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Isaacs JD, Brockbank S, Pedersen AW, Hilkens C, Anderson A, Stocks P, Lendrem D, Tarn J, Smith GR, Allen B, Casement J, Diboll J, Harry R, Cooles FAH, Cope AP, Simpson G, Toward R, Noble H, Parke A, Wu W, Clarke F, Scott D, Scott IC, Galloway J, Lempp H, Ibrahim F, Schwank S, Molyneux G, Lazarov T, Geissmann F, Goodyear CS, McInnes IB, Donnelly I, Gilmour A, Virlan AT, Porter D, Ponchel F, Emery P, El-Jawhari J, Parmar R, McDermott MF, Fisher BA, Young SP, Jones P, Raza K, Filer A, Pitzalis C, Barnes MR, Watson DS, Henkin R, Thorborn G, Fossati-Jimack L, Kelly S, Humby F, Bombardieri M, Rana S, Jia Z, Goldmann K, Lewis M, Ng S, Barbosa-Silva A, Tzanis E, Gallagher-Syed A, John CR, Ehrenstein MR, Altobelli G, Martins S, Nguyen D, Ali H, Ciurtin C, Buch M, Symmons D, Worthington J, Bruce IN, Sergeant JC, Verstappen SMM, Stirling F, Hughes-Morley A, Tom B, Farewell V, Zhong Y, Taylor PC, Buckley CD, Keidel S, Cuff C, Levesque M, Long A, Liu Z, Lipsky S, Harvey B, Macoritto M, Hong F, Kaymakcalan S, Tsuji W, Sabin T, Ward N, Talbot S, Padhji D, Sleeman M, Finch D, Herath A, Lindholm C, Jenkins M, Ho M, Hollis S, Marshall C, Parker G, Page M, Edwards H, Cuza A, Gozzard N, Pandis I, Rowe A, Capdevila FB, Loza MJ, Curran M, Verbeeck D, Dan Baker, Mela CM, Vranic I, Mela CT, Wright S, Rowell L, Vernon E, Joseph N, Payne N, Rao R, Binks M, Belson A, Ludbrook V, Hicks K, Tipney H, Ellis J, Hasan S, Didierlaurent A, Burny W, Haynes A, Larminie C, Harris R, Dastros-Pitei D, Carini C, Kola B, Jelinsky S, Hodge M, Maciejewski M, Ziemek D, Schulz-Knappe P, Zucht HD, Budde P, Coles M, Butler JA, Read S. RA-MAP, molecular immunological landscapes in early rheumatoid arthritis and healthy vaccine recipients. Sci Data 2022; 9:196. [PMID: 35534493 PMCID: PMC9085807 DOI: 10.1038/s41597-022-01264-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/04/2022] [Indexed: 11/21/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disorder with poorly defined aetiology characterised by synovial inflammation with variable disease severity and drug responsiveness. To investigate the peripheral blood immune cell landscape of early, drug naive RA, we performed comprehensive clinical and molecular profiling of 267 RA patients and 52 healthy vaccine recipients for up to 18 months to establish a high quality sample biobank including plasma, serum, peripheral blood cells, urine, genomic DNA, RNA from whole blood, lymphocyte and monocyte subsets. We have performed extensive multi-omic immune phenotyping, including genomic, metabolomic, proteomic, transcriptomic and autoantibody profiling. We anticipate that these detailed clinical and molecular data will serve as a fundamental resource offering insights into immune-mediated disease pathogenesis, progression and therapeutic response, ultimately contributing to the development and application of targeted therapies for RA.
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Carr TH, Adelman C, Barnicle A, Kozarewa I, Luke S, Lai Z, Hollis S, Dougherty B, Harrington EA, Kang J, Saad F, Sala N, Thiery-Vuillemin A, Clarke NW, Hodgson D, Barrett JC. Homologous Recombination Repair Gene Mutation Characterization by Liquid Biopsy: A Phase II Trial of Olaparib and Abiraterone in Metastatic Castrate-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:cancers13225830. [PMID: 34830984 PMCID: PMC8616430 DOI: 10.3390/cancers13225830] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Mutations in homologous recombination repair (HRR) genes are frequent in advanced prostate cancer and tumours harbouring these mutations have known sensitivity to PARP inhibitors, such as olaparib. In the randomized double-blind Phase II study (NCT01972218), olaparib and abiraterone prolonged radiographic progression-free survival (rPFS) versus placebo and abiraterone in patients with metastatic castration-resistant prostate cancer (mCRPC) unselected by HRR status. The study was designed to prioritize tumour samples for a pre-specified analysis of HRR status but was challenged by a low tissue submission rate. Circulating tumour DNA (ctDNA) and germline testing were initiated to supplement the assessment. Here, we present data from further germline and ctDNA analyses which increase the number of patients with confirmed HRR status. Our results support prior findings that patients with mCRPC benefit from olaparib and abiraterone treatment regardless of HRR status and highlight the value of ctDNA testing as a complement to tumour tissue sequencing. Abstract Background: Phase III randomized trial data have confirmed the activity for olaparib in homologous recombination repair (HRR) mutated metastatic castration-resistant prostate cancer (mCRPC) post next-generation hormonal agent (NHA) progression. Preclinical data have suggested the potential for a combined effect between olaparib and NHAs irrespective of whether an HRR gene alteration was present. NCT01972217 was a randomised double-blind Phase II study which evaluated olaparib and abiraterone versus placebo and abiraterone in mCRPC patients who had received prior chemotherapy containing docetaxel. The study showed that radiologic progression was significantly delayed by the combination of olaparib and abiraterone regardless of homologous recombination repair mutation (HRRm) status. The study utilized tumour, blood (germline), and circulating tumour DNA (ctDNA) analysis to profile patient HRRm status, but tumour tissue provision was not mandated, leading to relatively low tissue acquisition and DNA sequencing success rates not representative of real-world testing. Patients and methods: Further analysis of germline and ctDNA samples has been performed for the trial to characterize HRRm status more fully and robustly analyse patient response to treatment. Results: Germline and plasma testing increased the HRRm characterized population from 27% to 68% of 142 randomized patients. Tumour-derived variants were detectable with high confidence in 78% of patients with a baseline plasma sample (71% of randomized patients). There was high concordance across methodologies (plasma vs. tumour; plasma vs. germline). The HR for the exploratory analysis of radiographic progression-free survival was 0.54 (95% CI: 0.32–0.93) in favour of olaparib and abiraterone in the updated HRR wild type (HRRwt) group (n = 73) and 0.62 (95% CI: 0.23–1.65) in the HRRm group (n = 23). Conclusion: Our results confirm the value of plasma testing for HRRm status when there is insufficient high-quality tissue for multi-gene molecular testing. We show that patients with mCRPC benefit from the combination of olaparib and abiraterone treatment regardless of HRRm status. The combination is currently being further investigated in the Phase III PROpel trial.
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Affiliation(s)
- T. Hedley Carr
- AstraZeneca, Cambridge CB4 0WG, UK; (A.B.); (I.K.); (S.L.); (S.H.); (E.A.H.)
- Correspondence: (T.H.C.); (J.C.B.); Tel.: +44-(0)1223-223568 (T.H.C.)
| | - Carrie Adelman
- AstraZeneca, Boston, MA 43183, USA; (C.A.); (Z.L.); (B.D.); (D.H.)
| | - Alan Barnicle
- AstraZeneca, Cambridge CB4 0WG, UK; (A.B.); (I.K.); (S.L.); (S.H.); (E.A.H.)
| | - Iwanka Kozarewa
- AstraZeneca, Cambridge CB4 0WG, UK; (A.B.); (I.K.); (S.L.); (S.H.); (E.A.H.)
| | - Sally Luke
- AstraZeneca, Cambridge CB4 0WG, UK; (A.B.); (I.K.); (S.L.); (S.H.); (E.A.H.)
| | - Zhongwu Lai
- AstraZeneca, Boston, MA 43183, USA; (C.A.); (Z.L.); (B.D.); (D.H.)
| | - Sally Hollis
- AstraZeneca, Cambridge CB4 0WG, UK; (A.B.); (I.K.); (S.L.); (S.H.); (E.A.H.)
| | - Brian Dougherty
- AstraZeneca, Boston, MA 43183, USA; (C.A.); (Z.L.); (B.D.); (D.H.)
| | | | - Jinyu Kang
- AstraZeneca, Gaithersburg, MD 20878, USA;
| | - Fred Saad
- University of Montreal Hospital Research Centre, Montreal, QC H4A 3J1, Canada;
| | - Nuria Sala
- Catalan Institute of Oncology, Hospital Josep Trueta, 17007 Girona, Spain;
| | | | - Noel W. Clarke
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Darren Hodgson
- AstraZeneca, Boston, MA 43183, USA; (C.A.); (Z.L.); (B.D.); (D.H.)
| | - J. Carl Barrett
- AstraZeneca, Boston, MA 43183, USA; (C.A.); (Z.L.); (B.D.); (D.H.)
- Correspondence: (T.H.C.); (J.C.B.); Tel.: +44-(0)1223-223568 (T.H.C.)
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Bateman ED, Busse W, Pedersen SE, Bousquet J, Huang S, Zhou X, Gul N, Hollis S, Gibbs M. Global Initiative for Asthma 2016-derived asthma control with fluticasone propionate and salmeterol: A Gaining Optimal Asthma Control (GOAL) study reanalysis. Ann Allergy Asthma Immunol 2019; 123:57-63.e2. [PMID: 31028894 DOI: 10.1016/j.anai.2019.04.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND In 2004, the landmark Gaining Optimal Asthma Control (GOAL) study demonstrated that most patients can achieve asthma control through sustained treatment and that adding a long-acting β2-adrenoreceptor agonist to an inhaled corticosteroid (ICS) is more effective than ICS alone in this regard. Definitions of asthma control have since evolved, and the consequent implications for the GOAL study findings are unclear. OBJECTIVE To evaluate the efficacy of fluticasone propionate and salmeterol and fluticasone propionate alone in achieving and maintaining asthma control, as derived from the Global Initiative for Asthma (GINA) 2016 report. METHODS In total, 3416 patients were stratified by prior medication (ICS-naive [stratum 1], low-dose ICS [stratum 2], or medium-dose ICS [stratum 3]) and randomized to receive fluticasone propionate and salmeterol or fluticasone propionate. The primary end point was the proportion of patients achieving well-controlled or partly controlled asthma; secondary end points included the proportion of patients achieving well-controlled asthma. Control was evaluated during the last 4 weeks of each dose titration. RESULTS In all strata, more patients achieved well-controlled or partly controlled asthma with fluticasone propionate and salmeterol vs fluticasone propionate alone (stratum 1: 91% vs 85%; P = .003; stratum 2: 86% vs 82%; P = .07; and stratum 3: 76% vs 66%; P < .001), as well as patients with well-controlled asthma (stratum 1: 64% vs 56%; P = .005; stratum 2: 59% vs 41%; P < .001; and stratum 3: 40% vs 22%; P < .001). CONCLUSION A markedly higher proportion of patients with uncontrolled asthma in each stratum achieved control according to GINA 2016 criteria compared with the original study criteria. The proportion of patients achieving control remained greater with fluticasone propionate and salmeterol than with fluticasone propionate alone.
