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A Multi-Center Retrospective Study of Polatuzumab for Patients with Large B-Cell Lymphoma Relapsed after Standard of Care CAR T-Cell Therapy
Gouni, Sushanth , Crombie, Jennifer L. , Hess, Brian , Watson, Grace, Ayers, Amy , Neelapu, Sattva S. , Khurana, Arushi , Rosenthal, Allison , Ip, Andrew , Kamdar, Manali , Feng, Lei , Watson, Grace, Iqbal, Madiha , Lin, Yi , Merryman, Reid W. , Strati, Paolo

Blood | November 24, 2021 | Volume: 138 | Issue: Supplement 1 | Pages: 2495-2495

10.1182/blood-2021-147591 Get It

Abstract Introduction. About 60% of patients with large B-cell lymphoma (LBCL) relapse after standard of care (SOC) anti-CD19 autologous chimeric antigen receptor (CAR) T-cell therapy, CD19 downregulation representing a major mechanism of resistance. Therefore, agents able to target B-cell antigens other than CD19 could be clinically effective for these patients. Polatuzumab vedotin (PV) is an antibody-drug conjugate targeting CD79b, and approved by the FDA in combination with bendamustine and rituximab for patients with relapsed or refractory (r/r) LBCL. Patients who relapsed after CAR T-cell therapy were not included in the registration study, and reports of PV use after CAR T-cells in real world practice are very limited. Methods. This is a multi-center retrospective analysis of patients with LBCL who relapsed after SOC CAR T-cell therapy and subsequently received SOC PV with or without rituximab and bendamustine between 07/2019 and 04/2021. PV was given at the standard dose of 1.8 mg/kg IV every 3 weeks in all patients (except for one patient, who received 1.4 mg/Kg). Response to treatment and progression were defined according to 2014 Lugano criteria. Survival curves were calculated using Kaplan-Meier estimates, and were compared between subgroups using the log-rank test. Cox regression was used for multivariate analysis (MVA). Results. Fifty-four patients were included in the study: median age was 59 (range, 22-79 years), 38 (70%) were male, and 30 (56%) had an internal prognostic index score > 3. Median number of systemic therapies before CAR T-cell therapy was 2 (range, 2-6), 16 (30%) patients previously had autologous stem cell transplant (SCT), and 2 (4%) had allogeneic SCT. Sixteen (30%) patients were primary refractory to CAR T-cell therapy, and median time from CAR T-cell therapy to PV was 5 months (range, 1-40 months). CD19 status at time of relapse after CAR T-cell therapy was assessed by immunohistochemistry and/or flow cytometry in 41 patients, and positive in 34 (83%); CD79b status was assessed in 14 patients, and positive in all cases (100%). Thirty-two (59%) patients received PV-based therapy immediately after CAR T cell therapy, while 22 (41%) had intervening treatments (median 1, range 1-5). At time of PV initiation, median absolute neutrophil count was 2.9 (range 0.5-19 X10 9/L), median platelet count was 87 X10 9/L (range 15-437 X10 9/L), median serum creatinine was 0.9 mg/dL (range 0.4-22 mg/dL), and 44 (81%) patients had elevated serum lactate dehydrogenase (LDH). The median number of PV cycles was 2 (range, 1-16): PV was combined with rituximab in 51 (94%) patients, and administered with bendamustine in 33 (61%). A response was achieved in 24 (45%) patients, including complete remission (CR) in 8 (14%) patients and partial remission in 16 (30%)(Figure A), with a median duration of response of 11 weeks (95%CI, 5-17 weeks). No significant association between baseline characteristics and response was observed. To date, 49 (91%) patients stopped PV: 38 (70%) due to progression, 7 (13%) because of CR/patient decision, 3 (6%) to proceed to allogeneic SCT, and 1 (2%) to proceed to an immunotherapy clinical trial (despite absence of progression). No patients stopped therapy because of toxicity. After a median follow up of 45 weeks (95% CI, 20-70 weeks), 44 (81%) patients progressed/died, and median PFS was 9 weeks (95% CI, 4-14 weeks). To date, 34 (63%) died, and median OS was 16 weeks (95% CI, 13-19 weeks)(Figure B). Causes of death included progression in 31 patients and transplant-related complications in 3. On univariate analysis, a shorter median progression-free survival (PFS) was observed for patients with bone marrow (BM) involvement (3 vs 10 weeks, p=0.002), prior central nervous system involvement (4 vs 10 weeks, p=0.02), and elevated LDH (6 months vs not reached, p=0.004). On MVA, the association was maintained only for BM involvement (hazard ratio [HR] 4.8; 95% confidence interval [CI] 1.6-12.5, p=0.004) and elevated LDH (HR 5; 1.4-16.7, p=0.01)(Figure C). Discussion. PV is safe and effective, but has short duration of response in r/r LBCL after anti-CD19 CAR T-cell therapy, except for patients with normal LDH. Studies aimed at better characterizing intrinsic mechanism of resistance, including upregulation of BCL2 family proteins, to favor the development of more effective PV-based combination strategies for these patients, are warranted. Figure 1 Figure 1. Disclosures Crombie: Roche: Research Funding; Merck: Research Funding; Abbvie: Research Funding; Bayer: Research Funding; Karyopharm: Consultancy; Incyte: Consultancy. Kamdar: Celgene (BMS): Consultancy; Adaptive Biotechnologies: Consultancy; Genentech: Research Funding; Kite: Consultancy; AstraZeneca: Consultancy; ADC Therapeutics: Consultancy; Genetech: Other; TG Therapeutics: Research Funding; SeaGen: Speakers Bureau; Celgene: Other; KaryoPharm: Consultancy; AbbVie: Consultancy. Hess: ADC Therapeutics: Consultancy; BMS: Speakers Bureau. Neelapu: Takeda Pharmaceuticals and related to cell therapy: Patents & Royalties; Kite, a Gilead Company, Bristol Myers Squibb, Merck, Poseida, Cellectis, Celgene, Karus Therapeutics, Unum Therapeutics (Cogent Biosciences), Allogene, Precision BioSciences, Acerta and Adicet Bio: Research Funding; Kite, a Gilead Company, Merck, Bristol Myers Squibb, Novartis, Celgene, Pfizer, Allogene Therapeutics, Cell Medica/Kuur, Incyte, Precision Biosciences, Legend Biotech, Adicet Bio, Calibr, Unum Therapeutics and Bluebird Bio: Honoraria; Kite, a Gilead Company, Merck, Bristol Myers Squibb, Novartis, Celgene, Pfizer, Allogene, Kuur, Incyte, Precision BioSciences, Legend, Adicet Bio, Calibr, and Unum Therapeutics: Other: personal fees. Lin: Novartis: Consultancy; Bluebird Bio: Consultancy, Research Funding; Juno: Consultancy; Kite, a Gilead Company: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Gamida Cell: Consultancy; Sorrento: Consultancy; Legend: Consultancy; Takeda: Research Funding; Merck: Research Funding; Vineti: Consultancy. Strati: Astrazeneca-Acerta: Research Funding; Roche-Genentech: Consultancy.
Mutational Landscape of MDS Patients with HMA Failure Revealed By the Correlative Analysis from Inspire Trial
Luger, Selina M. , Al‐Kali, Aref , Warlick, Erica D. , Keng, Michael , Furudate, Ken , Zbyszewski, Patrick S., Parris, Matthew, Fruchtman, Steven, Garcia‐Manero, Guillermo , Takahashi, Koichi , Jonasova, Anna T , Valcárcel, David , Díez‐Campelo, María , Wang, Feng

