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Raghu G, Ley B, Brown KK, Cottin V, Gibson KF, Kaner RJ, Lederer DJ, Noble PW, Song JW, Wells AU, Whelan TP, Lynch DA, Humphries SM, Moreau E, Goodman K, Patterson SD, Smith V, Gong Q, Sundy JS, O'Riordan TG, Martinez FJ. Risk factors for disease progression in idiopathic pulmonary fibrosis. Thorax 2019; 75:78-80. [PMID: 31611341 DOI: 10.1136/thoraxjnl-2019-213620] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 11/04/2022]
Abstract
In this retrospective study of a randomised trial of simtuzumab in idiopathic pulmonary fibrosis (IPF), prodromal decline in forced vital capacity (FVC) was significantly associated with increased risk of mortality, respiratory and all-cause hospitalisations, and categorical disease progression. Predictive modelling of progression-free survival event risk was used to assess the effect of population enrichment for patients at risk of rapid progression of IPF; C-index values were 0.64 (death), 0.69 (disease progression), and 0.72 (adjudicated respiratory hospitalisation) and 0.76 (all-cause hospitalisation). Predictive modelling may be a useful tool for improving efficiency of clinical trials with categorical end points.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brett Ley
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kevin K Brown
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colorado, USA
| | - Vincent Cottin
- Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, University of Lyon, UMR754, Lyon, France
| | - Kevin F Gibson
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert J Kaner
- Department of Clinical Medicine and Genetic Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David J Lederer
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Medical Center, New York, New York, USA
| | - Paul W Noble
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Athol U Wells
- Department of Medicine, National Heart & Lung Institute, Royal Brompton Hospital, Imperial College, London, UK
| | - Timothy P Whelan
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | | | | | - Krista Goodman
- Clinical Research, Gilead Sciences, Inc, Seattle, Washington, USA
| | | | - Victoria Smith
- Clinical Research, Gilead Sciences, Inc, Seattle, Washington, USA
| | - Qi Gong
- Biostatistics, Gilead Sciences, Inc, Foster City, California, USA
| | - John S Sundy
- Clinical Research, Gilead Sciences, Inc, Seattle, Washington, USA
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Elmore S, Wisse A, Chapin RW, Whelan TP, Silver RM. Voriconazole-associated periostitis presenting as hypertrophic osteoarthropathy following lung transplantation report of two cases and review of the literature. Semin Arthritis Rheum 2019; 49:319-323. [PMID: 31103239 DOI: 10.1016/j.semarthrit.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/17/2019] [Accepted: 04/22/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by abnormal proliferation of skin and osseous tissue frequently associated with underlying pulmonary disorders. Cardinal features include digital clubbing, periostitis and significant joint and bone pain. A number of recent reports have emerged of HOA and periostitis occurring in association with the antifungal agent voriconazole. METHODS We present two additional cases of voriconazole-induced HOA and periostitis in lung transplant recipients with a review the medical literature. RESULTS In both cases, symptoms were painful and severe enough to require opioid medication. Rapid improvement occurred within days of voriconazole cessation. A review of existing literature revealed an additional 17 cases of voriconazole-induced HOA and periostitis in lung transplant patients. CONCLUSION We highlight the importance of recognizing the association of voriconazole with painful HOA and periostitis in lung transplant patients receiving antifungal therapy. Management of this painful condition involves cessation of voriconazole therapy, which may necessitate alternative anti-fungal drug therapies as well as adjustment of immunosuppressive drug dosage since voriconazole is a strong drug-inducer.
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Affiliation(s)
- Stephen Elmore
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 822, Charleston, SC 29401, USA
| | - Amy Wisse
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC 29401, USA
| | - Russell W Chapin
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29401, USA
| | - Timothy P Whelan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC 29401, USA
| | - Richard M Silver
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 822, Charleston, SC 29401, USA.
