NSW), as well as adherence before the transition to subsidised PrEP. METHODS Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) was a pragmatic, prospective, single-arm, implementation study of daily, oral PrEP in 31 sites (sexual health clinics, general practices, and a hospital) in NSW, Australia. Eligible participants were HIV-negative adults (aged ≥18 years) who were at high risk of HIV infection as defined in local PrEP guidelines. Participants were prescribed coformulated (once-daily, oral tablet) tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP and were followed up with HIV testing, sexually transmitted infection testing, and PrEP dispensing. Originally planned for 3700 participants followed for 1 year, the study was expanded so that all eligible participants in the state could obtain PrEP and extended until publicly subsidised PrEP became available in Australia. The primary outcome was new HIV infection among all participants who were dispensed PrEP at least once and had at least one follow-up HIV test result. Adherence was estimated by medication possession ratio (MPR), defined as the proportion of PrEP pills dispensed in 90 days, assuming daily dosing. This study is registered with ClinicalTrials.gov, NCT02870790. FINDINGS Between March 1, 2016, and April 30, 2018, we enrolled 9709 participants. 9596 participants were dispensed PrEP, of whom 9448 (98·3%) were gay or bisexual men. Participants were followed up until March 31, 2019, with at least one follow-up HIV test available in 9520 (99·2%) participants. Mean MPR declined from 0·93 to 0·64 from the first to the ninth quarter. There were 30 HIV seroconversions over 18 628 person-years, an incidence of 1·61 per 1000 person-years (95% CI 1·13-2·30). Being younger, living in a postcode with fewer gay men, reporting more risk behaviours at baseline, and having an MPR of less than 0·6 were each univariately associated with increased HIV incidence. In the final year of follow-up, when PrEP was mostly purchased rather than provided free by the study, HIV incidence remained low at 2·24 per 1000 person-years (1·46-3·44). INTERPRETATION HIV incidence remained low over up to 3 years of follow-up, including during a transition from study-provided to publicly subsidised PrEP. In a setting of affordable PrEP and associated health-care services, very low HIV incidence of 1 to 2 per 1000 person-years can be maintained in gay and bisexual men who were previously at high risk. FUNDING New South Wales Ministry of Health, Australian Capital Territory Health Directorate, Gilead Sciences.
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Affiliation(s)
- Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Barbara Yeung
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohamed A Hammoud
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Janaki Amin
- Department of Health Systems and Populations, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gesalit Cabrera
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Shawn Clackett
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; New South Wales Ministry of Health, Sydney, NSW, Australia
| | - Erin Ogilvie
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stefanie Vaccher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Tobias Vickers
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David J Smith
- North Coast HIV/Sexual Health Services, Lismore, NSW, Australia
| | - Nila J Dharan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Cherie Power
- New South Wales Ministry of Health, Sydney, NSW, Australia
| | | | - Iryna Zablotska
- Western Sydney Sexual Health Centre and Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia
| | | | - Mark Bloch
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Holdsworth House Medical Practice, Darlinghurst, NSW, Australia
| | | | | | - Andrew Carr
- St Vincent's Hospital, Darlinghurst, NSW, Australia
| | | | | | | | - David A Lewis
- Western Sydney Sexual Health Centre and Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia; Marie Bashir Institute for Biosecurity and Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - Josephine Lusk
- Short Street Clinic, Kogorah, St George Hospital, NSW, Australia
| | - Sarah Martin
- Canberra Sexual Health Centre, Canberra Health Services, Canberra Hospital, Canberra, ACT, Australia
| | | | - Phillip Read
- Kirketon Road Centre, Kings Cross, NSW, Australia
| | - Nathan Ryder
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Hunter-New England Sexual Health, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Don Smith
- The Albion Centre, Surry Hills, NSW, Australia
| | - Clara Tuck Meng Soo
- Hobart Place General Practice and East Canberra General Practice, ACT, Australia
| | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District Camperdown, NSW, Australia
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Di Giallonardo F, Pinto AN, Keen P, Shaik A, Carrera A, Salem H, Selvey C, Nigro SJ, Fraser N, Price K, Holden J, Lee FJ, Dwyer DE, Bavinton BR, Geoghegan JL, Grulich AE, Kelleher AD. Subtype-specific differences in transmission cluster dynamics of HIV-1 B and CRF01_AE in New South Wales, Australia. J Int AIDS Soc 2021; 24:e25655. [PMID: 33474833 PMCID: PMC7817915 DOI: 10.1002/jia2.25655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The human immunodeficiency virus 1 (HIV-1) pandemic is characterized by numerous distinct sub-epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses. METHODS We used HIV-1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV-1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW-specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi-Square statistics. RESULTS We identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a > 2-fold increase in the number of NSW-specific CRF01_AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01_AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01_AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above-average growth rate (>1.5 sequences / 6-months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals. CONCLUSIONS The large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE.
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Affiliation(s)
| | - Angie N Pinto
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
- Royal Prince Alfred HospitalSydneyNSWAustralia
| | - Phillip Keen
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
| | - Ansari Shaik
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
| | | | - Hanan Salem
- New South Wales Health Pathology‐RPARoyal Prince Alfred HospitalCamperdownNSWAustralia
| | | | | | - Neil Fraser
- Positive Life New South WalesSydneyNSWAustralia
| | | | | | - Frederick J Lee
- New South Wales Health Pathology‐RPARoyal Prince Alfred HospitalCamperdownNSWAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia
| | - Dominic E Dwyer
- New South Wales Health Pathology‐ICPMRWestmead HospitalWestmeadNSWAustralia
| | | | - Jemma L Geoghegan
- Department of Microbiology and ImmunologyUniversity of OtagoDunedinNew Zealand
- Institute of Environmental Science and ResearchWellingtonNew Zealand
| | - Andrew E Grulich
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
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23
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Di Giallonardo F, Pinto AN, Keen P, Shaik A, Carrera A, Salem H, Selvey C, Nigro SJ, Fraser N, Price K, Holden J, Lee FJ, Dwyer DE, Bavinton BR, Grulich AE, Kelleher AD, On Behalf Of The Nsw Hiv Prevention Partnership Project. Increased HIV Subtype Diversity Reflecting Demographic Changes in the HIV Epidemic in New South Wales, Australia. Viruses 2020; 12:E1402. [PMID: 33291330 PMCID: PMC7762219 DOI: 10.3390/v12121402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
Changes over time in HIV-1 subtype diversity within a population reflect changes in factors influencing the development of local epidemics. Here we report on the genetic diversity of 2364 reverse transcriptase sequences from people living with HIV-1 in New South Wales (NSW) notified between 2004 and 2018. These data represent >70% of all new HIV-1 notifications in the state over this period. Phylogenetic analysis was performed to identify subtype-specific transmission clusters. Subtype B and non-B infections differed across all demographics analysed (p < 0.001). We found a strong positive association for infections among females, individuals not born in Australia or reporting heterosexual transmission being of non-B origin. Further, we found an overall increase in non-B infections among men who have sex with men from 50 to 79% in the last 10 years. However, we also found differences between non-B subtypes; heterosexual transmission was positively associated with subtype C only. In addition, the majority of subtype B infections were associated with clusters, while the majority of non-B infections were singletons. However, we found seven non-B clusters (≥5 sequences) indicative of local ongoing transmission. In conclusion, we present how the HIV-1 epidemic has changed over time in NSW, becoming more heterogeneous with distinct subtype-specific demographic associations.