Blood | November 23, 2021 | Volume: 138 | Issue: Supplement 1 | Pages: 1517-1517

10.1182/blood-2021-152048 Get It

Abstract Background: Hypomethylating agents (HMA) are well established standard of care for patients (pts) with higher-risk MDS (HR-MDS). However, approximately half of the pts do not respond to HMA therapy and most of the responders eventually lose response (HMA failure). There is no standard of care for pts after HMA failure and median overall survival (OS) post HMA failure is around 6 months (Jabbour et al. 2015). While the mutational landscapes and their role in prognosis are increasingly becoming apparent in pts with HR-MDS at diagnosis, mutational profiles at the time of HMA failure and their impact on clinical outcomes are not well understood. Here, using samples collected from a global Phase 3 trial randomizing HR-MDS pts post HMA failure to I.V. rigosertib (RGS) or physician's choice (PC) (INSPIRE: NCT02562443), we analyzed the landscape of driver mutations in HR-MDS after HMA failure and investigated the association with the clinical outcomes. Since RGS is a non-ATP-competitive small molecule RAS mimetic (Athuluri-Divakar 2016), the study also offered an opportunity to test the hypothesis whether HR-MDS pts with oncogenic RAS pathway mutations benefit from RGS. Methods: HR-MDS pts after HMA failure were randomized 2:1 to RGS or PC. All pts failed to respond to or progressed on prior HMA therapy. Bone marrow samples or peripheral blood samples were collected at the time of trial screening. Genomic DNA was sequenced by the targeted capture deep sequencing of 295 genes (median 500x). Results: 372 pts were enrolled in INSPIRE trial (248 to RGS and 124 to PC). The median age of the trial participants was 73 (range: 40-85). All pts were previously treated and with an HMA with the median duration of prior HMA therapy of 6.7 months. 64% and 28% of the pts were classified as IPSS-R very high risk or high risk, respectively, at the time of randomization. Among the 372 participants, DNA sequencing of pre-treatment samples was performed in 188 pts (51% of the participants, N = 122 in RGS arm, N = 66 in PC arm). The most frequently identified driver mutations involved ASXL1 (36%) followed by RUNX1 (24%), TET2 (23%), STAG2 (22%) and TP53 (21%). Mutations in splicing pathway genes were found in 36% of the pts. Oncogenic RAS pathway mutations were detected in 15% of the pts (NRAS = 3 %, KRAS = 2%, CBL = 4%, NF1 = 5%, PTPN11 = 3%, and 1% had multi-hit mutations). Compared to the previously untreated MDS pts (N = 446, Papaemmanuil et al. Blood 2013), mutations in ASXL1 (36% vs. 18%, P < 0.0001), BCOR (9% vs. 3%, P = 0.002), CEBPA (4% vs. 0.2%, P = 0.001), NF1 (5% vs. 0.9%, P = 0.003), RUNX1 (25% vs. 11%, P < 0.0001), STAG2 (22% vs. 5%, P < 0.0001), TP53 (21% vs. 6%, P < 0.0001), and IDH1/2 (13% vs. 7%, P =0.016) were significantly more enriched in pts with HMA failure, whereas mutations in SF3B1 (7% vs. 37%, P < 0.0001), TET2 (23% vs. 35%, P = 0.006), and splicing pathway genes (36% vs. 68%, P < 0.0001) were significantly less frequent in HMA failure pts. These results are consistent with the high-risk profiles of HMA failure pts. Frequency of oncogenic RAS pathway mutations were similar between HMA failure and previously untreated MDS pts (15% vs. 13%, P = 0.612). Correlation analysis between the types of HMA failure and gene mutations showed that TP53 mutations were significantly enriched in pts who relapsed after initial response to HMA (P = 0.001), whereas oncogenic RAS pathway mutations were significantly enriched in pts who progressed during the HMA therapy (P = 0.03). Overall, RGS did not significantly improve the overall survival (OS) of HMA failure pts compared to PC. Survival difference between RGS arm and PC arm was not observed in any subgroups stratified by the gene mutations. The only subgroup that showed improved OS with RGS compared to PC was pts with RAEB-t (median OS 7.5 vs. 3.9 months, P = 0.049). Of note, among pts with oncogenic