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Affiliation(s)
- Eric D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - William Busse
- University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Søren E Pedersen
- Pediatric Research Unit, University of Southern Denmark, Kolding Hospital, Kolding, Denmark
| | - Jean Bousquet
- Fondation MACVIA-LR, Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, University of Montpellier, Montpellier, France
| | - Shaoguang Huang
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Zhou
- Shanghai First People's Hospital, Shanghai, China
| | - Nadeem Gul
- Global Respiratory Franchise, GSK House, Brentford, Middlesex, United Kingdom
| | | | - Michael Gibbs
- Global Respiratory Franchise, GSK House, Brentford, Middlesex, United Kingdom
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Kuht JA, Woods D, Hollis S. Case series of non-freezing cold injury: the modern clinical syndrome. BMJ Mil Health 2019; 166:324-329. [PMID: 30826752 DOI: 10.1136/jramc-2018-001099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/02/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Non-freezing cold injury (NFCI) occurs when peripheral tissue is damaged by cold exposure but not to the extent of freezing. Historically, the phenotype of NFCIs sustained was severe, whereas today the spectrum of injury represented in the UK military predominantly comprises subtler injuries. The diagnostic challenge of recognising these injuries, both in the acute and chronic settings, can lead to mismanagement and subsequent morbidity. METHODS We characterised a recent case series of 100 UK Service Personnel referred with suspected NFCI to a Military UK NFCI clinic. We characterised the acute and chronic phenotype of those diagnosed with NFCI (n=76) and made comparison to those who received alternate diagnoses (n=24), to find discriminatory symptoms and signs. RESULTS The most common acute symptoms of NFCI were the extremities becoming cold to the point of loss of feeling for more than 30 min (sensitivity 96%, specificity 90%, p<0.001), followed by a period of painful rewarming (sensitivity 81%, specificity 67%, p<0.001). In-field foot/hand inspections took place in half of the NFCI cases. Importantly, remaining in the field and undergoing multiple cycles of cooling and rewarming after an initial NFCI was associated with having double the risk of the NFCI persisting for more than a week. The most common and discriminant chronic symptoms and signs of NFCI were having extremities that behave differently during cold exposures (sensitivity 81%, specificity 75%, p<0.001) and having abnormal pinprick sensation in the affected extremity (sensitivity 88%, specificity 88%, p<0.001). CONCLUSIONS A small collection of symptoms and signs characterise acute and chronic NFCIs and distinguish this vasoneuropathy from NFCI mimics.
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Affiliation(s)
- James Alan Kuht
- Defence Medical Services, RAF Leeming Medical Centre, Northallerton, UK
| | - D Woods
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - S Hollis
- Regional Occupational Health Team, Defence Medical Services, MOD, Catterick Garrison, UK
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Kuht JA, Woods D, Hollis S. Case series of non-freezing cold injury: epidemiology and risk factors. J ROY ARMY MED CORPS 2018; 165:400-404. [DOI: 10.1136/jramc-2018-000992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/13/2018] [Accepted: 08/29/2018] [Indexed: 11/04/2022]
Abstract
BackgroundNon-freezing cold injury (NFCI) occurs when the peripheral tissue is cooled sufficiently that damage occurs, but not to the point of tissue freezing. Historically, the phenotype of the injuries studied was often severe, and it is unclear whether knowledge gained from these cases is entirely relevant to the frequently subtle injuries seen today.MethodsWe therefore sought to characterise a recent case series of 100 patients referred with suspected NFCI to a military UK NFCI clinic. Their demographics, medical history and situational risk factors leading to their injuries were analysed, and comparison was made between those subsequently diagnosed with NFCI (n=76) and those receiving alternate diagnoses (n=24).ResultsStatistically significant predisposing factors for NFCI in the UK service personnel (SP) were being of African-Caribbean ethnicity and having a short duration of service in the Armed Forces. Past or current smoking was not identified as a risk factor. Injuries were almost always suffered on training exercises (most commonly in the UK); being generally cold and being on static duties were statistically significant situational risk factors. Non-significant trends of risk were also found for having wet clothing, wet boots and immersion. Self-reported dehydration was not found to be a risk factor for NFCI.ConclusionsOur demographic findings are in general agreement with those of previous studies. Our situational risk factor findings, however, highlight a pattern of NFCI risk factors to the modern UK SP: winter training exercises, when troops are generally cold and extremities often wet, with static duties frequently implicated in the disease mechanism.
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Carr T, Adelman C, Barnicle A, Kozarewa I, Luke S, Lai Z, Menon S, Hollis S, Dougherty B, Harrington E, Barrett J, Goessl C, Saad F, Sala N, Clarke N, Hodgson D. Multimodal detection of homologous recombination repair gene mutations (HRRm) in a phase II trial of olaparib plus abiraterone in metastatic castrate resistant prostate cancer (mCRPC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aboagye E, Alger K, Archibald S, Bakar N, Barton N, Bergare J, Bloom J, Bragg R, Burke B, Burns M, Carroll L, Calatayud D, Cawthorne C, Cortezon-Tamarit F, Crean C, Crump M, Dilworth J, Domarkas J, Duckett S, Eggleston I, Elmore C, van Es E, Fekete M, Goodwin M, Green G, Grönberg G, Hayes C, Hayes M, Hollis S, Hueting R, Ivanov P, Johnston G, Kerr W, Kohler A, Knox G, Lawrie K, Lee R, Lewis W, Lin B, Lockley W, López-Torres E, Lv K, Maddocks S, Marsh B, Mendiola A, Mirabello V, Miranda C, Norcott P, O'Hagan D, Olaru A, Pascu S, Rayner P, Read D, Ridge K, Ritter T, Roberts I, Samuri N, Sarpaki S, Somers D, Taylor R, Tuttle T, Varcoe J, Willis C. Abstracts of the 25th
International Isotope Society (UK Group) symposium: Synthesis and applications of labelled compounds 2016. J Labelled Comp Radiopharm 2017. [DOI: 10.1002/jlcr.3523] [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: 11/07/2022]
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Cope AP, Barnes MR, Belson A, Binks M, Brockbank S, Bonachela-Capdevila F, Carini C, Fisher BA, Goodyear CS, Emery P, Ehrenstein MR, Gozzard N, Harris R, Hollis S, Keidel S, Levesque M, Lindholm C, McDermott MF, McInnes IB, Mela CM, Parker G, Read S, Pedersen AW, Ponchel F, Porter D, Rao R, Rowe A, Schulz-Knappe P, Sleeman MA, Symmons D, Taylor PC, Tom B, Tsuji W, Verbeeck D, Isaacs JD. The RA-MAP Consortium: a working model for academia-industry collaboration. Nat Rev Rheumatol 2017; 14:53-60. [PMID: 29213124 DOI: 10.1038/nrrheum.2017.200] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Collaboration can be challenging; nevertheless, the emerging successes of large, multi-partner, multi-national cooperatives and research networks in the biomedical sector have sustained the appetite of academics and industry partners for developing and fostering new research consortia. This model has percolated down to national funding agencies across the globe, leading to funding for projects that aim to realise the true potential of genomic medicine in the 21st century and to reap the rewards of 'big data'. In this Perspectives article, the experiences of the RA-MAP consortium, a group of more than 140 individuals affiliated with 21 academic and industry organizations that are focused on making genomic medicine in rheumatoid arthritis a reality are described. The challenges of multi-partner collaboration in the UK are highlighted and wide-ranging solutions are offered that might benefit large research consortia around the world.
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Affiliation(s)
- Andrew P Cope
- Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 1UL, UK
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Hollis S, Jorup C, Lythgoe D, Martensson G, Regnell P, Eckerwall G. Risk of pneumonia with budesonide-containing treatments in COPD: an individual patient-level pooled analysis of interventional studies. Int J Chron Obstruct Pulmon Dis 2017; 12:1071-1084. [PMID: 28435240 PMCID: PMC5389656 DOI: 10.2147/copd.s128358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 11/23/2022] Open
Abstract
Background Concerns have been raised that treatment of COPD with inhaled corticosteroids may increase pneumonia risk. Responding to a request from the European Medicines Agency Pharmacovigilance Risk Assessment Committee, a pooled analysis of interventional studies compared pneumonia risk with inhaled budesonide-containing versus non-budesonide-containing treatments and the impact of other clinically relevant factors. Methods AstraZeneca-sponsored, parallel-group, double-blind, randomized controlled trials meeting the following criteria were included: >8 weeks’ duration; ≥60 patients with COPD; inhaled budesonide treatment arm (budesonide/formoterol or budesonide); and non-budesonide-containing comparator arm (formoterol or placebo). Primary and secondary outcomes were time to first pneumonia treatment-emergent serious adverse event (TESAE) and treatment-emergent adverse event (TEAEs), respectively, analyzed using Cox regression models stratified by study. Results Eleven studies were identified; 10,570 out of 10,574 randomized patients receiving ≥1 dose of study treatment were included for safety analysis (budesonide-containing, n=5,750; non-budesonide-containing, n=4,820). Maximum exposure to treatment was 48 months. The overall pooled hazard ratio (HR), comparing budesonide versus non-budesonide-containing treatments, was 1.15 for pneumonia TESAEs (95% confidence interval [CI]: 0.83, 1.57) and 1.13 for pneumonia TEAEs (95% CI: 0.94, 1.36). The annual incidence of pneumonia TESAEs was 1.9% and 1.5% for budesonide-containing and non-budesonide-containing treatments, respectively. Comparing budesonide/formoterol with non-budesonide-containing treatment, the HRs for pneumonia TESAEs and TEAEs were 1.00 (95% CI: 0.69, 1.44) and 1.21 (95% CI: 0.93, 1.57), respectively. For budesonide versus placebo, HRs were 1.57 for pneumonia TESAEs (95% CI: 0.90, 2.74) and 1.07 for pneumonia TEAEs (95% CI: 0.83, 1.38). Conclusion This pooled analysis found no statistically significant increase in overall risk for pneumonia TESAEs or TEAEs with budesonide-containing versus non-budesonide-containing treatments. However, a small increase in risk with budesonide-containing treatment cannot be ruled out; there is considerable heterogeneity in study designs and patient characteristics, particularly in the early budesonide studies, and each study contributes <40 pneumonia TESAEs.