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Affiliation(s)
| | - Angie N Pinto
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
- Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Phillip Keen
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Ansari Shaik
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Alex Carrera
- HIV Reference Laboratory, Sydney 2010, Australia
| | - Hanan Salem
- New South Wales Health Pathology-RPA, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | | | | | - Neil Fraser
- Positive Life New South Wales, Sydney 2010, Australia
| | - Karen Price
- AIDS Council of NSW (ACON), Sydney 2010, Australia
| | | | - Frederick J Lee
- New South Wales Health Pathology-RPA, Royal Prince Alfred Hospital, Camperdown 2050, Australia
- Sydney Medical School, University of Sydney, Sydney 2050, Australia
| | - Dominic E Dwyer
- New South Wales Health Pathology-ICPMR, Westmead Hospital, Westmead 2145, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Anthony D Kelleher
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
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McManus H, Grulich AE, Amin J, Selvey C, Vickers T, Bavinton B, Zablotska I, Vaccher S, Jin F, Holden J, Price K, Yeung B, Cabrera Quichua G, Ogilvie E, McNulty A, Smith D, Guy R. Comparison of Trends in Rates of Sexually Transmitted Infections Before vs After Initiation of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men. JAMA Netw Open 2020; 3:e2030806. [PMID: 33355675 PMCID: PMC7758809 DOI: 10.1001/jamanetworkopen.2020.30806] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE There have been concerns that HIV preexposure prophylaxis (PrEP) may be associated with increases in sexually transmitted infections (STIs) because of subsequent reductions in condom use and/or increases in sexual partners. OBJECTIVE To determine trends in STI test positivity among high-risk men who have sex with men (MSM) before and after the start of HIV PrEP. DESIGN, SETTING, AND PARTICIPANTS A before-after analysis was conducted using a subcohort of a single-group PrEP implementation study cohort in New South Wales, Australia (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]), from up to 1 year before enrollment if after January 1, 2015, and up to 2 years after enrollment and before December 31, 2018. STI testing data were extracted from a network of 54 sexual health clinics and 6 primary health care clinics Australia-wide, using software to deidentify, encrypt, and anonymously link participants between clinics. A cohort of MSM dispensed PrEP for the first time during the study, with 2 or more STI tests in the prior year and who tested during follow-up, were included from the EPIC-NSW cohort of HIV-negative participants with high-risk sexual behavior. Data analysis was performed from June to December 2019. EXPOSURES Participants were dispensed coformulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP. MAIN OUTCOMES AND MEASURES The main outcome was STI, measured using test positivity, defined as the proportion of participants testing positive for an STI at least once per quarter of follow-up. Outcomes were calculated for Chlamydia trachomatis and Neisseria gonorrhoea by site of infection (anorectal, pharyngeal, urethral, or any) and for syphilis. RESULTS Of the EPIC-NSW cohort of 9709 MSM, 2404 were included in the before-after analysis. The mean (SD) age of the participants was 36 (10.4) years, and 1192 (50%) were Australia-born. STI positivity was 52% in the year after PrEP (23.3% per quarter; 95% CI, 22.5%-24.2% per quarter) with no significant trend (mean rate ratio [RR] increase of 1.01 per quarter [95% CI, 0.99-1.02]; P = .29), compared with 50% positivity in the year prior to PrEP (20.0% per quarter [95% CI, 19.04%-20.95% per quarter]; RR for overall STI positivity, 1.17 [95% CI, 1.10-1.24]; P < .001), with an increase in quarterly STI positivity (mean RR of 1.08 per quarter, or an 8% increase per quarter [95% CI, 1.05-1.11]; P < .001; RR, 0.93 [95% CI, 0.90-0.96]; P < .001). Findings were similar when stratified by specific STIs and anatomical site. CONCLUSIONS AND RELEVANCE STI rates were high but stable among high-risk MSM while taking PrEP, compared with a high but increasing trend in STI positivity before commencing PrEP. These findings suggest the importance of considering trends in STIs when describing how PrEP use may be associated with STI incidence.
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Affiliation(s)
- Hamish McManus
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Andrew E. Grulich
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Janaki Amin
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Selvey
- Ministry of Health, New South Wales Government, St Leonards, New South Wales, Australia
| | - Tobias Vickers
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
| | - Stephanie Vaccher
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Joanne Holden
- AIDS Council New South Wales, Sydney, New South Wales, Australia
| | - Karen Price
- AIDS Council New South Wales, Sydney, New South Wales, Australia
| | - Barbara Yeung
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | | | - Erin Ogilvie
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - David Smith
- North Coast HIV/Sexual Health Services, Lismore, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Guy GP, Hargrave J, Dunn R, Price K, Short J, Thilaganathan B. Secondary non-invasive prenatal screening for fetal trisomy: an effectiveness study in a public health setting. BJOG 2020; 128:440-446. [PMID: 32790109 DOI: 10.1111/1471-0528.16464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of secondary screening using non-invasive prenatal testing (NIPT) in a routine NHS setting including test performance, turn-around times (TATs) and no-call (failure to obtain result) rates. To examine the influence of maternal and fetal characteristics on test performance. DESIGN Retrospective cohort. SETTING London teaching hospital. SAMPLE A total of 8651 pregnancies undergoing screening for fetal trisomy using NIPT provided by an NHS cell-free DNA screening laboratory - the SAFE laboratory. METHODS Screening test evaluation and TATs. Univariate and multivariate logistic regression analysis to identify significant predictors of no-call results and reported by low fetal fraction (<2%), very high fetal fraction (>40%) and processing failure. MAIN OUTCOME MEASURES Test performance, TATs and no-call rates, factors affecting no-call results. RESULTS Average TAT was 4.0 days (95% CI 4.0-4.2 days). Test sensitivities for trisomies 21 and 13/18 were 98.9% (95% CI 95.9-99.9%) and 90.4% (95% CI 80.0-96.8%), respectively. The overall no-call rate was 32/8651 (0.37%, 95% CI 0.26-0.52%). The overall risk of a no-call result was influenced by gestational age, dichorionic twin pregnancy, history of malignancy and pregnancies affected by trisomy 13/18, but not by maternal weight or use of low-molecular-weight heparin. CONCLUSIONS High-throughput NIPT can be effectively embedded into a public health NHS setting. TATs of 4 days and no-calls of <0.5% were well within clinically desirable tolerances. Gestational age, maternal weight, assisted reproductive techniques, use of low-molecular-weight heparin and past history of malignancy did not have major impacts on test no-call rates and should not constitute reasons for withholding the option of NIPT from women. TWEETABLE ABSTRACT Turn-around times of 4 days, no-call (test failure) rates of 0.37% and highly accurate NIPT can be successfully embedded in the NHS.