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Velez JCQ, Kadian M, Taburyanskaya M, Bohm NM, Delay TA, Karakala N, Rockey DC, Nietert PJ, Goodwin AJ, Whelan TP. Hepatorenal Acute Kidney Injury and the Importance of Raising Mean Arterial Pressure. Nephron Clin Pract 2015; 131:191-201. [PMID: 26485256 DOI: 10.1159/000441151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The efficacy of vasoconstrictors in hepatorenal syndrome (HRS) is variable. We hypothesized that the effectiveness of vasoconstrictor therapy in improving kidney function ultimately relates to the magnitude of the achieved mean arterial pressure (MAP) increase. METHODS A retrospective study was conducted to identify cirrhotic individuals treated with vasoconstrictors for acute kidney injury (AKI) presumably caused by HRS to examine the relationship between change in MAP and change in serum creatinine (sCr) using multivariate mixed linear regression. RESULTS Among 73 patients treated with midodrine/octreotide, change in MAP inversely correlated with change in sCr (p = 0.0005). The quartile with the greatest increase in MAP (+15.9 to +29.4 mm Hg) was associated with a subsequent absolute decrease in sCr. The strength of the correlation increased when the analysis was restricted to those who met the HRS criteria (n = 27, p = 0.002), where the third (+5.3 to +15.6 mm Hg) and fourth (+15.9 to +20.9 mm Hg) quartiles of MAP change were associated with a decrease in sCr. A similar but stronger correlation was found among 14 patients treated with norepinephrine either after failing midodrine/octreotide (n = 10) or de novo (n = 4; p = 0.002), where a rise in MAP of +19.2 to 25 mm Hg was associated with a larger reduction in sCr. Associations remained significant after adjustment for baseline parameters. CONCLUSIONS The magnitude of MAP rise during HRS therapy with midodrine/octreotide or norepinephrine correlated with a reduction in sCr concentration. Our results suggest that achieving a pre-specified target of MAP increase might improve renal outcomes in hepatorenal AKI.
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Affiliation(s)
- Juan Carlos Q Velez
- Division of Nephrology, Medical University of South Carolina, Charleston, S.C., USA
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Kempainen RR, Savik K, Whelan TP, Dunitz JM, Herrington CS, Billings JL. High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. Chest 2007; 131:1666-71. [PMID: 17400682 DOI: 10.1378/chest.06-2264] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of COPD. The aims of this study were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD. METHODS Forty-one COPD patients with a mean FEV1 of 24% of predicted underwent dual-probe 24-h esophageal pH monitoring, and 1 patient underwent esophagogastroduodenoscopy. RESULTS The prevalence of GERD was 57%. Elevated distal and proximal reflux were present in 41% and 46% of patients undergoing esophageal pH studies, respectively. Fifteen percent of these patients had abnormal proximal reflux despite having normal distal probe results. Most patients with GERD were not receiving acid blockers at the time of their referral, and only one third reported heartburn and/or acid regurgitation during the pH study. Only higher body mass index was predictive of reflux on regression analysis (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.5; p = 0.05). CONCLUSIONS GERD is common in advanced COPD. Patients are often asymptomatic and have a relatively high prevalence of isolated abnormal proximal reflux. Dual-probe monitoring is therefore well suited for detecting GERD in patients with advanced COPD.
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Affiliation(s)
- Robert R Kempainen
- Division of Pulmonary, Allergy, and Critical Care, University of Minnesota School of Medicine, MMC 276, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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Abstract
An increased risk of invasive pneumococcal infection (IPI) has been described among kidney or heart transplant recipients, but the epidemiology of IPI among lung transplant recipients has not been previously reported. We undertook a single center, retrospective cohort study to define the incidence, timing, clinical, and microbiologic features of IPI in lung transplant patients. Fourteen out of 220 recipients (6.4%) developed IPI at a median of 1.3 years after transplantation (incidence rate: 22.7 cases per 1000 person-years). All patients were receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at the time of diagnosis, and 10 (71%) had TMP-SMX-resistant isolates. All isolates were from the 23 valent polysaccharide vaccine-associated serogroups. The high incidence of IPI in lung transplant recipients is similar to that reported in kidney and heart recipients. Alternative prevention strategies, including use of the conjugated pneumococcal vaccine, should be explored in future studies.
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Affiliation(s)
- Guy de Bruyn
- Department of Medicine, University of Washington, Washington, WA, USA
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