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Affiliation(s)
- Sally Hollis
- AstraZeneca R&D, Alderley Park, Macclesfield, UK
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Hollis S. Chen D-GD and Peace KE, Applied meta-analysis with R. Stat Methods Med Res 2017. [DOI: 10.1177/0962280214566559] [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: 11/17/2022]
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Davis JR, Kern DM, Williams SA, Tunceli O, Wu B, Hollis S, Strange C, Trudo F. Health Care Utilization and Costs After Initiating Budesonide/Formoterol Combination or Fluticasone/Salmeterol Combination Among COPD Patients New to ICS/LABA Treatment. J Manag Care Spec Pharm 2016; 22:293-304. [PMID: 27003559 PMCID: PMC10397958 DOI: 10.18553/jmcp.2016.22.3.293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) affects approximately 15 million people in the United States and accounts for approximately $36 billion in economic burden, primarily due to medical costs. To address the increasing clinical and economic burden, the Global Initiative for Chronic Obstructive Lung Disease emphasizes the use of therapies that help prevent COPD exacerbations, including inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA). OBJECTIVE To evaluate health care costs and utilization among COPD patients newly initiating ICS/LABA combination therapy with budesonide/formoterol (BFC) or fluticasone/salmeterol (FSC) in a managed care system. METHODS COPD patients aged 40 years and older who initiated BFC (160/4.5 μg) or FSC (250/50 μg) treatment between March 1, 2009, and March 31, 2012, were identified using claims data from major U.S. health plans. BFC and FSC patients were propensity score matched (1:1) on age, sex, prior asthma diagnosis, prior COPD-related health care utilization, and respiratory medication use. COPD-related, pneumonia-related, and all-cause costs and utilization were analyzed during the 12-month follow-up period. Post-index costs were assessed with generalized linear models (GLMs) with gamma distribution. Health care utilization data were analyzed via logistic regression (any event vs. none) and GLMs with negative binomial distribution (number of visits) and were adjusted for the analogous pre-index variable as well as pre-index characteristics that remained imbalanced after matching. RESULTS After matching, each cohort had 3,697 patients balanced on age (mean 64 years), sex (female 52% BFC and 54% FSC), asthma and other comorbid conditions, prior COPD-related health care utilization, and respiratory medication use. During the 12-month follow-up, COPD-related costs averaged $316 less for BFC versus FSC patients ($4,326 vs. $4,846; P = 0.003), reflecting lower inpatient ($966 vs. $1,202; P < 0.001), pharmacy ($1,482 vs. $1,609; P = 0.002), and outpatient/office ($1,378 vs. $1,436; P = 0.048) costs, but higher emergency department ($257 vs. $252; P = 0.033) costs. Pneumonia-related health care costs were also lower on average for BFC patients ($2,855 vs. $3,605; P < 0.001). Similarly, initiating BFC was associated with lower all-use health care costs versus initiating FSC ($21,580 vs. $24,483; P < 0.001, respectively). No differences in health care utilization were found between the 2 groups. CONCLUSIONS In this study, although no difference was observed in rates of health care utilization, COPD patients initiating BFC treatment incurred lower average COPD-related, pneumonia-related, and all-cause costs versus FSC initiators, which was driven by cumulative differences in inpatient, outpatient, and pharmacy costs.
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Affiliation(s)
- Jill R Davis
- 1 Director, Health Economics and Outcomes Research, AstraZeneca Pharmaceuticals, Wilmington, Delaware
| | - David M Kern
- 2 Associate Research Director, Industry Sponsored Research, HealthCore, Wilmington, Delaware
| | - Setareh A Williams
- 3 Senior Director, Medical Evidence Center, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland
| | - Ozgur Tunceli
- 4 Director, Industry Sponsored Research, HealthCore, Wilmington, Delaware
| | - Bingcao Wu
- 5 Research Manager, Industry Sponsored Research, HealthCore, Wilmington, Delaware
| | - Sally Hollis
- 6 Senior Director and Biometrics Team Leader, AstraZeneca Pharmaceuticals, Alderley Park, Cheshire, United Kingdom
| | - Charlie Strange
- 7 Professor, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Frank Trudo
- 8 Medical Lead, Respiratory, AstraZeneca Pharmaceuticals, Wilmington, Delaware
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Peters SP, Bleecker ER, Canonica GW, Park YB, Ramirez R, Hollis S, Fjallbrant H, Jorup C, Martin UJ. Serious Asthma Events with Budesonide plus Formoterol vs. Budesonide Alone. N Engl J Med 2016; 375:850-60. [PMID: 27579635 DOI: 10.1056/nejmoa1511190] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Concerns remain about the safety of adding long-acting β2-agonists to inhaled glucocorticoids for the treatment of asthma. In a postmarketing safety study mandated by the Food and Drug Administration, we evaluated whether the addition of formoterol to budesonide maintenance therapy increased the risk of serious asthma-related events in patients with asthma. METHODS In this multicenter, double-blind, 26-week study, we randomly assigned patients, 12 years of age or older, who had persistent asthma, were receiving daily asthma medication, and had had one to four asthma exacerbations in the previous year to receive budesonide-formoterol or budesonide alone. Patients with a history of life-threatening asthma were excluded. The primary end point was the first serious asthma-related event (a composite of adjudicated death, intubation, and hospitalization), as assessed in a time-to-event analysis. The noninferiority of budesonide-formoterol to budesonide was defined as an upper limit of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The primary efficacy end point was the first asthma exacerbation, as assessed in a time-to-event analysis. RESULTS A total of 11,693 patients underwent randomization, of whom 5846 were assigned to receive budesonide-formoterol and 5847 to receive budesonide. A serious asthma-related event occurred in 43 patients who were receiving budesonide-formoterol and in 40 patients who were receiving budesonide (hazard ratio, 1.07; 95% confidence interval [CI], 0.70 to 1.65]); budesonide-formoterol was shown to be noninferior to budesonide alone. There were two asthma-related deaths, both in the budesonide-formoterol group; one of these patients had undergone an asthma-related intubation. The risk of an asthma exacerbation was 16.5% lower with budesonide-formoterol than with budesonide (hazard ratio, 0.84; 95% CI, 0.74 to 0.94; P=0.002). CONCLUSIONS Among adolescents and adults with predominantly moderate-to-severe asthma, treatment with budesonide-formoterol was associated with a lower risk of asthma exacerbations than budesonide and a similar risk of serious asthma-related events. (Funded by AstraZeneca; ClinicalTrials.gov number, NCT01444430 .).
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Affiliation(s)
- Stephen P Peters
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Eugene R Bleecker
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Giorgio W Canonica
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Yong B Park
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Ricardo Ramirez
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Sally Hollis
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Harald Fjallbrant
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Carin Jorup
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
| | - Ubaldo J Martin
- From Wake Forest School of Medicine, Winston-Salem, NC (S.P.P., E.R.B.); University of Genoa, Genoa, Italy (G.W.C.); Hallym University, Seoul, South Korea (Y.B.P.); Centro de Investigacion y Atencion Integral, Durango, Mexico (R.R.); AstraZeneca, Macclesfield, United Kingdom (S.H.); AstraZeneca Research and Development, Gothenburg, Sweden (H.F., C.J.); and AstraZeneca, Gaithersburg, MD (U.J.M.)
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Affiliation(s)
- S Hollis
- Department of Mathematics & Statistics, Lancaster University, Lancaster LA1 4YF, UK
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14
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Affiliation(s)
| | - Sally Hollis
- AstraZeneca, Alderley Park, Cheshire, SK10 4TG, UK.,Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | | | - Christoph Gerlinger
- Global Research and Development Statistics, Bayer Pharma AG, 13353, Berlin, Germany.,Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421, Homburg, Saar, Germany
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Hollis S, Fletcher C, Lynn F, Urban HJ, Branson J, Burger HU, Tudur Smith C, Sydes MR, Gerlinger C. Best practice for analysis of shared clinical trial data. BMC Med Res Methodol 2016; 16 Suppl 1:76. [PMID: 27410240 PMCID: PMC4943488 DOI: 10.1186/s12874-016-0170-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Greater transparency, including sharing of patient-level data for further research, is an increasingly important topic for organisations who sponsor, fund and conduct clinical trials. This is a major paradigm shift with the aim of maximising the value of patient-level data from clinical trials for the benefit of future patients and society. We consider the analysis of shared clinical trial data in three broad categories: (1) reanalysis - further investigation of the efficacy and safety of the randomized intervention, (2) meta-analysis, and (3) supplemental analysis for a research question that is not directly assessing the randomized intervention. Discussion In order to support appropriate interpretation and limit the risk of misleading findings, analysis of shared clinical trial data should have a pre-specified analysis plan. However, it is not generally possible to limit bias and control multiplicity to the extent that is possible in the original trial design, conduct and analysis, and this should be acknowledged and taken into account when interpreting results. We highlight a number of areas where specific considerations arise in planning, conducting, interpreting and reporting analyses of shared clinical trial data. A key issue is that that these analyses essentially share many of the limitations of any post hoc analyses beyond the original specified analyses. The use of individual patient data in meta-analysis can provide increased precision and reduce bias. Supplemental analyses are subject to many of the same issues that arise in broader epidemiological analyses. Specific discussion topics are addressed within each of these areas. Summary Increased provision of patient-level data from industry and academic-led clinical trials for secondary research can benefit future patients and society. Responsible data sharing, including transparency of the research objectives, analysis plans and of the results will support appropriate interpretation and help to address the risk of misleading results and avoid unfounded health scares.
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Affiliation(s)
- Sally Hollis
- AstraZeneca, Alderley Park, Cheshire, SK10 4TG, UK.,Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | | | - Frances Lynn
- BioMarin, 10 Bloomsbury Way, London, WC1A 2SL, UK
| | - Hans-Joerg Urban
- Hoffman-La Roche, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | | | | | - Catrin Tudur Smith
- MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.,MRC London Hub for Trials Methodology Research, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Christoph Gerlinger
- Research and Development Statistics, Bayer Pharma AG, 13353, Berlin, Germany. .,Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421, Homburg/Saar, Germany.