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Affiliation(s)
- G P Guy
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - J Hargrave
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,St George's Antenatal Fetal Evaluation (SAFE) Laboratory, St George's Hospital, St George's University of London, London, UK
| | - R Dunn
- St George's Antenatal Fetal Evaluation (SAFE) Laboratory, St George's Hospital, St George's University of London, London, UK
| | - K Price
- St George's Antenatal Fetal Evaluation (SAFE) Laboratory, St George's Hospital, St George's University of London, London, UK
| | - J Short
- St George's Antenatal Fetal Evaluation (SAFE) Laboratory, St George's Hospital, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,St George's Antenatal Fetal Evaluation (SAFE) Laboratory, St George's Hospital, St George's University of London, London, UK
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Engelhardt J, Akter R, Loffredo J, Bezman N, So P, Tipton K, Irving B, West J, Freebern W, Bunch T, Price K. Abstract 4551: Preclinical characterization of novel anti-CTLA-4 prodrug antibodies with an enhanced therapeutic index. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Blockade of the CTLA-4 pathway with ipilimumab (IPI) as monotherapy or in combination with nivolumab (anti–PD-1) is an effective treatment for a variety of cancers. To enhance the therapeutic index of CTLA-4–directed therapy, a proprietary Probody® therapeutics (PB-Tx) technology platform was used to generate anti–CTLA-4 monoclonal antibodies (mAbs) with a masking peptide to attenuate CTLA-4 binding in the periphery. Increased protease activity in the tumor microenvironment is hypothesized to preferentially cleave the masking peptide. Here, we describe the preclinical characterization of 2 novel anti–CTLA-4 PB mAbs: anti–CTLA-4 PB (BMS-986249) is a peptide-masked version of IPI, and anti–CTLA-4 nonfucosylated (NF) PB (BMS-986288) is a peptide-masked version of anti–CTLA-4 NF, which has enhanced antibody-dependent cellular cytotoxicity (ADCC) and regulatory T-cell (Treg) depletion compared with IPI.
Methods: Antibody binding to CD16 was studied by surface plasmon resonance. IL-2 release from staphylococcal enterotoxin B (SEB)–stimulated normal human peripheral blood mononuclear cells (PBMCs) and CD4+ T cells was measured; ADCC function was evaluated by IL-2–activated, NK-cell–induced lysis of CD4+ T cells or activated CD4+Foxp3+ Tregs. Tumor growth was measured in transgenic (human CTLA-4 knock-in) mice implanted with MC38 tumors. Peripheral pharmacodynamic (PD) markers (ICOS, Ki-67) of anti–CTLA-4 activity were assessed using Tregs and effector T cells from the spleens of treated mice. PD was evaluated in cynomolgus (CYNO) macaques after administration of customized adenovirus-5 vector vaccines.
Results: With the masking peptide intact, both anti–CTLA-4 PB and anti–CTLA-4 NF PB showed decreased activity vs IPI and anti–CTLA-4 NF, respectively, in non–protease containing in vitro assays. Anti–CTLA-4 PB exhibited a 40-fold reduction in CTLA-4 binding affinity vs IPI and decreased activity in SEB-activated PBMCs. Anti–CTLA-4 NF PB showed decreased ADCC activity vs anti–CTLA-4 NF in vitro. When tested in a MC38 tumor model, anti–CTLA-4 PB and anti–CTLA-4 NF PB showed equivalent antitumor activity to IPI and anti–CTLA-4 NF, respectively. Both anti–CTLA-4 PB and anti–CTLA-4 NF PB showed equivalent intratumoral PD activity and reduced peripheral PD activity relative to their parental mAbs. Similarly, anti–CTLA-4 PB and anti–CTLA-4 NF PB resulted in reduced inflammation and peripheral PD responses relative to their parental mAbs in CYNO macaques.
Conclusion: These data demonstrate the potential of the PB-Tx technology platform to improve the therapeutic indices of anti–CTLA-4 PB and anti–CTLA-4 NF PB relative to their parental mAbs. The safety and antitumor activity of anti–CTLA-4 PB (NCT03369223) and anti–CTLA-4 NF PB (NCT03994601) are being investigated in patients with advanced solid cancers in ongoing phase 1 studies.
Citation Format: John Engelhardt, Rahima Akter, John Loffredo, Natalie Bezman, Paula So, Kimberly Tipton, Bryan Irving, James West, Wendy Freebern, Todd Bunch, Karen Price. Preclinical characterization of novel anti-CTLA-4 prodrug antibodies with an enhanced therapeutic index [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4551.
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Affiliation(s)
| | | | | | | | - Paula So
- 1Bristol-Myers Squibb, Redwood City, CA
| | | | - Bryan Irving
- 3CytomX Therapeutics, Inc., South San Francisco, CA
| | - James West
- 3CytomX Therapeutics, Inc., South San Francisco, CA
| | | | - Todd Bunch
- 2Bristol-Myers Squibb, Lawrenceville, NJ
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Engelhardt J, Akter R, Loffredo J, So P, Bezman N, Price K. Abstract 4552: Preclinical characterization of BMS-986218, a novel nonfucosylated anti–CTLA-4 antibody designed to enhance antitumor activity. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Blockade of the CTLA-4 pathway with ipilimumab (IPI) as monotherapy or in combination with nivolumab (anti–PD-1) is an effective treatment for a variety of cancers. Antibody-dependent cellular cytotoxicity (ADCC) is a cellular process through which effector immune cells that express an Fc receptor (FcR) recognize and eliminate antibody-bound targets. Anti–CTLA-4 has been shown to mediate the ADCC depletion of tumor-infiltrating regulatory T cells (Tregs), which play an important role in suppressing antitumor immune response in the tumor microenvironment. A version of IPI that is nonfucosylated (NF) in the Fc region (BMS-986218; anti–CTLA-4 NF) was created to increase binding affinity to activating Fcγ receptors (FcγR, CD16) and improve ADCC, thus increasing intratumoral Treg depletion.
Methods: Antibody binding to CD16 was studied by surface plasmon resonance. IL-2 release from staphylococcal enterotoxin B (SEB)–stimulated normal human peripheral blood mononuclear cells (PBMCs) and CD4+ T cells was measured; ADCC function was evaluated by IL-2–activated NK cell–induced lysis of CD4+ T cells or activated CD4+Foxp3+ Tregs. Tumor growth was measured in transgenic (human CD16) mice implanted with MC38 tumors. Peripheral pharmacodynamics (PD) was evaluated in cynomolgus (CYNO) macaques after administration of customized adenovirus-5 vector vaccines.
Results: Binding affinity to human CD16 was enhanced by BMS-986218 compared with IPI. BMS-986218 induced greater NK cell–mediated lysis of CD4+ T cells (37%) and Tregs (100%) compared with that induced by IPI (7% and 58%, respectively). Anti–CTLA-4 NF was also more effective than IPI in enhancing IL-2 release from SEB-stimulated PBMCs. Addition of an anti-CD16 antibody blocked the IL-2 response, supporting the concept that CD16 was necessary for anti–CTLA-4 NF activity. In mice, anti–CTLA-4 NF produced greater dose-dependent tumor growth inhibition (99%) than anti–CTLA-4 (61%). Tumors from anti–CTLA-4 NF–treated mice compared with anti–CTLA-4–treated mice had a greater decrease in Treg levels (70% vs 30%, respectively) and a larger increase in CD8+ T-cell levels (82% vs 62%, respectively) and no changes in Treg or CD8+ cell levels in the spleen. A more pronounced vaccine-induced T-cell response in anti–CTLA-4 NF–treated vs anti–CTLA-4–treated CYNO macaques was observed over a 3-week period.
Conclusions: Nonfucosylation of an anti–CTLA-4 antibody increased binding affinity to CD16, induced depletion of Tregs while increasing T-effector cells in mouse tumors, and enhanced tumor growth inhibition in a dose-dependent manner, thus demonstrating improved ADCC compared with IPI. An ongoing phase 1/2 study is evaluating the safety and antitumor activity of anti–CTLA-4 NF alone and in combination with nivolumab (NCT03110107) in patients with advanced solid cancers.