RAS pathway mutations, no survival difference was observed between RGS and PC arms. Conclusion: High-risk gene mutations, such as TP53, ASXL1, RUNX1, and STAG2 (Ogawa. Blood 2019). were significantly enriched in MDS pts with HMA failure, suggesting their role in HMA resistance and disease progression. Identifying the mutations present de novo and with HMA failure offers the opportunity to determine prognosis based on these mutations as well as potential strategies to target these mutations with new medical entities. Disclosures Takahashi: GSK: Consultancy; Celgene/BMS: Consultancy; Novartis: Consultancy; Symbio Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees. Luger: Syros: Honoraria; Agios: Honoraria; Daiichi Sankyo: Honoraria; Jazz Pharmaceuticals: Honoraria; Brystol Myers Squibb: Honoraria; Acceleron: Honoraria; Astellas: Honoraria; Pfizer: Honoraria; Onconova: Research Funding; Celgene: Research Funding; Biosight: Research Funding; Hoffman LaRoche: Research Funding; Kura: Research Funding. Al-Kali: Novartis: Research Funding; Astex: Other: Research support to institution. Diez-Campelo: BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Takeda Oncology: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. OffLabel Disclosure: Rigosertib for MDS patients after HMA failure
ALK-positive histiocytosis: a new clinicopathologic spectrum highlighting neurologic involvement and responses to ALK inhibition
Kemps, Paul G. , Picarsic, Jennifer , Durham, Benjamin H. , Hélias‐Rodzewicz, Zofia , Hiemcke‐Jiwa, Laura S. , Bos, Cor van den , Noesel, Carel J.M. van , Laar, Jan van , Verdijk, Robert M. , Flucke, Uta , Hogendoorn, Pancras C.W. , Woei-A-Jin, Feng Jung Sherida H. , Beilken, Andreas , Ebinger, Martin , Möhle, Robert, Bornemann, Antje, Wiegering, Verena , Ernestus, Karen, Méry, Tina, Gryniewicz–Kwiatkowska, Olga , Evseev, D. A. , Gaspari, Stefania , Gessi, Marco , Tamburrini, Gianpiero , Héritier, Sébastien , Bonneau‐Lagacherie, Jacinthe, Lamaison, Claire, Farnault, Laure , Fraitag, Sylvie , Jullié, Marie‐Laure , Haroche, Julien , Allotey, Jackie, Madni, Majid, Turner, Kerry , Picton, Susan, Barbaro, Pasquale , Poulin, Alysa, Tam, Ingrid S. , Empringham, Brianna , Whitlock, James A. , Swanson, Amy A. , Suchi, Mariko, Brandt, Jon M., Yaseen, Nabeel R. , Weinstein, Joanna , Eldem, İrem , Sisk, Bryan A. , Sridhar, Vaishnavi , Atkinson, Mandy, Massoth, Lucas R. , Alexandrescu, Sanda , Yeo, Kee Kiat , Petrova‐Drus, Kseniya , Peeke, Stephen , Muñoz-Arcos, Laura , Leino, Daniel , Grier, David D. , Lorsbach, Robert B., Kumar, Ashish R. , Garg, Shipra , Tiwari, Nishant , Schafernak, Kristian T. , Henry, M M , Halteren, Astrid G. S. van , Abla, Oussama , Kumar, Ashish , Hiemcke-Jiwa, Laura , van den Bos, Cor , van Noesel, Carel J M , van Laar, Jan A M , Verdijk, Robert M , Flucke, Uta E , Hogendoorn, Pancras C W , Woei-A-Jin, F J Sherida H , Sciot, Raf , Beilken, Andreas , Feuerhake, Friedrich , Ebinger, Martin , Fend, Falko , Wiegering, Verena , Gryniewicz-Kwiatkowska, Olga , Dembowska-Baginska, Bozenna , Evseev, Dmitry A , Potapenko, Vsevolod , Baykov, Vadim V , Gaspari, Stefania , Rossi, Sabrina , Gessi, Marco , Tamburrini, Gianpiero , Héritier, Sébastien , Donadieu, Jean , Farnault, Laure , Fraitag, Sylvie , Jullié, Marie-Laure , Collin, Matthew , Turner, Kerry , Barbaro, Pasquale M , Tam, Ingrid S , El Demellawy, Dina , Empringham, Brianna , Raghunathan, Aditya , Suchi, Mariko , Weinstein, Joanna L , Eldem, Irem , Sisk, Bryan A , Massoth, Lucas R , Hornick, Jason L , Alexandrescu, Sanda , Yeo, Kee Kiat , Petrova-Drus, Kseniya , Peeke, Stephen Z , Muñoz-Arcos, Laura S , Leino, Daniel G , Grier, David D , Roy, Somak , Kumar, Ashish R , Henry, Michael M , van Halteren, Astrid G S , Abla, Oussama , Diamond, Eli L , Emile, Jean-François , Picarsic, Jennifer L , Schafernak, Kristian , Durham, Benjamin , Wetering, Marianne D. van de , Sciot, Raf , Rossi, Sabrina , Collin, Matthew , Raghunathan, Aditya , Hornick, Jason L. , Diamond, Eli L. , Emile, Jean‐François