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Tucker K, Branson J, Dilleen M, Hollis S, Loughlin P, Nixon MJ, Williams Z. Protecting patient privacy when sharing patient-level data from clinical trials. BMC Med Res Methodol 2016; 16 Suppl 1:77. [PMID: 27410040 PMCID: PMC4943495 DOI: 10.1186/s12874-016-0169-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Greater transparency and, in particular, sharing of patient-level data for further scientific research is an increasingly important topic for the pharmaceutical industry and other organisations who sponsor and conduct clinical trials as well as generally in the interests of patients participating in studies. A concern remains, however, over how to appropriately prepare and share clinical trial data with third party researchers, whilst maintaining patient confidentiality. Clinical trial datasets contain very detailed information on each participant. Risk to patient privacy can be mitigated by data reduction techniques. However, retention of data utility is important in order to allow meaningful scientific research. In addition, for clinical trial data, an excessive application of such techniques may pose a public health risk if misleading results are produced. After considering existing guidance, this article makes recommendations with the aim of promoting an approach that balances data utility and privacy risk and is applicable across clinical trial data holders. DISCUSSION Our key recommendations are as follows: 1. Data anonymisation/de-identification: Data holders are responsible for generating de-identified datasets which are intended to offer increased protection for patient privacy through masking or generalisation of direct and some indirect identifiers. 2. Controlled access to data, including use of a data sharing agreement: A legally binding data sharing agreement should be in place, including agreements not to download or further share data and not to attempt to seek to identify patients. Appropriate levels of security should be used for transferring data or providing access; one solution is use of a secure 'locked box' system which provides additional safeguards. This article provides recommendations on best practices to de-identify/anonymise clinical trial data for sharing with third-party researchers, as well as controlled access to data and data sharing agreements. The recommendations are applicable to all clinical trial data holders. Further work will be needed to identify and evaluate competing possibilities as regulations, attitudes to risk and technologies evolve.
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Affiliation(s)
- Katherine Tucker
- Roche Products Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK.
| | | | - Maria Dilleen
- Pfizer Ltd, Walton Oaks, Dorking Road, Walton-on-the-Hill, Tadworth, Surrey, UK
| | - Sally Hollis
- AstraZeneca, Alderley Park, Cheshire, Macclesfield, SK10 4TG, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | - Paul Loughlin
- AstraZeneca, Alderley Park, Cheshire, Macclesfield, SK10 4TG, UK
| | - Mark J Nixon
- Chilli Consultancy Ltd, Aldwych House, Winchester Street, Andover, Hampshire, SP10 2EA, UK
| | - Zoë Williams
- LEO Pharma, Horizon, Honey Lane, Hurley, SL6 6RJ, UK
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Abstract
BACKGROUND Greater transparency and, in particular, sharing of clinical study reports and patient level data for further research is an increasingly important topic for the pharmaceutical and biotechnology industry and other organisations who sponsor and conduct clinical research as well as academic researchers and patient advocacy groups. Statisticians are ambassadors for data sharing and are central to its success. They play an integral role in data sharing discussions within their companies and also externally helping to shape policy and processes while providing input into practical solutions to aid data sharing. Data sharing is generating changes in the required profile for statisticians in the pharmaceutical and biotechnology industry, as well as academic institutions and patient advocacy groups. DISCUSSION Successful statisticians need to possess many qualities required in today's pharmaceutical environment such as collaboration, diplomacy, written and oral skills and an ability to be responsive; they are also knowledgeable when debating strategy and analytical techniques. However, increasing data transparency will require statisticians to evolve and learn new skills and behaviours during their career which may not have been an accepted part of the traditional role. Statisticians will move from being the gate-keepers of data to be data facilitators. To adapt successfully to this new environment, the role of the statistician is likely to be broader, including defining new responsibilities that lie beyond the boundaries of the traditional role. Statisticians should understand how data transparency can benefit them and the potential strategic advantage it can bring and be fully aware of the pharmaceutical and biotechnology industry commitments to data transparency and the policies within their company or research institute in addition to focusing on reviewing requests and provisioning data. Data transparency will evolve the role of statisticians within the pharmaceutical and biotechnology industry, academia and research bodies to a level which may not have been an accepted part of their traditional role or career. In the future, skills will be required to manage challenges arising from data sharing; statisticians will need strong scientific and statistical guiding principles for reanalysis and supplementary analyses based on researchers' requests, have enhanced consultancy skills, in particular the ability to defend good statistical practice in the face of criticism and the ability to critique methods of analysis. Statisticians will also require expertise in data privacy regulations, data redaction and anonymisation and be able to assess the probability of re-identification, an ability to understand analyses conducted by researchers and recognise why such analyses may propose different results compared to the original analyses. Bringing these skills to the implementation of data sharing and interpretation of the results will help to maximise the value of shared data while guarding against misleading conclusions.
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Affiliation(s)
- Nick Manamley
- Amgen Ltd., 240 Cambridge Science Park, Cambridge, CB4 0WD, UK.
| | - Steve Mallett
- GlaxoSmithkline, Stockley Park West, 1-3 Ironbridge Road, Uxbridge, Middlesex, UB11 1BT, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
- MRC London Hub for Trials Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Sally Hollis
- AstraZeneca, Alderley Park, Cheshire, SK10 4TG, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | | | | | - Hans-Joerg Urban
- Hoffman-La Roche, Grenzacherstrasse 124, Basel, 4070, Switzerland
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Davis JR, Kern DM, Williams SA, Tunceli O, Wu B, Hollis S, Strange C, Trudo F. Health Care Utilization and Costs After Initiating Budesonide/Formoterol Combination or Fluticasone/Salmeterol Combination Among COPD Patients New to ICS/LABA Treatment. J Manag Care Spec Pharm 2016. [DOI: 10.18553/jmcp.2016.15127] [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: 11/05/2022]
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Toon E, Davey M, Hollis S, Nixon G, Horne R, Biggs S. Validation of two popular commercial devices for the assessment of sleep in children. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carter NJ, Hill NE, Nicol ED, Hollis S, Patil Mead ML, Thompson GR. Dyslipidaemia and the military patient. J ROY ARMY MED CORPS 2015; 161:206-10. [DOI: 10.1136/jramc-2015-000491] [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] [Received: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/04/2022]
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Kern DM, Davis J, Williams SA, Tunceli O, Wu B, Hollis S, Strange C, Trudo F. Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population. Int J Chron Obstruct Pulmon Dis 2015; 10:1417-25. [PMID: 26229461 PMCID: PMC4516198 DOI: 10.2147/copd.s83135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. METHODS Selecting from a repository containing members' data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx-486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. RESULTS A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%-92.0%) versus 73.4% (95% CI: 66.8%-79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%-87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%-80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%-92.6%). CONCLUSION Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims data are a valid tool when studying the safety of COPD therapies that could potentially lead to increased pneumonia susceptibility or severity.
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Affiliation(s)
| | - Jill Davis
- AstraZeneca Pharmaceuticals, Wilmington, DE, USA
| | | | | | | | | | - Charlie Strange
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Frank Trudo
- AstraZeneca Pharmaceuticals, Wilmington, DE, USA
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Abstract
This review has been withdrawn for the following reasons: ‐ a review author contravenes Cochrane's Commercial Sponsorship Policy. This policy ensures the independence of Cochrane reviews by making sure that there is no bias associated with commercial conflicts of interest in the conduct of Cochrane reviews. The author was employed by the biopharmaceutical company AstraZeneca and cannot say with certainty that the company did not produce or have any financial interest in the interventions in this review ‐ the review is substantially out of date To view the published versions of this article, please click the 'Other versions' tab. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Richard S Nicholas
- Charing Cross HospitalWest London Neurosciences CentreFulham Palace RoadLondonUKW6 8RF
| | - Tim Friede
- Universitatsmedizin GöttingenAbteilung fur Innere Medizin 1GöttingenGermany
| | - Sally Hollis
- University of Nottinghamc/o Cochrane Skin GroupKing's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Carolyn A Young
- The Walton Centre NHS Foundation TrustLower LaneFazakerleyLiverpoolUKL9 7LJ
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Abstract
This review has been withdrawn because a review author contravenes Cochrane's Commercial Sponsorship Policy. This policy ensures the independence of Cochrane reviews by making sure that there is no bias associated with commercial conflicts of interest in the conduct of Cochrane reviews. The author was employed by the biopharmaceutical company AstraZeneca and cannot say with certainty that the company did not produce or have any financial interest in the interventions in this review. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Miny Samuel
- Research Triangle Institute‐Health SolutionsWilliams House, Lloyd Street NorthManchester Science ParkManchesterUKM15 6SE
| | - Rebecca Brooke
- University of Nottinghamc/o Cochrane Skin GroupKing's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Sally Hollis
- University of Nottinghamc/o Cochrane Skin GroupKing's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Christopher EM Griffiths
- The University of Manchester, Salford Royal NHS Foundation TrustThe Dermatology CentreStott LaneSalfordManchesterUKM6 8HD
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Kern DM, Davis J, Williams SA, Tunceli O, Wu B, Hollis S, Strange C, Trudo F. Comparative effectiveness of budesonide/formoterol combination and fluticasone/salmeterol combination among chronic obstructive pulmonary disease patients new to controller treatment: a US administrative claims database study. Respir Res 2015; 16:52. [PMID: 25899176 PMCID: PMC4409772 DOI: 10.1186/s12931-015-0210-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 02/11/2015] [Accepted: 03/20/2015] [Indexed: 12/24/2022] Open
Abstract
Background Inhaled corticosteroid/long-acting β2-agonist combinations (ICS/LABA) have emerged as first line therapies for chronic obstructive pulmonary disease (COPD) patients with exacerbation history. No randomized clinical trial has compared exacerbation rates among COPD patients receiving budesonide/formoterol combination (BFC) and fluticasone/salmeterol combination (FSC) to date, and only limited comparative data are available. This study compared the real-world effectiveness of approved BFC and FSC treatments among matched cohorts of COPD patients in a large US managed care setting. Methods COPD patients (≥40 years) naive to ICS/LABA who initiated BFC or FSC treatments between 03/01/2009-03/31/2012 were identified in a geographically diverse US managed care database and followed for 12 months; index date was defined as first prescription fill date. Patients with a cancer diagnosis or chronic (≥180 days) oral corticosteroid (OCS) use within 12 months prior to index were excluded. Patients were matched 1-to-1 on demographic and pre-initiation clinical characteristics using propensity scores from a random forest model. The primary efficacy outcome was COPD exacerbation rate, and secondary efficacy outcomes included exacerbation rates by event type and healthcare resource utilization. Pneumonia objectives included rates of any diagnosis of pneumonia and pneumonia-related healthcare resource utilization. Results Matching of the identified 3,788 BFC and 6,439 FSC patients resulted in 3,697 patients in each group. Matched patients were well balanced on age (mean = 64 years), gender (BFC: 52% female; FSC: 54%), prior COPD-related medication use, healthcare utilization, and comorbid conditions. During follow-up, no significant difference was seen between BFC and FSC patients for number of COPD-related exacerbations overall (rate ratio [RR] = 1.02, 95% CI = [0.96,1.09], p = 0.56) or by event type: COPD-related hospitalizations (RR = 0.96), COPD-related ED visits (RR = 1.11), and COPD-related office/outpatient visits with OCS and/or antibiotic use (RR = 1.01). The proportion of patients diagnosed with pneumonia during the post-index period was similar for patients in each group (BFC = 17.3%, FSC = 19.0%, odds ratio = 0.92 [0.81,1.04], p = 0.19), and no difference was detected for pneumonia-related healthcare utilization by place of service. Conclusion This study demonstrated no difference in COPD-related exacerbations or pneumonia events between BFC and FSC treatment groups for patients new to ICS/LABA treatment in a real-world setting. Trial registration ClinicalTrials.gov identifier NCT01921127.