Citation Format: John Engelhardt, Rahima Akter, John Loffredo, Paula So, Natalie Bezman, Karen Price. Preclinical characterization of BMS-986218, a novel nonfucosylated anti–CTLA-4 antibody designed to enhance antitumor activity [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4552.
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Affiliation(s)
| | | | | | - Paula So
- 1Bristol-Myers Squibb, Redwood City, CA
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Marson BA, Oakley BJ, Srinivasan S, S S, Chell J, Halliday K, Hunter J, Price K. Is it safe for extended-role radiographers to measure migration percentage in children with cerebral palsy? Radiography (Lond) 2020; 26:e246-e250. [PMID: 32335020 DOI: 10.1016/j.radi.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/21/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In the surveillance of children with cerebral palsy, the measurement of migration percentage is used to identify children at risk of hip dislocation. Early identification of children at risk facilitates early intervention with less invasive surgical procedures to prevent further deterioration. The aim of this study is to evaluate the safety of the measurements of migration percentage for surveillance in cerebral palsy by extended-role radiographers by evaluating the reliability and validity of measurements performed by these professionals. METHODS A sample of thirty pelvic x-rays were selected from the local cerebral palsy database. A range of hip displacement was selected including some challenging borderline x-rays. All ten extended-role radiographers completed measurements using TraumaCAD which were repeated at a minimum of 4 weeks. Inter-rater and intra-rater reliability was calculated using intraclass correlation coefficients. The accuracy and safety of the system was evaluated by converting measurements into referral categories (red, amber or green) and cohen's kappa was calculated when categories were compared to measurements to orthopaedic surgeon RESULTS: The inter-rater reliability between radiographers was 0.938 (95% CI 0.914-0.991). The intra-rater reliability was 0.941 (95% CI 0.931-0.949). The percentage agreement was 94.8% for green, 93.8% for amber and 98.2% for red hips. The weighted kappa value was 0.923 (95% CI 0.889-0.957). CONCLUSION The reliability and accuracy of radiographer measurement of migration percentage is excellent. It is safe for radiographers to calculate the migration percentage using semi-automated software for the surveillance of children with cerebral palsy. IMPLICATIONS FOR PRACTICE We recommend the measurement of migration percentage may be performed by extended-role radiographers to deliver accurate and reliable measurements for use in cerebral palsy surveillance.
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Affiliation(s)
- B A Marson
- Department of Trauma and Orthopaedics, Nottingham Children's Hospital, QMC, Nottingham, NG7 2UH, United Kingdom.
| | - B J Oakley
- Department of Trauma and Orthopaedics, Kings Mill Hospital, Sutton on Ashfield, NG17 4JL, United Kingdom.
| | - S Srinivasan
- Department of Trauma and Orthopaedics, Kings Mill Hospital, Sutton on Ashfield, NG17 4JL, United Kingdom.
| | - S S
- Department of Trauma and Orthopaedics, Kings Mill Hospital, Sutton on Ashfield, NG17 4JL, United Kingdom.
| | - J Chell
- Department of Trauma and Orthopaedics, Nottingham Children's Hospital, QMC, Nottingham, NG7 2UH, United Kingdom.
| | - K Halliday
- Department of Radiology, Nottingham Children's Hospital, QMC, Nottingham, NG7 2UH, United Kingdom.
| | - J Hunter
- Department of Trauma and Orthopaedics, Nottingham Children's Hospital, QMC, Nottingham, NG7 2UH, United Kingdom.
| | - K Price
- Department of Trauma and Orthopaedics, Nottingham Children's Hospital, QMC, Nottingham, NG7 2UH, United Kingdom.
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Fazer C, Chintakuntlawar A, Price K. Capecitabine for Salvage Treatment of Patients with Heavily Pre-treated Human Papillomavirus-Associated Oropharynx Cancer (HPV-OPC) with Distant Metastases. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ma D, Moore E, Van Abel K, Lohse C, Bailey K, Price K, Patel S, Hinni M, Garcia J, Neben-Wittich M, Garces Y, Chintakuntlawar A, Price D, Olsen K, Kasperbauer J, Janus J, McGee L, Lester S, Rwigema J, Foote R. Risk Factors for Disease Progression Following Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus–Associated Oropharynx Squamous Cell Carcinoma (HPV-OSCC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.343] [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]
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Starrett J, Guernet A, Cuomo M, Poels K, van Alderwerelt van Rosenburgh I, Nagelberg A, Farnsworth D, Price K, Khan H, Ashtekar K, Gaefele M, Ayeni D, Stewart T, Kuhlmann A, Kaech S, Unni A, Homer R, Lockwood W, Michor F, Goldberg S, Lemmon M, Smith P, Cross D, Politi K. B32 Drug Sensitivity and Allele Specificity of First-Line Osimertinib Resistance EGFR Mutations. J Thorac Oncol 2020. [DOI: 10.1016/j.jtho.2019.12.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND AND OBJECTIVES Researchers and clinicians have been criticised for frequently misinterpreting and misusing P values. This study sought to understand how general practitioners (GPs) in Australia and New Zealand conceptualise P values presented in the manner typically encountered in a medical publication. METHODS This mixed-methods study used quantitative and qualitative questions embedded in an online questionnaire and delivered through an Australian and New Zealand GP-specific Facebook group in 2017. It included questions that elaborated on the participant’s conceptualisation of ‘P = 0.05’ within a scenario and tested their P value interpretation ability and confidence. RESULTS There were 247 participants who completed the questionnaire. Participant conceptualisations of P values were described using six thematic categories. The most common (and erroneous) conceptualisation was that P values numerically indicated a ‘real-world probability’. No demographic factor, including research experience, seemed
associated with better interpretation ability. A confidence–ability gap was detected. DISCUSSION P value misunderstanding is pervasive and might be influenced by a few central misconceptions. Statistics education for clinicians should explicitly address the most common misconceptions.
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Affiliation(s)
- Chun Wah Michael Tam
- BSc (Med), MBBS, MMH (GP), FRACGP, Staff Specialist, Academic Primary and Integrated Care Unit, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research; Conjoint Senior Lecturer, School of Public Health and Community Medicine, UNSW Sydney, NSW.