Blood | November 2, 2021 | Volume: 139 | Issue: 2 | Pages: 256-280

10.1182/blood.2021013338 | PMID 34727172 Get It

Abstract ALK-positive histiocytosis is a rare subtype of histiocytic neoplasm first described in 2008 in 3 infants with multisystemic disease involving the liver and hematopoietic system. This entity has subsequently been documented in case reports and series to occupy a wider clinicopathologic spectrum with recurrent KIF5B-ALK fusions. The full clinicopathologic and molecular spectra of ALK-positive histiocytosis remain, however, poorly characterized. Here, we describe the largest study of ALK-positive histiocytosis to date, with detailed clinicopathologic data of 39 cases, including 37 cases with confirmed ALK rearrangements. The clinical spectrum comprised distinct clinical phenotypic groups: infants with multisystemic disease with liver and hematopoietic involvement, as originally described (Group 1A: 6/39), other patients with multisystemic disease (Group 1B: 10/39), and patients with single-system disease (Group 2: 23/39). Nineteen patients of the entire cohort (49%) had neurologic involvement (7 and 12 from Groups 1B and 2, respectively). Histology included classic xanthogranuloma features in almost one-third of cases, whereas the majority displayed a more densely cellular, monomorphic appearance without lipidized histiocytes but sometimes more spindled or epithelioid morphology. Neoplastic histiocytes were positive for macrophage markers and often conferred strong expression of phosphorylated extracellular signal-regulated kinase, confirming MAPK pathway activation. KIF5B-ALK fusions were detected in 27 patients, whereas CLTC-ALK, TPM3-ALK, TFG-ALK, EML4-ALK, and DCTN1-ALK fusions were identified in single cases. Robust and durable responses were observed in 11/11 patients treated with ALK inhibition, 10 with neurologic involvement. This study presents the existing clinicopathologic and molecular landscape of ALK-positive histiocytosis and provides guidance for the clinical management of this emerging histiocytic entity.
EBV+ high‐grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements: a multi‐institutional study
Liu, Hui , Wang, Wei , Kim, Young , Ji, Yuan , Chen, Weina , Fedoriw, George Y, Zhu, Feng , Luedke, Catherine, Hu, Shimin , Hu, Shimin , Yuan, Ji , Xu‐Monette, Zijun Y. , Tang, Guilin , Li, Yu , Li, Yanping , Fang, Xiaosheng , Medeiros, L. Jeffrey , Young, Ken H.