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Affiliation(s)
- David M Kern
- HealthCore, Inc., 123 Justison St, Suite 200, Wilmington, DE, 19801-5134, USA.
| | - Jill Davis
- AstraZeneca Pharmaceuticals, 1800 Concord Pike, Wilmington, DE, 19850, USA.
| | - Setareh A Williams
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD, 20878, USA.
| | - Ozgur Tunceli
- HealthCore, Inc., 123 Justison St, Suite 200, Wilmington, DE, 19801-5134, USA.
| | - Bingcao Wu
- HealthCore, Inc., 123 Justison St, Suite 200, Wilmington, DE, 19801-5134, USA.
| | - Sally Hollis
- AstraZeneca Pharmaceuticals, Alderley Park, Cheshire, UK.
| | - Charlie Strange
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Frank Trudo
- AstraZeneca Pharmaceuticals, 1800 Concord Pike, Wilmington, DE, 19850, USA.
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Weinblatt ME, Genovese MC, Ho M, Hollis S, Rosiak-Jedrychowicz K, Kavanaugh A, Millson DS, Leon G, Wang M, van der Heijde D. Effects of fostamatinib, an oral spleen tyrosine kinase inhibitor, in rheumatoid arthritis patients with an inadequate response to methotrexate: results from a phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheumatol 2015. [PMID: 25223724 DOI: 10.1002/art.38851/abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This phase III, 52-week study compared fostamatinib with placebo (for 24 weeks) in patients with active rheumatoid arthritis (RA) and an inadequate response to methotrexate (MTX) therapy. METHODS Patients taking MTX were randomized (1:1:1) to receive fostamatinib 100 mg twice daily for 52 weeks (group A), fostamatinib 100 mg twice daily for 4 weeks and then 150 mg once daily (group B), or placebo for 24 weeks and then fostamatinib 100 mg twice daily (group C). At week 24, the co-primary end points were change from baseline in the American College of Rheumatology 20% (ACR20) improvement response rates and change in the modified total Sharp/van der Heijde score of radiographic damage (SHS). RESULTS In this study, 918 patients were randomized and received ≥1 dose of study drug (fostamatinib or placebo); the demographic and baseline clinical characteristics were well balanced. Following treatment with both fostamatinib regimens, a statistically significant difference in the ACR20 improvement response was achieved at week 24 as compared with that in patients receiving placebo (49.0% [group A] and 44.4%, [group B] versus 34.2%; P < 0.001 and P = 0.006, respectively), but there was no statistically significant difference in the SHS between either fostamatinib group and placebo (P = 0.25 and P = 0.17, respectively). The most common adverse events in patients in groups A, B, and C were hypertension (15.8%, 15.1%, and 3.9%, respectively) and diarrhea (13.9%, 15.1%, and 3.9%, respectively). Elevated blood pressure (≥140/90 mm Hg) occurred at ≥1 visit in 44.2%, 41.6%, and 19.3% of patients in each respective group. CONCLUSION With the use of either fostamatinib regimen in patients with RA, statistically significant, but not clinically significant, improvements in the ACR20 improvement response over placebo were achieved at 24 weeks, whereas a significant difference in the SHS was not seen. The overall level of response to treatment with fostamatinib was lower than had been observed in the phase II program, but similar adverse events were reported.
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Dalevi D, Lovick S, Mann H, Metcalfe PD, Spencer S, Hollis S, Ruau D. Data Science Solution to Event Prediction in Outsourced Clinical Trial Models. Stud Health Technol Inform 2015; 216:1065. [PMID: 26262364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Late phase clinical trials are regularly outsourced to a Contract Research Organisation (CRO) while the risk and accountability remain within the sponsor company. Many statistical tasks are delivered by the CRO and later revalidated by the sponsor. Here, we report a technological approach to standardised event prediction. We have built a dynamic web application around an R-package with the aim of delivering reliable event predictions, simplifying communication and increasing trust between the CRO and the in-house statisticians via transparency. Short learning curve, interactivity, reproducibility and data diagnostics are key here. The current implementation is motivated by time-to-event prediction in oncology. We demonstrate a clear benefit of standardisation for both parties. The tool can be used for exploration, communication, sensitivity analysis and generating standard reports. At this point we wish to present this tool and share some of the insights we have gained during the development.
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Affiliation(s)
- Daniel Dalevi
- Advanced Analytics Centre, Biometrics and Information Sciences, AstraZeneca, Sweden/UK
| | - Susan Lovick
- Biometrics and Information Sciences, AstraZeneca, UK
| | - Helen Mann
- Biometrics and Information Sciences, AstraZeneca, UK
| | - Paul D Metcalfe
- Advanced Analytics Centre, Biometrics and Information Sciences, AstraZeneca, Sweden/UK
| | | | - Sally Hollis
- Biometrics and Information Sciences, AstraZeneca, UK
| | - David Ruau
- Advanced Analytics Centre, Biometrics and Information Sciences, AstraZeneca, Sweden/UK
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Weinblatt ME, Genovese MC, Ho M, Hollis S, Rosiak-Jedrychowicz K, Kavanaugh A, Millson DS, Leon G, Wang M, van der Heijde D. Effects of Fostamatinib, an Oral Spleen Tyrosine Kinase Inhibitor, in Rheumatoid Arthritis Patients With an Inadequate Response to Methotrexate: Results From a Phase III, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study. Arthritis Rheumatol 2014; 66:3255-64. [DOI: 10.1002/art.38851] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/12/2014] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Meilien Ho
- AstraZeneca R&D, Alderley Park; Macclesfield UK
| | | | | | | | | | - Gustavo Leon
- Instituto de Ginecología y Reproducción-Cirugía Mínimamente Invasiva; Lima Peru
| | - Millie Wang
- AstraZeneca R&D, Alderley Park; Macclesfield UK
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Hollis S, Heller G, Stevenson M, Schofield P. RECURRENT MILD TRAUMATIC BRAIN INJURY AMONGST A COHORT OF RUGBY UNION PLAYERS. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.133] [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: 11/03/2022]
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Higgins JP, Lane PW, Anagnostelis B, Anzures-Cabrera J, Baker NF, Cappelleri JC, Haughie S, Hollis S, Lewis SC, Moneuse P, Whitehead A. A tool to assess the quality of a meta-analysis. Res Synth Methods 2013; 4:351-66. [DOI: 10.1002/jrsm.1092] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 06/17/2013] [Accepted: 07/02/2013] [Indexed: 01/08/2023]
Affiliation(s)
| | - Peter W. Lane
- Statistical Consultancy Group; GlaxoSmithKline R&D; Stevenage UK
| | - Betsy Anagnostelis
- Royal Free Hospital Medical Library; University College London; London UK
| | | | | | | | - Scott Haughie
- Primary Care Business Unit, Pfizer Global R&D; Sandwich UK
| | - Sally Hollis
- Global Medicines Development, AstraZeneca; Macclesfield UK
| | - Steff C. Lewis
- Centre for Population Health Sciences; University of Edinburgh Medical School; Teviot Place Edinburgh EH8 9AG UK
| | | | - Anne Whitehead
- Medical and Pharmaceutical Statistics Research Unit; Lancaster University; Lancaster UK
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Lane PW, Higgins JP, Anagnostelis B, Anzures-Cabrera J, Baker NF, Cappelleri JC, Haughie S, Hollis S, Lewis SC, Moneuse P, Whitehead A. Methodological quality of meta-analyses: matched-pairs comparison over time and between industry-sponsored and academic-sponsored reports. Res Synth Methods 2013; 4:342-50. [DOI: 10.1002/jrsm.1072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 09/11/2012] [Accepted: 12/07/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Peter W. Lane
- Statistical Consultancy Group; GlaxoSmithKline R&D; Stevenage UK
| | | | - Betsy Anagnostelis
- Royal Free Hospital Medical Library; University College London; London UK
| | | | | | | | - Scott Haughie
- Primary Care Business Unit; Pfizer Global R&D; Sandwich UK
| | - Sally Hollis
- Global Medicines Development; AstraZeneca; Macclesfield UK
| | - Steff C. Lewis
- Centre for Population Health Sciences; University of Edinburgh Medical School; Teviot Place Edinburgh EH8 9AG UK
| | | | - Anne Whitehead
- Medical and Pharmaceutical Statistics Research Unit; Lancaster University; Lancaster UK
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Hollis S. New oral anticoagulants and risks in ENT. Clin Otolaryngol 2013; 38:355-7. [DOI: 10.1111/coa.12148] [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] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. Hollis
- Department of ENT; Southmead Hospital; Bristol; UK
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Keystone EC, Wang MM, Layton M, Hollis S, McInnes IB. Clinical evaluation of the efficacy of the P2X7 purinergic receptor antagonist AZD9056 on the signs and symptoms of rheumatoid arthritis in patients with active disease despite treatment with methotrexate or sulphasalazine. Ann Rheum Dis 2012; 71:1630-5. [PMID: 22966146 DOI: 10.1136/annrheumdis-2011-143578] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The P2X(7) purinergic receptor antagonist AZD9056 was evaluated in a phase IIa study and subsequently in a phase IIb study to assess the effects of orally administered AZD9056 on the signs/symptoms of rheumatoid arthritis (RA), with American College of Rheumatology 20% response criteria (ACR20) as the primary outcome. METHODS Both studies were randomised, double-blind, placebo-controlled, parallel-group studies in patients with RA receiving methotrexate or sulphasalazine. Phase IIa was an ascending-dose trial in two cohorts (n=75) using AZD9056 administered daily over 4 weeks. Phase IIb included an open-label etanercept treatment group. Patients were randomised to receive treatment for 6 months with 50, 100, 200 or 400 mg AZD9056 (oral, once a day) or matching placebo (oral, once a day), or subcutaneous etanercept (50 mg once a week). RESULTS In phase IIa, 65% of AZD9056 recipients at 400 mg/day responded at the ACR20 level compared with 27% of placebo-treated patients. A significant reduction in swollen and tender joint count was observed in the actively treated group compared with placebo, whereas no effect on acute-phase response was observed. Of 385 randomised patients in the phase IIb study, 383 received treatment. AZD9056 (all doses) had no clinically or statistically significant effect on RA relative to placebo as measured by the proportion of patients meeting the ACR20 criteria at 6 months and further supported by secondary end points. In both studies AZD9056 was well tolerated up to 400 mg/day. CONCLUSIONS AZD9056 does not have significant efficacy in the treatment of RA, and the P2X(7) receptor does not appear to be a therapeutically useful target in RA. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT00520572.