| | | | - Andrew Knight
- MBBS, MMedSci, FRACGP, FAICD, Acting Director, Academic Primary and Integrated Care Unit, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research; Conjoint Senior Lecturer, School of Public Health and Community Medicine, UNSW Sydney, NSW
| | - Joel Rhee
- BSc (Med), MBBS (Hons), GCULT, PhD, FRACGP, Associate Professor in General Practice, Graduate School of Medicine, University of Wollongong, NSW
| | - Karen Price
- MBBS, Dip Adolescent Medicine, FRACGP, Clinical academic, Department of General Practice, Monash University, Vic; moderator, GPs Down Under
| | - Katrina McLean
- BMLSc (Dist), PGDip Sport Med, MBChB, FRNZCGP, FRACGP, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University, Qld; moderator, GPs Down Under
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Di Giallonardo F, Pinto AN, Keen P, Shaik A, Carrera A, Salem H, Telfer B, Cooper C, Price K, Selvey C, Holden J, Bachmann N, Lee FJ, Dwyer DE, Duchêne S, Holmes EC, Grulich AE, Kelleher AD. Limited Sustained Local Transmission of HIV-1 CRF01_AE in New South Wales, Australia. Viruses 2019; 11:v11050482. [PMID: 31137836 PMCID: PMC6563510 DOI: 10.3390/v11050482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
Australia’s response to the human immunodeficiency virus type 1 (HIV-1) pandemic led to effective control of HIV transmission and one of the world’s lowest HIV incidence rates—0.14%. Although there has been a recent decline in new HIV diagnoses in New South Wales (NSW), the most populous state in Australia, there has been a concomitant increase with non-B subtype infections, particularly for the HIV-1 circulating recombinant form CRF01_AE. This aforementioned CRF01_AE sampled in NSW, were combined with those sampled globally to identify NSW-specific viral clades. The population growth of these clades was assessed in two-year period intervals from 2009 to 2017. Overall, 109 NSW-specific clades were identified, most comprising pairs of sequences; however, five large clades comprising ≥10 sequences were also found. Forty-four clades grew over time with one or two sequences added to each in different two-year periods. Importantly, while 10 of these clades have seemingly discontinued, the remaining 34 were still active in 2016/2017. Seven such clades each comprised ≥10 sequences, and are representative of individual sub-epidemics in NSW. Thus, although the majority of new CRF01_AE infections were associated with small clades that rarely establish ongoing chains of local transmission, individual sub-epidemics are present and should be closely monitored.
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Affiliation(s)
- Francesca Di Giallonardo
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Angie N Pinto
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
- Department of Infectious Diseases & Microbiology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
| | - Phillip Keen
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Ansari Shaik
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Alex Carrera
- New South Wales State Reference Laboratory for HIV/AIDS, Darlinghurst, New South Wales 2010, Australia.
| | - Hanan Salem
- New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
| | - Barbara Telfer
- Health Protection New South Wales, New South Wales Health, NSW, North Sydne, New South Wales 2060, Australia.
| | - Craig Cooper
- Positive Life New South Wales, Surry Hills, New South Wales 2010, Australia.
| | - Karen Price
- ACON Health Ltd., Surry Hills, New South Wales 2010, Australia.
| | - Christine Selvey
- Health Protection New South Wales, New South Wales Health, NSW, North Sydne, New South Wales 2060, Australia.
| | - Joanne Holden
- Centre for Population Health, New South Wales Ministry of Health, North Sydney, New South Wales 2059, Australia.
| | - Nadine Bachmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Institute of Medical Virology, University of Zurich, 8091 Zurich, Switzerland.
| | - Frederick J Lee
- New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
- Department of Clinical Immunology & Allergy, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
- Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Dominic E Dwyer
- New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales 2145, Australia.
| | - Sebastián Duchêne
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia.
| | - Edward C Holmes
- Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia.
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Andrew E Grulich
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Anthony D Kelleher
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
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Prockop S, Doubrovina E, Hasan A, Suser S, Rodriguez-Sanchez I, Price K, Slocum A, O'Reilly R. Durable responses to 3rd party viral specific T cells mediated by different patterns of engraftment. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fagogenis G, Mencattelli M, Machaidze Z, Rosa B, Price K, Wu F, Weixler V, Saeed M, Mayer JE, Dupont PE. Autonomous Robotic Intracardiac Catheter Navigation Using Haptic Vision. Sci Robot 2019; 4:eaaw1977. [PMID: 31414071 PMCID: PMC6693882 DOI: 10.1126/scirobotics.aaw1977] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While all minimally invasive procedures involve navigating from a small incision in the skin to the site of the intervention, it has not been previously demonstrated how this can be done autonomously. To show that autonomous navigation is possible, we investigated it in the hardest place to do it - inside the beating heart. We created a robotic catheter that can navigate through the blood-filled heart using wall-following algorithms inspired by positively thigmotactic animals. The catheter employs haptic vision, a hybrid sense using imaging for both touch-based surface identification and force sensing, to accomplish wall following inside the blood-filled heart. Through in vivo animal experiments, we demonstrate that the performance of an autonomously-controlled robotic catheter rivals that of an experienced clinician. Autonomous navigation is a fundamental capability on which more sophisticated levels of autonomy can be built, e.g., to perform a procedure. Similar to the role of automation in fighter aircraft, such capabilities can free the clinician to focus on the most critical aspects of the procedure while providing precise and repeatable tool motions independent of operator experience and fatigue.
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Affiliation(s)
- G Fagogenis
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - M Mencattelli
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Z Machaidze
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - B Rosa
- ICube, Université de Strasbourg, CNRS, Strasbourg, France
| | - K Price
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - F Wu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - V Weixler
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - M Saeed
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - J E Mayer
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - P E Dupont
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Ruberg SJ, Harrell FE, Gamalo-Siebers M, LaVange L, Jack Lee J, Price K, Peck C. Inference and Decision Making for 21st-Century Drug Development and Approval. AM STAT 2019. [DOI: 10.1080/00031305.2019.1566091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Frank E. Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Lisa LaVange
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J. Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Price
- Lilly Corporate Center, Eli Lilly & Company, Indianapolis, IN
| | - Carl Peck
- NDA Partners, LLC, San Luis Obispo, CA
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Albarqouni L, Hoffmann T, McLean K, Price K, Glasziou P. Role of professional networks on social media in addressing clinical questions at general practice: a cross-sectional study of general practitioners in Australia and New Zealand. BMC Fam Pract 2019; 20:43. [PMID: 30841866 PMCID: PMC6404315 DOI: 10.1186/s12875-019-0931-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022]
Abstract
Background Clinicians frequently have questions about patient care. However, for more than half of the generated questions, answers are never pursued, and if they are, often not answered satisfactorily. We aimed to characterise the clinical questions asked and answers provided by general practitioners (GP) through posts to a popular professional social media network. Methods In this cross-sectional study, we analysed clinical questions and answers posted between January 20th and February 10th 2018 on a popular GP-restricted (Australia, New Zealand) Facebook group. Each clinical question was categorised according to ‘background’ or ‘foreground’ question; type (e.g. treatment, diagnosis); and the clinical topic (e.g. cardiovascular). Each answer provided in response to included questions was categorised into: (i) short answer (e.g. agree/disagree); (ii) provided an explanation to justify the answer; and (iii) referred to a published relevant evidence resource. Results Of 1060 new posts during the study period, 204 (19%) included a clinical question. GPs most commonly asked about treatment (n = 87; 43%) and diagnosis (n = 59; 29%). Five major topics (23% skin, 10% psychology, 9% cardiovascular, 8% female genital, and 7% musculoskeletal) accounted for 118 (58%) questions. Each question received on average 10 (SD = 9) answers: 42% were short; 51% provided an explanation; and only 6% referred to relevant research evidence. Only 3 answers referred to systematic reviews. Conclusions In this sample of Australian and New Zealand GPs, who were members of a GP social media group, GPs asked clinical questions that can be organised into a limited number of question types and topics. This might help guide the development of GP learning programs.