Histopathology | October 13, 2021 | Volume: 80 | Issue: 3 | Pages: 575-588

10.1111/his.14585 | PMID 34637146 Get It

AimsIt is unknown whether Epstein–Barr virus (EBV) infection can occur in high‐grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, also known as double‐ or triple‐hit lymphoma (DHL/THL).Methods and resultsHere we report 16 cases of EBV+ DHL/THL from screening 846 cases of DHL/THL and obtaining additional EBV+ cases through multi‐institutional collaboration: eight MYC and BCL2 DHL, six MYC and BCL6 DHL and two THL. There were eight men and eight women, with a median age of 65 years (range = 32–86). Two patients had a history of follicular lymphoma and one had AIDS. Nine of 14 patients had an International Prognostic Index of ≥3. Half of the cases showed high‐grade/Burkitt‐like morphology and the other half diffuse large B cell lymphoma morphology. Using immunohistochemistry, the lymphoma cells were positive for MYC (n = 14 of 16), BCL2 (n = 12 of 16), BCL6 (n = 14 of 16), CD10 (n = 13 of 16) and MUM1 (n = six of 14). Using Hans’ algorithm, 13 cases were classified as germinal centre B cell (GCB) and three as non‐GCB. The lymphomas frequently showed an EBV latency Type I with a median EBV‐encoded small RNAs of 80% positive cells (range = 20–100%). After a median follow‐up of 36.3 months (range = 2.0–41.6), seven patients died, with a median survival of 15.4 months (range = 3.4–47.3) after diagnosis of EBV+ DHL/THL. Five of six patients with MYC and BCL6 DHL were alive, including four in complete remission. In contrast, only four of 10 patients with MYC and BCL2 DHL or THL were alive, including two in complete remission. The median survival in patients with MYC and BCL6 DHL was unreached and was 21.6 months in patients with MYC and BCL2 DHL or THL.ConclusionsEBV infection in DHL/THL is rare (~1.5%). Cases of EBV+ DHL/THL are largely similar to their EBV– counterparts clinicopathologically. Our findings expand the spectrum of EBV+ B cell lymphomas currently recognised in the World Health Organisation classification and suggest differences between EBV+ MYC and BCL2 DHL versus EBV+MYC and BCL6 DHL that may have therapeutic implications.
Generalized methodology for radiomic feature selection and modeling in predicting clinical outcomes
Yang, Jing , Xu, Lei , Wan, Yidong , Yen, Eric, Chen, Feng , Lu, Zhongjie, Rong, Yi , Niu, Tianye , Rong, Yi , Niu, Tianye , Yang, Pengfei , Luo, Chen , Lu, Yun He

Physics in Medicine & Biology | October 11, 2021 | Volume: 66 | Issue: 21 | Pages: 215005

10.1088/1361-6560/ac2ea5 | PMID 34633308 Get It

Abstract Background. Quantitative radiomic features of medical images could provide clinical significance in assisting decision-making, but the existing feature selection and modeling methods are usually parameter-dependent. We aim to develop and validate a generalized radiomic method applicable to a variety of clinical outcomes. Methods and materials. A generalized methodology for radiomic feature selection and modeling (‘GRFM’ for short), including two-step feature selection and logistic regression, was proposed for studying clinical outcomes correlations. The two-step feature selection consists of Pearson correlation analysis followed by a sequential forward floating selection algorithm to identify robust feature subsets. We also applied an adaptive searching strategy to systematically determine globally optimal parameters, rather than relying on preset parameters. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of three outcomes: lymph node metastasis of gastric cancer (GC), the five-year survival status of high-grade osteosarcoma (HOS), and the pathological grade of pancreatic neuroendocrine tumors (pNETs). Results. The optimal Pearson thresholds were 0.85, 0.80 and 0.75, and the optimal feature numbers were 11, 14 and 8 in GC, HOS and pNETs, respectively. The AUC values of the three predictive models combined with the corresponding parameters were 0.9017 versus 0.9026, 0.7652 versus 0.7113, and 0.8438 versus 0.8212 for the training and validation cohorts, showing promissing generality and classifier performance . Conclusion. The proposed method was helpful in predicting different clinical outcomes, and has potential application as a general and noninvasive prediction tool to guide clinical decision-making in various cancer sites.
Risk of hypertension in erenumab‐treated patients with migraine: Analyses of clinical trial and postmarketing data
Dodick, David W. , Tepper, Stewart J. , Pannacciulli, Nicola, Navetta, Marco S., Loop, Brett, Zhang, Feng , Khodavirdi, Ani C., Mann, Allison, Abdrabboh, Ahmad, Kalim, Jawed, Dodick, David W , Ailani, Jessica