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Affiliation(s)
- Edward C Keystone
- The Rebecca MacDonald Centre For Arthritis & Autoimmune Diseases, Mount Sinai Hospital, 60 Murray St, Box 4, Toronto, ON, Canada M5T 3L9.
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Gerlag DM, Hollis S, Layton M, Vencovský J, Szekanecz Z, Braddock M, Tak PP. Preclinical and clinical investigation of a CCR5 antagonist, AZD5672, in patients with rheumatoid arthritis receiving methotrexate. ACTA ACUST UNITED AC 2010; 62:3154-60. [DOI: 10.1002/art.27652] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jones D, McEvoy S, Merz TM, Higgins A, Bellomo R, Cooper JD, Hollis S, McArthur C, Myburgh JA, Taylor C, Liu B, Norton R, Finfer S. International albumin use: 1995 to 2006. Anaesth Intensive Care 2010; 38:266-73. [PMID: 20369758 DOI: 10.1177/0310057x1003800207] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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
Over the last ten years more reliable information regarding the risks and benefits of the use of albumin for fluid resuscitation has emerged. To determine what influence this has had on clinical practice, we sought to document albumin use (from mass of albumin supplied to hospitals) in 16 industrialised countries between 1995 and 2006. Data on national albumin and synthetic colloid use was sought from independent intensive care researchers and albumin issuers. The mass of albumin supplied per 10,000 persons on an annual basis by country and aggregated across the study countries was calculated. Volumes of synthetic colloid supplied per 10,000 persons were calculated. Data were obtained for 15 countries. Albumin use varied significantly between countries and throughout the observation period. Overall, aggregate albumin use decreased from a peak of 2.54 kg per 10,000 persons in 1995 to 1.40 kg per 10,000 persons in 1999; use has remained relatively constant since. Data on supply of synthetic colloids was available in only three countries and varied from 11.7 litres per 10,000 persons in Canada in 1995, to 231.8 litres per 10,000 persons in Denmark in 2004. Between 1995 and 1999 albumin use decreased and has been materially constant since; where data were available, use of synthetic colloids increased. Whether these practice changes have resulted in a net health gain or in harm requires further research.
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Affiliation(s)
- D Jones
- Critical Care and Trauma Division, The George Institute for International Health, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin.Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of excision margins remains unclear. This uncertainty warrants systematic review. OBJECTIVES To assess the effects of different excision margins for primary cutaneous melanoma. SEARCH STRATEGY In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), MEDLINE, EMBASE, LILACS, and other databases including Ongoing Trials Registers. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) of surgical excision of melanoma comparing different width excision margins. DATA COLLECTION AND ANALYSIS We assessed trial quality, and extracted and analysed data on survival and recurrence. We collected adverse effects information from included trials. MAIN RESULTS We identified five trials. There were 1633 participants in the narrow excision margin group and 1664 in the wide excision margin group. Narrow margin definition ranged from 1 to 2 cm; wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. AUTHORS' CONCLUSIONS This systematic review summarises the evidence regarding width of excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or wide excision.The summary estimate for overall survival favoured wide excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower excision and a 15% relative reduction in overall mortality favouring wider excision. Therefore, a small (but potentially important) difference in overall survival between wide and narrow excision margins cannot be confidently ruled out.The summary estimate for recurrence free survival favoured wide excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level).Current randomised trial evidence is insufficient to address optimal excision margins for primary cutaneous melanoma.
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Affiliation(s)
- Michael J Sladden
- Department of Medicine, University of Tasmania, Launceston General Hospital, Launceston, Tasmania, Australia, 7250
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Abstract
BACKGROUND Multiple Sclerosis (MS) is the commonest physically disabling chronic neurological disease affecting young people. Urinary symptoms are present in about 68% of people with MS but their basis has a number of potential aetiologies that can change with time. OBJECTIVES To assess the absolute and comparative efficacy, tolerability and safety of anticholinergic agents in MS patients. SEARCH STRATEGY We searched the Cochrane Multiple Sclerosis Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue1), MEDLINE (January 1966 to January 2008), EMBASE (January 1974 to January 2008), supplemented with search of reference lists, personal communication with authors and relevant drug manufacturers. SELECTION CRITERIA Randomised trials and cross-over trials (blinded and unblinded) that are either placebo-controlled or comparing two or more treatments. DATA COLLECTION AND ANALYSIS All four review authors independently assessed eligibility and trial quality, and extracted data. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Our search strategy identified 33 articles of which thirty were excluded. Three single centre trials were included. No details were given regarding randomisation and blinding in the first two trials but side effects were frequent with all treatments.The first (Hebjorn 1977) was a double blind randomised crossover trial. Thirty four persons with MS received three drugs Methantheline Bromide, Flavoxate Chloride and Meladrazine Tartrate each for 14 days, washout periods were not mentioned. Median volume measurements at the first bladder contraction were statistically significant at a 5% level for Methantheline Bromide only compared to no treatment.The second (Gajewski 1986) was a prospective parallel group randomised study. Thirty four persons with MS were treated for 6-8 weeks with Oxybutynin (19 subjects) or Propantheline (15 subjects). For frequency, nocturia, urgency, and urge incontinence differences in symptom grade in favour of Oxybutynin were found. However, only for frequency the difference was statistically significant at 5% level.The third (Fader 2007) was a double blind crossover trial. Sixty four persons with MS received oral Oxybutynin or intravesical Atropine for 14 days. Details of randomisation and blinding were given. There was no significant difference between the two treatments in any efficacy outcome measure. Side effects and QOL scores showed significant differences in favour of atropine. AUTHORS' CONCLUSIONS From the available evidence we cannot advocate the use of anticholinergics in MS.
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Affiliation(s)
- Richard S Nicholas
- West London Neurosciences Centre, Charing Cross Hospital, Fulham Palace Road, London, UK, W6 8RF.
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Abstract
BACKGROUND Fungal infections of the feet normally occur in the outermost layer of the skin (epidermis). The skin between the toes is a frequent site of infection which can cause pain and itchiness. Fungal infections of the nail (onychomycosis) can affect the entire nail plate. OBJECTIVES To assess the effects of topical treatments in successfully treating (rate of treatment failure) fungal infections of the skin of the feet and toenails and in preventing recurrence. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE and EMBASE (from inception to January 2005). We screened the Science Citation Index, BIOSIS, CAB - Health and Healthstar, CINAHL DARE, NHS Economic Evaluation Database and EconLit (March 2005). Bibliographies were searched. SELECTION CRITERIA Randomised controlled trials (RCTs) using participants who had mycologically diagnosed fungal infections of the skin and nails of the foot. DATA COLLECTION AND ANALYSIS Two authors independently summarised the included trials and appraised their quality of reporting using a structured data extraction tool. MAIN RESULTS Of the 144 identified papers, 67 trials met the inclusion criteria. Placebo-controlled trials yielded the following pooled risk ratios (RR) of treatment failure for skin infections: allylamines RR 0.33 (95% CI 0.24 to 0.44); azoles RR 0.30 (95% CI 0.20 to 0.45); ciclopiroxolamine RR 0.27 (95% CI 0.11 to 0.66); tolnaftate RR 0.19 (95% CI 0.08 to 0.44); butenafine RR 0.33 (95% CI 0.24 to 0.45); undecanoates RR 0.29 (95% CI 0.12 - 0.70). Meta-analysis of 11 trials comparing allylamines and azoles showed a risk ratio of treatment failure RR 0.63 (95% CI 0.42 to 0.94) in favour of allylamines. Evidence for the management of topical treatments for infections of the toenails is sparser. There is some evidence that ciclopiroxolamine and butenafine are both effective but they both need to be applied daily for prolonged periods (at least 1 year). The 6 trials of nail infections provided evidence that topical ciclopiroxolamine has poor cure rates and that amorolfine might be substantially more effective but more research is required. AUTHORS' CONCLUSIONS Placebo-controlled trials of allylamines and azoles for athlete's foot consistently produce much higher percentages of cure than placebo. Allylamines cure slightly more infections than azoles and are now available OTC. Further research into the effectiveness of antifungal agents for nail infections is required.
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Affiliation(s)
- F Crawford
- University of Dundee, Tayside Centre for General Practice, MacKenzie Building, Kirsty Semple Way, Edinburgh, UK, EH3 8DE.
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van Zuuren EJ, Gupta AK, Gover MD, Graber M, Hollis S. Systematic review of rosacea treatments. J Am Acad Dermatol 2007; 56:107-15. [PMID: 17190628 DOI: 10.1016/j.jaad.2006.04.084] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 04/13/2006] [Accepted: 04/15/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rosacea is a common chronic skin and ocular condition. It is unclear which treatments are most effective. We have conducted a Cochrane review of rosacea therapies. This article is a distillation of that work. OBJECTIVE We sought to assess the evidence for the efficacy and safety of rosacea therapies. METHODS Multiple databases were systematically searched. Randomized controlled trials in people with moderate to severe rosacea were included. Study selection, assessment of methodologic quality, data extraction, and analysis were carried out by two independent researchers. RESULTS In all, 29 studies met inclusion criteria. Topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95-12.06). Azelaic acid is more effective than placebo (odds ratio 2.45, 95% confidence interval 1.82-3.28). Firm conclusions could not be drawn about other therapies. LIMITATIONS The quality of the studies was generally poor. CONCLUSIONS There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.
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Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology B1-Q, Leiden University Medical Center, The Netherlands.