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Affiliation(s)
- Loai Albarqouni
- Centre for Research in Evidence Based Practice, Bond University, 14 University Dr, Robina, QLD, 4229, Australia.
| | - Tammy Hoffmann
- Centre for Research in Evidence Based Practice, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Katrina McLean
- Faculty of Health Science and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Karen Price
- School of Primary Health Care, Monash University, Melbourne, Australia
| | - Paul Glasziou
- Centre for Research in Evidence Based Practice, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
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Harrington L, Price K, Rampota C, Edmonds P. 61ELECTRONIC DO NOT ATTEMPT CARDIO-PULMONARY RESUSCITATION (DNACPR): TOO FAR? AN EVALUATION OF PRACTICE WITHIN GERONTOLOGY AT KING’S COLLEGE HOSPITAL (KCH), LONDON, UK. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Harrington
- Core Trainees in Departments of Gerontology and
- Equal Co-authorship between L Harrington and K Price
| | - K Price
- Renal Medicine, King’s College Hospital, NHS Foundation Trust Consultant in Palliative Care
- Equal Co-authorship between L Harrington and K Price
| | - C Rampota
- Core Trainees in Departments of Gerontology and
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, Randell P, Mansell S, Lloyd J, Bell S, Butler Y, Hooton H, Navarra A, Roper G, Babington L, Crate H, Cripps A, Ledlie C, Moulds R, Malloy J, Norton B, Petrova O, Silkstone C, Smith K, Ghai M, Murray V, Viswanathan M, Henegan O, Kawadry J, Olson L, Maddox K, Patterson T, Ahmad B, Flores D, Domek S, Domek K, Copeland M, George J, Less T, Davis M, Short A, Martin J, Dwarakanathan P, O’Donnell B, Boerner L, Larson M, Phillips M, Rendell K, Larson C, Smith K, Zebrowski L, Kuechenmeister M, Miller J, Thevarayapillai M, Daniels H, Speer N, Forghani R, Quintana C, Reh A, Bhangoo P, Desrosiers L, Ireland T, Misla C, Milliot E, Torres S, Wells J, Villar M, Yu D, Berry D, Cook J, Soder A, Powell M, Ng M, Morrison Z, Moore M, Haslam M, Lawson B, Bradley J, Courtney C, Richardson C, Watson E, Keely D, DeCurtis M, Vaccarcello-Cruz Z, Torres K, Muller S, Sandberg H, Hsiang B, Joy D, McCormick A, Powell H, Jones J, Bell S, Hargadon S, Hudson M, Kummer S, Nguyen T, Sauder E, Sutton K, Gensel R, Aguirre-Castaneda V, Benavides, Lopez D, Hemp S, Allen J, Stear E, Davis T, O’Donnell R, Jones A, Roberts J, Dart N, Paramalingam L, Levitt Katz N, Chaudhary K, Murphy S, Willi B, Schwartzman C, Kapadia D, Roberts A, Larson D, McClellan G, Shaibai L, Kelley G, Villa C, Kelley R, Diamond M, Kabbani T, Dajani F, Hoekstra M, Sadler K, Magorno J, Holst V, Chauhan N, Wilson P, Bononi M, Sperl A, Millward M, Eaton L, Dean J, Olshan H, Stavros T, Renna C, Milliard, Brodksy L, Bacon J, Quintos L, Topor S, Bialo B, Bancroft A, Soto W, Lagarde H, Tamura R, Lockemer T, Vanderploeg M, Ibrahim M, Huie V, Sanchez R, Edelen R, Marchiando J, Palmer T, Repas M, Wasson P, Wood K, Auker J, Culbertson T, Kieffer D, Voorhees T, Borgwardt L, DeRaad K, Eckert E, Isaacson H, Kuhn A, Carroll M, Xu P, Schubert G, Francis S, Hagan T, Le M, Penn E, Wickham C, Leyva K, Rivera J, Padilla I, Rodriguez N, Young K, Jospe J, Czyzyk B, Johnson U, Nadgir N, Marlen G, Prakasam C, Rieger N, Glaser E, Heiser B, Harris C, Alies P, Foster H, Slater K, Wheeler D, Donaldson M, Murray D, Hale R, Tragus D, Word J, Lynch L, Pankratz W, Badias F, Rogers R, Newfield S, Holland M, Hashiguchi M, Gottschalk A, Philis-Tsimikas R, Rosal S, Franklin S, Guardado N, Bohannon M, Baker A, Garcia T, Aguinaldo J, Phan V, Barraza D, Cohen J, Pinsker U, Khan J, Wiley L, Jovanovic P, Misra M, Bassi M, Wright D, Cohen K, Huang M, Skiles S, Maxcy C, Pihoker K, Cochrane J, Fosse S, Kearns M, Klingsheim N, Beam C, Wright L, Viles H, Smith S, Heller M, Cunningham A, Daniels L, Zeiden J, Field R, Walker K, Griffin L, Boulware D, Bartholow C, Erickson J, Howard B, Krabbenhoft C, Sandman A, Vanveldhuizen J, Wurlger A, Zimmerman K, Hanisch L, Davis-Keppen A, Bounmananh L, Cotterill J, Kirby M, Harris A, Schmidt C, Kishiyama C, Flores J, Milton W, Martin C, Whysham A, Yerka T, Bream S, Freels J, Hassing J, Webster R, Green P, Carter J, Galloway D, Hoelzer S, Roberts S, Said P, Sullivan H, Freeman D, Allen E, Reiter E, Feinberg C, Johnson L, Newhook D, Hagerty N, White L, Levandoski J, Kyllo M, Johnson C, Gough J, Benoit P, Iyer F, Diamond H, Hosono S, Jackman L, Barette P, Jones I, Sills S, Bzdick J, Bulger R, Ginem J, Weinstock I, Douek R, Andrews G, Modgill G, Gyorffy L, Robin N, Vaidya S, Crouch K, O’Brien C, Thompson N, Granger M, Thorne J, Blumer J, Kalic L, Klepek J, Paulett B, Rosolowski J, Horner M, Watkins J, Casey K, Carpenter C, Michelle Kieffer MH, Burns J, Horton C, Pritchard D, Soetaert A, Wynne C, Chin O, Molina C, Patel R, Senguttuvan M, Wheeler O, Lane P, Furet C, Steuhm D, Jelley S, Goudeau L, Chalmers D, Greer C, Panagiotopoulos D, Metzger D, Nguyen M, Horowitz M, Linton C, Christiansen E, Glades C, Morimoto M, Macarewich R, Norman K, Patin C, Vargas A, Barbanica A, Yu P, Vaidyanathan W, Nallamshetty L, Osborne R, Mehra S, Kaster S, Neace J, Horner G, Reeves C, Cordrey L, Marrs T, Miller S, Dowshen D, Oduah V, Doyle S, Walker D, Catte H, Dean M, Drury-Brown B, Hackman M, Lee S, Malkani K, Cullen K, Johnson P, Parrimon Y, Hampton M, McCarrell C, Curtis E, Paul, Zambrano Y, Paulus K, Pilger J, Ramiro J, Luvon Ritzie AQ, Sharma A, Shor A, Song X, Terry A, Weinberger J, Wootten M, Lachin JM, Foulkes M, Harding P, Krause-Steinrauf H, McDonough S, McGee PF, Owens Hess K, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Leschek E, Spain L, Savage P, Aas S, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Vigersky R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Veatch R, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Leschek E, Marks J, Matheson D, Rafkin L, Rodriguez H, Spain L, Wilson D, Redondo M, Gomez D, McDonald A, Pena S, Pietropaolo M, Shippy K, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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Manzar G, Lester S, Kobic A, Hosfield E, Neben-Wittich M, Garces Y, Price K, Chintakuntlawar A, Price D, Foote R, Graner D, Ma D. Longitudinal Objective Speech and Swallow Function after Treatment with Definitive Radiation Therapy (RT) for Larynx Cancer in the Intensity Modulated Radiation Therapy (IMRT) Era. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Deshmukh S, Marson B, Price K. Characterising the incidence and management of paediatric forearm fractures in a UK trauma centre over a one-year period. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Alsidawi S, Price K, Foote R, Garcia J, Westin G, Moore E, Chintakuntlawar A. Adjuvant Chemotherapy Utilization According to Treatment Facility Type in Resected Head and Neck Cancer With Negative Surgical Margins and No Extracapsular Nodal Extension. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Price K, Moore E, Foote R, Patel S, Hinni M, Chintakuntlawar A, Garcia J, Graner D, Neben-Wittich M, Garces Y, Hallemeier C, Kasperbauer J, Janus J, Van Abel K, Price D, Ma D. Toxicity, Swallow Function, and Quality of life on MC1273, a Phase 2 Study of Dose De-escalation for Adjuvant Chemoradiation in HPV+ Oropharynx Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.027] [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: 11/27/2022]
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Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA, Grulich AE. Correction: expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in new South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health 2018; 18:297. [PMID: 29490635 PMCID: PMC5831707 DOI: 10.1186/s12889-018-5173-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
After publication of the article [1], it has been brought to our attention that one of the members of the EPIC-NSW study group has had their name spelt incorrectly in the acknowledgements. The article mentions "Muhammad Hammoud" when in fact the correct spelling is "Mohamed Hammoud".