Headache: The Journal of Head and Face Pain | September 30, 2021 | Volume: 61 | Issue: 9 | Pages: 1411-1420

10.1111/head.14208 | PMID 34591982 Get It

Abstract Objective To assess the risk of hypertension in patients with migraine who received erenumab in clinical trials and in the postmarketing setting. Background Erenumab is a monoclonal antibody for migraine prevention that targets the calcitonin gene‐related peptide (CGRP) receptor. Hypertension is a theoretical risk for inhibitors of the CGRP pathway. Although no evidence of an association between erenumab treatment and hypertension was observed during the clinical development program, adverse events (AEs) of hypertension have been identified in the postmarketing setting. Methods Safety data from four phase 2 and phase 3 clinical trials were used to perform a pooled analysis of hypertension AEs in patients with migraine receiving erenumab. Postmarketing AEs of hypertension were identified from the Amgen Global Safety database from May 17, 2018, through January 31, 2020. Results In the pooled analysis of clinical trials, hypertension AEs (placebo, 9/1043 [0.9%]; erenumab 70 mg, 7/893 [0.8%]; erenumab 140 mg, 1/507 [0.2%]) and percentage of patients initiating medication to treat hypertension (12/1043 [1.2%], 7/893 [0.8%], 1/507 [0.2%], respectively) were similar across treatment groups. A total of 362 AEs of hypertension were identified from the postmarketing setting, 26.2% (95/362) of which were serious, >245,000 patient‐years of exposure. The exposure‐adjusted incidence of hypertension was 0.144 per 100 patient‐years. Conclusions Clinical trials did not demonstrate an increased risk of hypertension with erenumab compared with placebo, and AE rates of hypertension reported with erenumab in the postmarketing setting were generally low. Additional data are needed to fully characterize the extent to which hypertension is a risk associated with erenumab.
Comparison of the real‐world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug‐resistant epilepsy: A post hoc analysis of the HOPS study
Fallah, Aria , Lewis, Evan , Ibrahim, George M. , Tseng, Chi‐Hong , Harris, William B., Chen, Jia‐Shu , Lin, Kao‐Min, Cai, Lixin , Liu, Qingzhu , Lin, Jiuluan , Mathern, Gary W. , Smyth, Matthew D. , O’Neill, Brent R., Dudley, Roy , Ragheb, John , Bhatia, Sanjiv, Delev, Daniel , Ramantani, Georgia , Zentner, Josef , Dorfer, Christian , Feucht, Martha , Czech, Thomas , Bollo, Robert J. , Issabekov, Galymzhan , Zhu, Hongwei , Connolly, Mary , Steinbok, Paul , Zhang, Kai , Weiner, Howard L. , Lapalme‐Remis, Samuel , Tripathi, Manjari , Chandra, P. Sarat , Hader, Walter , Wang, Feng‐Peng , Champagne, Pierre‐Olivier , Brunette‐Clément, Tristan , Budke, Marcelo , Pérez-Jiménez, María Ángeles, Raftopoulos, Christian , Finet, Patrice, Michel, Pauline, Schaller, Karl , Malone, Christian Cantillano, Pociecha, Juan , Chamorro, Noelia, Muro, Valeria L., Lehe, Marec von , Vieker, Silvia, Oluigbo, Chima , Gaillard, William D. , Al‐Khateeb, Mashael, Alotaibi, Faisal , Krayenbühl, Niklaus , Bolton, Jeffrey , Weil, Alexander G. , Cai, Li-Xin , Ramantani, Georgia , Dorfer, Christian , Feucht, Martha , Wong-Kisiel, Lily, Tripathi, Manjari , Sarat Chandra, Poodipedi , von Lehe, Marec , Gaillard, William D , Weil, Alexander G , Fallah, Aria , Chen, Jia-Shu , Oluigbo, Chima O , Kola, Olivia , Zhou, Wen-Jing , Wang, Anthony , Zhang, Jianguo , Hidalgo, Eveline Teresa , Wong‐Kisiel, Lily C. , Wang, Feng‐Peng, Yao, Yi , Guo, Qiang , Li, Shao‐Chun, Stienen, Martin Nikolaus , Baro, Valentina , Pearl, Phillip L.