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Abstract
BACKGROUND Pre-existing medical conditions (PMCs) have been shown to increase mortality after trauma even after adjustment for the effect of chronological aging. It has been suggested that there is an interaction between injury severity and physiologic reserve, such that diminished physiologic reserve will have an adverse effect on survival at lower injury severity, but that at higher levels of injury severity, physiologic reserve will have much less of an impact. METHODS Records of 65,743 patients, admitted after trauma, were extracted from the database of the United Kingdom Trauma Network to explore the impacts of age, gender and PMCs on mortality, and modification of these effects by severity of injury. RESULTS PMCs were categorized as absent (23%), present (23%), or unrecorded (54%). There was an increase in mortality with increasing age at all levels of injury severity. Presence of a PMC was associated with a marked increase in mortality of patients with minor injuries (odds ratio [OR] = 5.9, 95% confidence interval [CI] 4.4, 8.0) or moderate injuries (OR = 2.0, 95% CI 1.4, 2.9), but not in those with more severe injuries (OR = 1.1, 95% CI 0.9, 1.4). The impact of age and male gender were also somewhat more pronounced for patients with less severe injuries. CONCLUSION These findings support the hypothesis of an interaction between physiologic reserve and injury severity, where PMCs are associated with increased mortality when combined with low to moderate severity injuries, but not when combined with more severe injuries.
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Affiliation(s)
- Sally Hollis
- Medical Statistics Unit, Lancaster University, England
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Abstract
BACKGROUND In the Trauma Audit and Research Network (TARN), currently the largest trauma network in Europe, outcome prediction is performed using the TRISS methodology since 1989. Its database contains 200,000 hospital admissions from 110 hospitals over the country, but a large amount of data is lost for the modelling because of missing data. To improve some of the shortcomings of TRISS a new model was developed. METHODS The data for modelling consisted of 100,399 hospital trauma admissions over the period 1996 to 2001. Using the Glasgow Coma Score (GCS) instead of RTS has dramatically reduced the number of missing cases. Gender and its interaction with age have also been included in the model. The model was tested on different subsets of cases traditionally excluded, such as children, those with penetrating injuries, and ventilated and transferred patients. The new model included all those subsets using age, a transformation of ISS, GCS, gender and gender by age interaction as predictors. RESULTS The model has shown a good discriminant ability tested by the area under the receiver operating characteristic (AROC) curve. The values of the AROC for the new model were 0.947 (95% CI: 0.943-0.951) on the prediction set and 0.952 (95% CI: 0.946-0.957) on the validation set compared respectively with 0.937 (95% CI: 0.932-0.943) and 0.941 (95% CI: 0.936-0.952) for TRISS. CONCLUSION The new model has enabled us to include most of the cases that were excluded under the TRISS's inclusion criteria, less missing data are incurred and the predictive performance was significantly better than that of the TRISS model as shown by the AROC curves.
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Affiliation(s)
- Omar Bouamra
- The University of Manchester, The Trauma Audit & Research Network, Clinical Sciences Building, Hope Hospital, Salford M6 8HD, UK.
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Abstract
BACKGROUND The Trauma Audit & Research Network (TARN) has been using the TRISS methodology since 1989. Its database contains 200,000 hospital admissions from 110 hospitals over the country. To improve outcome prediction, a revision of the current model became necessary. Our model tried to overcome some of the concerns of the trauma community, namely missing data, functional form of the predictors, inclusion criteria and patient's death within 30 days. METHODS The data for modeling consisted of 100,399 anonymized hospital trauma admissions during the period 1996 to 2001. Cross validation was performed on this data set, and a multiple logistic regression model was derived using the prediction set and then its prediction ability was tested on the validation set. Fractional polynomials modeling showed that the linear functional form of the Injury Severity Score (ISS) in the model was not satisfactory. Using the Glasgow Coma Score (GCS) instead of the revised trauma score (RTS) has dramatically reduced the number of missing cases. Sex and its interaction with age have also been included in the model. The model was tested on different subsets of cases, traditionally excluded, such as children, those with penetrating injuries, and ventilated and transferred patients. The new model included all those subsets using age, a transformation of ISS, GCS, sex, and sex by age interaction as predictors. RESULTS The model has shown a good discriminant ability tested by the Area under the Receiver Operating Characteristic (AROC) curve. The values of the AROC for the new model were 0.947 (95% confidence interval [CI]: 0.943-0.951) on the prediction set and 0.952 (95% CI: 0.946-0.957) on the validation set compared, respectively, with 0.937 (95% CI: 0.932-0.943) and 0.941 (95% CI: 0.936-0.952) for TRISS. CONCLUSION The new model has enabled us to include most of the cases that were excluded under the TRISSs inclusion criteria, less missing data are incurred and the predictive performance was significantly better than that of the TRISS model as shown by the AROC curves.
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Affiliation(s)
- Omar Bouamra
- University of Manchester, The Trauma Audit & Research Network, Clinical Sciences Building, Hope Hospital, Salford, United Kingdom.
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Meaden C, Joshi M, Hollis S, Higham A, Lynch D. A randomized controlled trial comparing the accuracy of general diagnostic upper gastrointestinal endoscopy performed by nurse or medical endoscopists. Endoscopy 2006; 38:553-60. [PMID: 16802265 DOI: 10.1055/s-2006-925164] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Rising demand for general diagnostic upper gastrointestinal endoscopy in the UK is outgrowing the capacity of doctors to provide this service within a reasonable time. One solution is to train nurses to carry out the procedure, but it is not known whether nurses can perform general diagnostic upper gastrointestinal endoscopy as competently as doctors. PATIENTS AND METHODS A randomized controlled non-inferiority trial compared the adequacy and the accuracy of diagnostic upper gastrointestinal endoscopies performed by five medical and two nurse endoscopists. The videotaped procedures were assessed by a consultant gastroenterologist blinded to the identity of the endoscopist. RESULTS 641 patients were randomly allocated (before attendance and consent procedure) to endoscopy carried out either by a doctor or a nurse. Of these, 412 were enrolled and 367 (89 %) were included in the analysis. An adequate view was obtained throughout in 53.4 % (93/177) of doctor endoscopies and 91.6 % (174/190) of nurse endoscopies (difference 38.2 %, 95 % CL 30.5 %, 47.2 %). In adequately viewed areas, the mean agreement between doctor and expert was 81.0 % and between nurse and expert it was 78.3 % (difference between the means 2.7 %, 95 % CL - 1.0 %, 6.4 %). There was no difference between doctors and nurses in the rate of biopsy performance (90.4 % and 91.1 %, respectively, P = 0.862). Nurses took longer (8.1 minutes vs. 4.6 minutes, P < 0.001) and used intravenous sedation more often (57.6 %, P = 0.027). Adequacy of view correlated positively with endoscopy duration ( P < 0.001), but diagnostic accuracy correlated inversely with duration ( P < 0.001). Neither adequacy or accuracy correlated significantly with use of intravenous sedation. CONCLUSIONS In endoscopies performed by nurses, the proportion of adequate examinations was much higher than that found for doctors. In areas with an adequate view, there is no significant difference in accuracy between nurses and doctors. Nurses can provide an accurate general diagnostic upper gastrointestinal endoscopy service as competently as doctors.
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Affiliation(s)
- C Meaden
- Royal Lancaster Infirmary, Lancaster, UK.
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Bauer J, Morley J, Spanton S, Leusen FJJ, Henry R, Hollis S, Heitmann W, Mannino A, Quick J, Dziki W. Identification, Preparation, and Characterization of Several Polymorphs and Solvates of Terazosin Hydrochloride. J Pharm Sci 2006; 95:917-28. [PMID: 16493591 DOI: 10.1002/jps.20425] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The phenomenon of polymorphism is prevalent in pharmaceuticals, yet it is unusual to identify more than three or four forms for any particular drug. Terazosin hydrochloride has been found to exist at room temperature in four solvent-free forms that can be isolated directly, one solvent-free form that can be prepared by desolvation of a methanolate, a methanol solvate, and a dihydrate. This study presents characterization and methods for preparation of each of these forms. Data are also presented demonstrating the relative stability of these forms.
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Affiliation(s)
- J Bauer
- Abbott Laboratories, North Chicago, Illinois 60064-6293, USA.
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Abstract
BACKGROUND Chronic palmoplantar pustulosis (PPP) is a chronic inflammatory skin condition characterised by crops of sterile pustules (yellow pus spots) on the palms and soles which erupt repeatedly over months or years. The affected areas tend to become red and scaly; cracks may form and these are often painful. Many different treatments have been used for palmoplantar pustulosis but none is generally accepted as being reliably effective. OBJECTIVES To assess the effects of treatments for palmoplantar pustulosis, both in reducing disease severity and in maintaining remission once achieved. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (January 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to February 2003). We also cross-checked with the Salford Database of Psoriasis Trials and reference lists of articles. We also contacted authors included trials, members of the Cochrane Skin Group and dermatologists interested in psoriasis. SELECTION CRITERIA Any randomised controlled trial in which patients with chronic palmoplantar pustulosis were randomised to receive one or more interventions. DATA COLLECTION AND ANALYSIS At least two reviewers independently assessed trial eligibility and quality. Study authors were contacted for additional information. Adverse effects information was collected from the trials. MAIN RESULTS Twenty-three trials involving 724 people were included. There is evidence supporting the use of systemic retinoids (improvement rate difference 44%, 95 CI 28 to 59%), oral PUVA (improvement rate difference 44%, 95 CI 26 to 62%). However, a combination of PUVA and retinoids is better than the individual treatments. The use of topical steroid under hydrocolloid occlusion is beneficial. It would also appear that low dose ciclosporin, tetracycline antibiotics and Grenz Ray Therapy may be useful in treating PPP. Colchicine has a lot of side effects and it is unclear if it is effective and neither was topical PUVA (rate difference of 0.00, 95% CI -0.04 to +0.04). There is no evidence to suggest that short-term treatment with hydroxycarbamide (hydroxyurea) is effective. AUTHORS' CONCLUSIONS Many different interventions were reported to produce "improvement" in PPP. There is, however, no standardised method for assessing response to treatment, and reductions in pustule counts or other empirical semi-quantitative scoring systems may be of little relevance to the patient. This review has shown that the ideal treatment for PPP remains elusive and that the standards of study design and reporting need to be improved to inform patients and those treating them of the relative merits of the many treatments available to them.