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, NSW, Australia
| | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David Smith
- Mid North Coast Local Health District (Area HIV/Sexual Health Services), Lismore Health Service, Lismore, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.,MacquarieUniversity, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
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Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA, Grulich AE. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health 2018; 18:210. [PMID: 29394918 PMCID: PMC5797394 DOI: 10.1186/s12889-017-5018-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/21/2017] [Indexed: 01/08/2023] Open
Abstract
Background The New South Wales (NSW) HIV Strategy 2016–2020 aims for the virtual elimination of HIV transmission in NSW, Australia, by 2020. Despite high and increasing levels of HIV testing and treatment since 2012, the annual number of HIV diagnoses in NSW has remained generally unchanged. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among gay and bisexual men (GBM) when taken appropriately. However, there have been no population-level studies that evaluate the impact of rapid PrEP scale-up in high-risk GBM. Expanded PrEP Implementation in Communities in NSW (EPIC-NSW) is a population-level evaluation of the rapid, targeted roll-out of PrEP to high-risk individuals. Methods EPIC-NSW, is an open-label, single-arm, multi-centre prospective observational study of PrEP implementation and impact. Over 20 public and private clinics across urban and regional areas in NSW have participated in the rapid roll-out of PrEP, supported by strong community mobilization and PrEP promotion. The study began on 1 March 2016, aiming to enroll at least 3700 HIV negative people at high risk of HIV. This estimate took into consideration criteria for PrEP prescription in people at high risk for acquiring HIV as defined in the NSW PrEP guidelines. Study participants receive once daily co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and are followed for up to 24 months. Follow-up includes: testing for HIV at 1 month, HIV and other sexually transmissible infections three-monthly, HCV annually and monitoring of renal function six-monthly. Optional online behavioural surveys are conducted quarterly. The co-primary endpoints are (i) HIV diagnoses and incidence in the cohort and (ii) HIV diagnoses in NSW. Discussion EPIC-NSW is a population-based PrEP implementation trial which targets the entire estimated population of GBM at high risk for HIV infection in NSW. It will provide a unique opportunity to evaluate the population impact of PrEP on a concentrated HIV epidemic. Trial registration https://clinicaltrials.gov/ (identifying number NCT02870790; registration date 14 August 2016), pre-results stage. Electronic supplementary material The online version of this article (10.1186/s12889-017-5018-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, NSW, Australia
| | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David Smith
- Mid North Coast Local Health District (Area HIV/Sexual Health Services), Lismore Health Service, Lismore, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.,Macquarie University, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
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Ma D, Price K, Moore E, Patel S, Hinni M, Chintakuntlawar A, Garcia J, Graner D, Neben-Wittich M, Garces Y, Hallemeier C, Price D, Kasperbauer J, Janus J, Foster N, Foote R. Two-Year Results for MC1273, a Phase 2 Evaluation of Aggressive Dose De- Escalation for Adjuvant Chemoradiation in HPV+ Oropharynx Squamous Cell Carcinoma (OPSCC). Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Routman D, Funk R, Tangsriwong K, Lin A, Michael K, Garcia J, Stoddard D, Eric M, Day C, Zhai Q, Price K, Lukens J, Samuel S, Weinstein G, O'Malley B, Foote R, Ma D. Relapse Rates with Surgery Alone in HPV-Related Intermediate- and High-Risk-Group Oropharynx Squamous Cell Cancer: A Multi-Institutional Review. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Kim SC, Wakwe W, Higginbotham LB, Mathews DV, Breeden CP, Stephenson AC, Jenkins J, Strobert E, Price K, Price L, Kuhn R, Wang H, Yamniuk A, Suchard S, Farris AB, Pearson TC, Larsen CP, Ford ML, Suri A, Nadler S, Adams AB. Fc-Silent Anti-CD154 Domain Antibody Effectively Prevents Nonhuman Primate Renal Allograft Rejection. Am J Transplant 2017; 17:1182-1192. [PMID: 28097811 PMCID: PMC5409881 DOI: 10.1111/ajt.14197] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [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: 10/02/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 01/25/2023]
Abstract
The advent of costimulation blockade provides the prospect for targeted therapy with improved graft survival in transplant patients. Perhaps the most effective costimulation blockade in experimental models is the use of reagents to block the CD40/CD154 pathway. Unfortunately, successful clinical translation of anti-CD154 therapy has not been achieved. In an attempt to develop an agent that is as effective as previous CD154 blocking antibodies but lacks the risk of thromboembolism, we evaluated the efficacy and safety of a novel anti-human CD154 domain antibody (dAb, BMS-986004). The anti-CD154 dAb effectively blocked CD40-CD154 interactions but lacked crystallizable fragment (Fc) binding activity and resultant platelet activation. In a nonhuman primate kidney transplant model, anti-CD154 dAb was safe and efficacious, significantly prolonging allograft survival without evidence of thromboembolism (Median survival time 103 days). The combination of anti-CD154 dAb and conventional immunosuppression synergized to effectively control allograft rejection (Median survival time 397 days). Furthermore, anti-CD154 dAb treatment increased the frequency of CD4+ CD25+ Foxp3+ regulatory T cells. This study demonstrates that the use of a novel anti-CD154 dAb that lacks Fc binding activity is safe without evidence of thromboembolism and is equally as potent as previous anti-CD154 agents at prolonging renal allograft survival in a nonhuman primate preclinical model.