Epilepsia | September 12, 2021 | Volume: 62 | Issue: 11 | Pages: 2707-2718

10.1111/epi.17021 | PMID 34510448 Get It

AbstractObjectiveThis study was undertaken to determine whether the vertical parasagittal approach or the lateral peri‐insular/peri‐Sylvian approach to hemispheric surgery is the superior technique in achieving long‐term seizure freedom.MethodsWe conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri‐insular/peri‐Sylvian, or lateral trans‐Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time‐to‐event method and calculated using the Kaplan–Meier survival method.ResultsData for 672 participants across 23 centers were collected on the specific hemispherotomy approach. Of these, 72 (10.7%) underwent vertical parasagittal hemispherotomy and 600 (89.3%) underwent lateral peri‐insular/peri‐Sylvian or trans‐Sylvian hemispherotomy. Seizure freedom was obtained in 62.4% (95% confidence interval [CI] = 53.5%–70.2%) of the entire cohort at 10‐year follow‐up. Seizure freedom was 88.8% (95% CI = 78.9%–94.3%) at 1‐year follow‐up and persisted at 85.5% (95% CI = 74.7%–92.0%) across 5‐ and 10‐year follow‐up in the vertical subgroup. In contrast, seizure freedom decreased from 89.2% (95% CI = 86.3%–91.5%) at 1‐year to 72.1% (95% CI = 66.9%–76.7%) at 5‐year to 57.2% (95% CI = 46.6%–66.4%) at 10‐year follow‐up for the lateral subgroup. Log‐rank test found that vertical hemispherotomy was associated with durable seizure‐free progression compared to the lateral approach (p = .01). Patients undergoing the lateral hemispherotomy technique had a shorter time‐to‐seizure recurrence (hazard ratio = 2.56, 95% CI = 1.08–6.04, p = .03) and increased seizure recurrence odds (odds ratio = 3.67, 95% CI = 1.05–12.86, p = .04) compared to those undergoing the vertical hemispherotomy technique.SignificanceThis pilot study demonstrated more durable seizure freedom of the vertical technique compared to lateral hemispherotomy techniques. Further studies, such as prospective expertise‐based observational studies or a randomized clinical trial, are required to determine whether a vertical approach to hemispheric surgery provides superior long‐term seizure outcomes.
Reduction in migraine pain intensity in patients treated with erenumab: A post hoc analysis of two pivotal randomized studies
Kudrow, David, Reuter, Uwe , Tenenbaum, Nadia, Lima, Gabriel Paiva da Silva , Chou, Denise E. , Mikol, Daniel D., Reuter, Uwe , Lima, Gabriel Paiva da Silva , Lipton, Richard B. , Dodick, David W. , Zhang, Feng

Cephalalgia | August 19, 2021 | Volume: 41 | Issue: 14 | Pages: 1458-1466

10.1177/03331024211028966 | PMID 34407654 Get It

Background Erenumab (erenumab-aooe in the US) effectively reduces monthly migraine days in episodic and chronic migraine. This traditional outcome does not capture the intensity of headache pain on days with migraine. Methods This post hoc analysis of two pivotal randomized, placebo-controlled studies in patients with episodic migraine and chronic migraine examined the effect of erenumab 70 and 140 mg on migraine pain. Cumulative monthly migraine pain intensity is the sum of the peak pain intensity scores (0 = no migraine to 3 = migraine day with severe pain) on migraine days. Change from baseline in cumulative monthly migraine pain and average monthly pain intensity was assessed over months 4 to 6 for episodic migraine and month 3 for chronic migraine; change in average monthly pain intensity was assessed among monthly migraine days responders/non-responders. Results Efficacy analysis included 946 patients for the episodic migraine study and 656 patients for the chronic migraine study. Cumulative monthly migraine pain decreased significantly with erenumab versus placebo ( p < 0.001, for episodic migraine and chronic migraine). In addition, monthly average migraine pain intensity decreased significantly with erenumab versus placebo for episodic migraine ( p < 0.01); decreases were non-significant for chronic migraine. In comparison with placebo-treated patients, a greater proportion of erenumab-treated patients were pain intensity responders regardless of threshold used. Episodic migraine and chronic migraine patients with a ≥50% reduction in monthly migraine days (responders) had a greater reduction in monthly average pain intensity than non-responders. Conclusions Erenumab reduced cumulative monthly migraine pain in episodic migraine and chronic migraine patients and significantly reduced monthly average migraine pain in episodic migraine, demonstrating treatment benefit beyond reduction in migraine frequency. Clinical Trial Registration: ClinicalTrials.gov, NCT02456740; ClinicalTrials.gov, NCT02066415
Small Airway Reduction and Fibrosis Is an Early Pathologic Feature of Idiopathic Pulmonary Fibrosis
Ikezoe, Kohei , Peterson, S. , Prins, D. A., Hague, Cameron , Murphy, Darra , Ledoux, Stacey, Chu, Fanny, Xu, Feng , Cooper, Joel D. , Tanabe, Naoya , Ryerson, Christopher J. , Paré, Peter D., Coxson, Harvey O. , Colby, Thomas V. , Hogg, James C. , Vasilescu, Dragoş M. , Tanabe, Naoya , Vasilescu, Dragoş M , Hackett, Tillie‐Louise , Prins, Dante