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Affiliation(s)
- Robert Chalmers
- The University of Manchester, Salford Royal NHS Foundation TrustThe Dermatology CentreStott LaneSalfordManchesterUKM6 8HD
| | - Sally Hollis
- University of ManchesterCentre for Biostatistics, Institute of Population HealthManchester Academic Health Science CentreOxford RoadManchesterUKM13 9PL
| | - Jo Leonardi‐Bee
- The University of NottinghamDivision of Epidemiology and Public HealthClinical Sciences BuildingNottingham City Hospital NHS Trust Campus, Hucknall RoadNottinghamUKNG5 1PB
| | - Christopher EM Griffiths
- The University of Manchester, Salford Royal NHS Foundation TrustThe Dermatology CentreStott LaneSalfordManchesterUKM6 8HD
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Abstract
BACKGROUND Bullous pemphigoid is the most common autoimmune bullous disease in the West. Oral steroids are considered the standard treatment. OBJECTIVES To assess the effects of treatments for bullous pemphigoid. SEARCH STRATEGY We searched the Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE to March 2003 and bibliographies from identified studies. SELECTION CRITERIA Randomised controlled trials of treatments for patients with immunofluorescence confirmed bullous pemphigoid. DATA COLLECTION AND ANALYSIS Two reviewers evaluated the studies in terms of the inclusion criteria, five extracted data independently; disagreements were resolved by discussion. Statistical pooling of the data was inappropriate because of heterogeneity of treatments. MAIN RESULTS We found seven randomised controlled trials with a total of 634 patients. All studies involved different comparisons, none included a placebo group. Different doses, different formulations of corticosteroids and the addition of azathioprine failed to show significant differences in measures of disease control. However, patients who took azathioprine were able to almost halve the amount of prednisone required for disease control. Plasma exchange plus prednisone achieved significantly better disease control than prednisone alone; this favourable effect was not apparent in another study. The latter study also compared plasma exchange or azathioprine plus prednisone, but failed to show significant differences for disease control or mortality, although total adverse events at six months almost reached statistical significance in favour of plasma exchange plus prednisone. Comparing tetracycline plus nicotinamide with prednisolone, no significant difference for disease response was shown. A very potent topical corticosteroid was compared to oral prednisone in patients with moderate and extensive disease. In patients with extensive disease, the topical steroid group showed significantly better survival and disease control, and less severe complications, while no significant differences for these outcomes were seen in patients with moderate disease. Most of the reported deaths were in patients taking high doses of oral corticosteroids. AUTHORS' CONCLUSIONS Very potent topical steroids are effective and safe treatments for bullous pemphigoid; their use in extensive disease may be limited by side effects and practical factors. Starting doses of prednisolone greater than 0.75 mg/kg/day do not seem to give additional benefit, lower doses may be adequate for disease control; this could reduce the incidence and severity of adverse reactions. The effectiveness of the addition of plasma exchange or azathioprine to corticosteroids has not been established. Combination treatment with tetracycline and nicotinamide may be useful; this needs further validation.
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Affiliation(s)
- N Khumalo
- Dermatology Department, Groote Schuur Hospital, Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa, 7925.
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Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective. OBJECTIVES To assess the evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were searched. Relevant manufacturers and experts were contacted. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the authors to have seriously flawed methodology were excluded. DATA COLLECTION AND ANALYSIS Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent authors. Disagreements were resolved by discussion and consensus. MAIN RESULTS The evidence provided by twenty-nine included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea were included. Pooled data from two trials involving 174 participants indicated that according to the participants, topical metronidazole is more effective than placebo (odds ratio (OR) 5.96, 95% confidence interval (CI) 2.95 to 12.06). Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70 to 80% versus 50% to 55% (OR 2.45, 95% CI 1.82 to 3.28). A within-patient trial of azelaic cream versus placebo could not be pooled with the other three studies, but also showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians, tetracycline was effective (OR 6.06, 95% CI 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. AUTHORS' CONCLUSIONS The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. Good RCTs looking at these treatments are urgently needed.
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Affiliation(s)
- E J van Zuuren
- Dermatology department B1-Q, Leiden University Medical Centre, Albinus dreef 2, Leiden, Netherlands, 2333 ZA.
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Gamble C, Hollis S. Uncertainty method improved on best–worst case analysis in a binary meta-analysis. J Clin Epidemiol 2005; 58:579-88. [PMID: 15878471 DOI: 10.1016/j.jclinepi.2004.09.013] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 08/24/2004] [Accepted: 09/23/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Most systematic reviewers aim to perform an intention-to-treat meta-analysis, including all randomized participants from each trial. This is not straightforward in practice: reviewers must decide how to handle missing outcome data in the contributing trials. OBJECTIVE To investigate methods of allowing for uncertainty due to missing data in a meta-analysis. STUDY DESIGN AND SETTING The Cochrane Library was surveyed to assess current use of imputation methods. We developed a methodology for incorporating uncertainty, with weights assigned to trials based on uncertainty interval widths. The uncertainty interval for a trial incorporates both sampling error and the potential impact of missing data. We evaluated the performance of this method using simulated data. RESULTS The survey showed that complete-case analysis is commonly considered alongside best-worst case analysis. Best-worst case analysis gives an interval for the treatment effect that includes all of the uncertainty due to missing data. Unless there are few missing data, this interval is very wide. Simulations show that the uncertainty method consistently has better power and narrower interval widths than best-worst case analysis. CONCLUSION The uncertainty method performs consistently better than best-worst case imputation and should be considered along with complete-case analysis whenever missing data are a concern.
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Affiliation(s)
- Carrol Gamble
- Centre for Medical Statistics and Health Evaluation, Shelleys Cottage, University of Liverpool, Merseyside, UK.
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Nwosu EC, Kumar B, El-Sayed M, Hollis S. Is fetal gender significant in the perinatal outcome of pregnancies complicated by placental abruption? J OBSTET GYNAECOL 2005; 19:612-4. [PMID: 15512413 DOI: 10.1080/01443619963842] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Seventy cases of placental abruption were studied. These occurred in 12,800 deliveries, an incidence of 4.8 per 1000. There were more female infants (34-56%) compared with males (27-44%). Sixteen infants were stillborn and one baby died in the neonatal period. Thirteen of the perinatal deaths occurred in male infants. We speculate that a higher metabolic rate in male infants may account for this sex difference.
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Affiliation(s)
- E C Nwosu
- Obstetrics and Gynaecology Unit, Whiston Hospital, Prescot, Merseyside, UK
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Young RJ, Taylor J, Friede T, Hollis S, Mason JM, Lee P, Burns E, Long AF, Gambling T, New JP, Gibson JM. Pro-active call center treatment support (PACCTS) to improve glucose control in type 2 diabetes: a randomized controlled trial. Diabetes Care 2005; 28:278-82. [PMID: 15677779 DOI: 10.2337/diacare.28.2.278] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether Pro-Active Call Center Treatment Support (PACCTS), using trained nonmedical telephonists supported by specially designed software and a diabetes nurse, can effectively improve glycemic control in type 2 diabetes. RESEARCH DESIGN AND METHODS A randomized controlled implementation trial of 1-year duration was conducted in Salford, U.K. The trial comprised 591 randomly selected individuals with type 2 diabetes. By random allocation, 197 individuals were assigned to the usual care (control) group and 394 to the PACCTS (intervention) group. Lifestyle advice and drug treatment in both groups followed local guidelines. PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA(1c) level. The primary outcome was absolute reduction in HbA(1c), and the secondary outcome was the proportion of patients reducing HbA(1c) by at least 1%. RESULTS A total of 332 patients (84%) in the PACCTS group and 176 patients (89%) in the control group completed the study. Final HbA(1c) values were available in 374 patients (95%) in the PACCTS group and 180 patients (92%) in the usual care group. Compared with usual care, HbA(1c) improved by 0.31% (95% CI 0.11-0.52, P = 0.003) overall in the PACCTS patients. For patients with baseline HbA(1c) >7%, the improvement increased to 0.49% (0.21-0.77, P < 0.001), whereas in patients with baseline HbA(1c) <7% there was no change. The difference in the proportions of patients achieving a >/=1% reduction in HbA(1c) significantly favored the PACCTS intervention: 10% (4-16, P < 0.001) overall and 15% (7-24, P < 0.001) for patients with baseline HbA(1c) >7%. CONCLUSIONS In an urban Caucasian trial population with blood glucose HbA(1c) >7%, PACCTS facilitated significant improvement in glycemic control. Further research should extend the validity of findings to rural communities and other ethnic groups, as well as to smoking and lipid and blood pressure control.
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Affiliation(s)
- Robert J Young
- Diabetes & Endocrinology, Hope Hospital, Salford M6 8HD, UK.
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Abstract
BACKGROUND Photodamage describes skin changes such as fine and coarse wrinkles, roughness, freckles and pigmentation changes that occur as a result of prolonged exposure to the sun. Many treatments are available to reverse the damage, but it is unclear which work and at what cost in terms of unwanted side effects. OBJECTIVES To assess the effects of topically applied treatments, tablet treatments, laser and surgical procedures for photodamaged skin. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Issue 1 2002, MEDLINE (1966-June 2002), EMBASE (1974-June 2002), Health Periodicals (1976-June 2002). We checked references of articles and communicated with authors and the pharmaceutical industry. SELECTION CRITERIA Randomised controlled trials which compared drug or surgical interventions with no treatment, placebo or another drug, in adults with mild, moderate or severe photodamage of the face or forearms. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS Thirty studies of variable quality were included. Eight trials showed that topical tretinoin cream, in concentrations of 0.02% or higher, was superior to placebo for participants with mild to severe photodamage on the face and forearms (although losses to follow-up were relatively high in most studies). For example, the relative risk of improvement for 0.05% tretinoin cream, compared to placebo (three studies), at 24 weeks, was 1.73 (95% confidence interval 1.39 to 2.14). This effect was not seen for 0.001% topical tretinoin (one study) or 0.01% (three studies). A dose-response relationship was evident for both effectiveness and skin irritation. One small within-patient study showed benefit from topical ascorbic acid compared with placebo. Tazarotene (0.01% to 0.1%) and isotretinoin (0.1%) both showed significant improvement over placebo for moderate photodamage (one study each). There is limited evidence (one trial), to show that the effectiveness of 0.05% tretinoin, is equivalent to the effects of 0.05% and 0.1% tazarotene. One small study showed greater improvement in upper lip wrinkles with CO2 laser technique compared to Baker's phenol chemical peel, at 6 months. Three small RCTs comparing CO2 laser with dermabrasion found no difference in wrinkle score at 4 to 6 months, suggesting that both methods are equally efficacious, but more erythema was reported with the laser. The effectiveness of other interventions such as hydroxy acids and natural polysaccharides was not clear. AUTHORS' CONCLUSIONS There is conclusive evidence that topical tretinoin improves the appearance of mild to moderate photodamage on the face and forearms, in the short term. However erythema, scaling/dryness, burning/stinging and irritation may be experienced initially. There is limited evidence that tazarotene and isotretinoin benefit patients with moderate photodamage on the face: both are associated with skin irritation and erythema. The effectiveness of other interventions remains uncertain.
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Affiliation(s)
- M Samuel
- Clinical Trials & Epidemiology Research Unit, Ministry Of Health, 226 Outram road, Block A #02-02, Singapore, South East Asia, Singapore.
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