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Affiliation(s)
- Steven C Kim
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Walter Wakwe
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Laura B Higginbotham
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - David V Mathews
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Cynthia P Breeden
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Allison C Stephenson
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Joe Jenkins
- Yerkes National Primate Research Center, School of Medicine, Emory University, Atlanta, GA, USA
| | - Elizabeth Strobert
- Yerkes National Primate Research Center, School of Medicine, Emory University, Atlanta, GA, USA
| | - Karen Price
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Laura Price
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Robert Kuhn
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Haiqing Wang
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Aaron Yamniuk
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Suzanne Suchard
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Alton B Farris
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Thomas C Pearson
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Christian P Larsen
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Mandy L Ford
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
| | - Anish Suri
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Steven Nadler
- Bristol Myers-Squibb Pharmaceutical Research Institute, Princeton, NJ, USA
| | - Andrew B Adams
- Emory Transplant Center, Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA
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49
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Gamalo-Siebers M, Savic J, Basu C, Zhao X, Gopalakrishnan M, Gao A, Song G, Baygani S, Thompson L, Xia HA, Price K, Tiwari R, Carlin BP. Statistical modeling for Bayesian extrapolation of adult clinical trial information in pediatric drug evaluation. Pharm Stat 2017; 16:232-249. [PMID: 28448684 DOI: 10.1002/pst.1807] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 08/31/2016] [Revised: 01/19/2017] [Accepted: 03/03/2017] [Indexed: 11/06/2022]
Abstract
Children represent a large underserved population of "therapeutic orphans," as an estimated 80% of children are treated off-label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or "borrowing") of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure-response information for antiepileptic drugs to pediatrics.
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Affiliation(s)
| | | | - Cynthia Basu
- Division of Biostatistics, University of Minnesota, Minneapolis, 55455, MN, USA
| | - Xin Zhao
- Biostatistics, Johnson & Johnson, South San Francisco, 94080, CA, USA
| | - Mathangi Gopalakrishnan
- Research Assistant Professor, Center for Translational Medicine, University of Maryland, Baltimore, 21201, MD, USA
| | - Aijun Gao
- Biostatistics, Chiltern International Ltd., King of Prussia, 19406, PA, USA
| | | | - Simin Baygani
- Global Statistical Science, Eli Lilly & Co, Lilly Corporate Center, Indianapolis, 46285, IN, USA
| | - Laura Thompson
- Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, 20993, MD, USA
| | - H Amy Xia
- Biostatistics, Amgen, Thousand Oaks, 91320, CA, USA
| | - Karen Price
- Advanced Analytics, Eli Lilly & Co, Lilly Corporate Center, Indianapolis, 46285, IN, USA
| | - Ram Tiwari
- Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, 20993, MD, USA
| | - Bradley P Carlin
- Division of Biostatistics, University of Minnesota, Minneapolis, 55455, MN, USA
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50
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Thürlimann B, Giobbie-Hurder A, Colleoni M, Jensen MB, Ejlertsen B, de Azambuja E, Neven P, Láng I, Gladieff L, Bonnefoi H, Harvey VJ, Spazzapan S, Tondini C, Price K, Piccart-Gebhart M, Regan MM, Gelber RD, Coates AS, Goldhirsch A. Abstract P2-09-05: 12 years' median follow up (MFU) of BIG 1-98: Adjuvant letrozole, tamoxifen and their sequence for postmenopausal women with endocrine responsive early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-09-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The Breast International Group (BIG) 1-98 study is a randomized, phase 3, double-blind trial that compared five yrs of adjuvant treatment with letrozole, tamoxifen, or their sequence in postmenopausal women with hormone-receptor–positive early breast cancer. The study is conducted by the International Breast Cancer Study Group (IBCSG) on behalf of BIG. 8010 patients (pts) were enrolled between March 1998 and May 2003, and first results demonstrating a significant DFS benefit favoring letrozole compared with tamoxifen were reported in 2005 at 25.8 months' MFU. Subsequent updates showed continuing DFS benefit and updated results published in 2011 at 8.1 yrs' MFU showed OS benefit. Industry-sponsorship of the original BIG 1-98 ended in 2010; IBCSG launched an observational, non-interventional long-term follow-up study (BIG 1-98 LTFU) to collect survival, disease status and adverse events for an additional 5 yrs. We report results from BIG 1-98 LTFU at 12 yrs' MFU.
Methods
The original trial includes the 8010 patients enrolled. The potential BIG 1-98 LTFU cohort consisted of 148 academic medical centers with a maximum of 6843 pts who were alive and continuing follow-up when the original study ended. Response bias was addressed using weighting class adjustments estimated using multivariable logistic regression. Unadjusted incidence rates are reported here per 1000 pt-yrs with 95% Poisson confidence intervals. An updated abstract will include adjusted incidence rates, as well as estimates of OS and DFS based on a weighted Kaplan-Meier approach. The database will close in July 2016.
Results
As of May 2016, 81 centers participated in the BIG 1-98 LTFU study, contributing data from approximately 3900 pts (57%) and extending MFU to 12 yrs. Compared with the potential cohort of 6843 pts, the ~3900 in the LTFU analytic cohort were more likely to be under age 65 yrs at enrollment, have node-positive disease, and have tumors that were < 2 cm, PgR positive (≥1%), and with no evidence of peritumoral vascular invasion. Extended adjuvant endocrine therapy for primary BC was continued in 2% of pts. Unadjusted incidence estimates of myocardial infarction increased during LTFU, while incidence of thromboembolic events and osteoporosis decreased (Table). Variations in incidence rates were noted depending on recording mechanism (e.g. registry, clinic visit, telephone, information from family).
Unadjusted Incidence Rate/1000 pt-yrs (95% CI)Adverse EventDuring original studyDuring LTFUMyocardial Infarction1.7 (1.4-2.0)3.5 (2.7-4.5)Thromboembolic event6.0 (5.4-6.6)2.5 (1.8-3.3)Osteoporosis23.6 (22.5-24.9)18.2 (16.3-20.3)Bone fractures17.2 (16.2-18.3)15.0 (13.2-16.9)
Overall 1845 deaths were reported; the unadjusted incidence of death was lower in the original study compared with during LTFU (21.9 vs. 26.6/1000 pt-yrs); incidence remained relatively stable for pts assigned to tamoxifen (24.9 vs. 25.2/1000 pt-yrs), and increased for pts assigned to letrozole (22.0 vs. 27.1/1000 pt-yrs).
Conclusions
The BIG 1-98 LTFU study has been successfully conducted. The additional data from the BIG 1-98 LTFU study provides important long-term clinical information about OS, DFS and adverse events.
Citation Format: Thürlimann B, Giobbie-Hurder A, Colleoni M, Jensen M-B, Ejlertsen B, de Azambuja E, Neven P, Láng I, Gladieff L, Bonnefoi H, Harvey VJ, Spazzapan S, Tondini C, Price K, Piccart-Gebhart M, Regan MM, Gelber RD, Coates AS, Goldhirsch A. 12 years' median follow up (MFU) of BIG 1-98: Adjuvant letrozole, tamoxifen and their sequence for postmenopausal women with endocrine responsive early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-05.
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Affiliation(s)
- B Thürlimann
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - A Giobbie-Hurder
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - M Colleoni
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - M-B Jensen
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - B Ejlertsen
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - E de Azambuja
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - P Neven
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - I Láng
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - L Gladieff
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - H Bonnefoi
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - VJ Harvey
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - S Spazzapan
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - C Tondini
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - K Price
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - M Piccart-Gebhart
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - MM Regan
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - RD Gelber
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - AS Coates
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
| | - A Goldhirsch
- International Breast Cancer Study Group and BIG 1-98 Collaborative Group
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