American Journal of Respiratory and Critical Care Medicine | August 3, 2021 | Volume: 204 | Issue: 9 | Pages: 1048-1059

10.1164/rccm.202103-0585oc | PMID 34343057 Get It

Abstract Rationale To improve disease outcomes in idiopathic pulmonary fibrosis (IPF), it is essential to understand its early pathophysiology so that it can be targeted therapeutically. Objectives Perform three-dimensional assessment of the IPF lung microstructure using stereology and multiresolution computed tomography (CT) imaging. Methods Explanted lungs from patients with IPF (n = 8) and donor control subjects (n = 8) were inflated with air and frozen. CT scans were used to assess large airways. Unbiased, systematic uniform random samples (n = 8/lung) were scanned with microCT for stereological assessment of small airways (count number, and measure airway wall and lumen area) and parenchymal fibrosis (volume fraction of tissue, alveolar surface area, and septal wall thickness). Measurements and Main Results The total number of airways on clinical CT was greater in IPF lungs than control lungs (P &lt; 0.01), owing to an increase in the wall (P &lt; 0.05) and lumen area (P &lt; 0.05) resulting in more visible airways with a lumen larger than 2 mm. In IPF tissue samples without microscopic fibrosis, assessed by the volume fraction of tissue using microCT, there was a reduction in the number of the terminal (P &lt; 0.01) and transitional (P &lt; 0.001) bronchioles, and an increase in terminal bronchiole wall area (P &lt; 0.001) compared with control lungs. In IPF tissue samples with microscopic parenchymal fibrosis, terminal bronchioles had increased airway wall thickness (P &lt; 0.05) and dilated airway lumens (P &lt; 0.001) leading to honeycomb cyst formations. Conclusions This study has important implications for the current thinking on how the lung tissue is remodeled in IPF and highlights small airways as a potential target to modify IPF outcomes.
Cf‐02, a novel benzamide‐linked small molecule, blunts NF‐κB activation and NLRP3 inflammasome assembly and improves acute onset of accelerated and severe lupus nephritis in mice
Yang, Shin‐Ruen , Yang, Chih‐Yu , Chen, Ann , Weng, Jui‐Chun, Wan, Chih‐Jun, Wu, Chung‐Yao, Lee, Chia‐Chung, Chan, Jia‐Feng, Hsu, Yu‐Juei , Wu, Chia‐Chao , Huang, Hsu‐Shan , Liu, Feng‐Cheng , Ka, Shuk‐Man , Chen, Ann , Huang, Hsu-Shan , Liu, Feng-Cheng , Ka, Shuk-Man , Hua, Kuo‐Feng , Weng, Jui‐Chun, Tsai, Yu‐Ling , Wu, Chung-Yao, Hsieh, Chih‐Yu , Mukhopadhyay, Debabrata

The FASEB Journal | July 27, 2021 | Volume: 35 | Issue: 8 | Pages: No page available

10.1096/fj.202100047r | PMID 34314075 Get It

Abstract In the present study, acute onset of severe lupus nephritis was successfully treated in mice using a new, benzamide‐linked, small molecule that targets immune modulation and the NLRP3 inflammasome. Specifically, 6‐(2,4‐difluorophenyl)‐3‐(3‐(trifluoromethyl)phenyl)‐2H‐benzo[e][1,3]oxazine‐2,4(3H)‐dione (Cf‐02) (a) reduced serum levels of IgG anti‐dsDNA, IL‐1β, IL‐6, and TNF‐α, (b) inhibited activation of dendritic cells and differentially regulated T cell functions, and (c) suppressed the NF‐κB/NLRP3 inflammasome axis, targeting priming and activating signals of the inflammasome. Moreover, treatment with Cf‐02 significantly inhibited secretion of IL‐1β in lipopolysaccharide‐stimulated macrophages, but this effect was abolished by autophagy induction. These results recommend Cf‐02 as a promising drug candidate for the serious renal conditions associated with systemic lupus erythematosus. Future investigations should examine whether Cf‐02 may also be therapeutic in other types of chronic kidney disease involving NLRP3 inflammasome‐driven signaling.