scholarly journals 1082. Real-World Experience with Omadacycline for Nontuberculous Mycobacterial Infections: A Multicenter Evaluation

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S632-S633
Author(s):  
Taylor Morrisette ◽  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
Julie V Philley ◽  
Carly Sigler ◽  
...  
Keyword(s):  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Success ◽  
Panel Member ◽  
Mycobacterium Abscessus ◽  
Primary Objective ◽  
Real World Evidence ◽  
Gastrointestinal Distress ◽  
Research Grant

Abstract Background Nontuberculous mycobacteria (NTM) are resistant to numerous antibiotics and lead to significant morbidity and mortality. Omadacycline (OMC) is an aminomethylcycline antibiotic that is Food and Drug Administration-approved for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. Furthermore, OMC has shown in vitro activity against NTM. Given that real-world evidence is lacking, our primary objective was to evaluate the clinical success and tolerability of OMC when used for a variety of NTM infections. Methods This was a multicenter, retrospective, observational study conducted from January 2020 to June 2021. We included all patients ≥ 18 years of age that received OMC of any indication for Mycobacterium spp. The primary outcome was clinical success, defined as a lack of all-cause mortality, lack of persistence or re-emergence of infection during or after therapy, and lack of alteration of OMC. Incidence of adverse effects potentially attributable to OMC and reasons for OMC utilization were also analyzed. Results A total of 31 patients were included from 12 geographically distinct academic health systems (median age: 57 (IQR, 45-63) years; 45% male; 81% Caucasian). The majority of isolated pathogens were Mycobacterium abscessus complex (84%) and of those with subspeciation performed (54%), the majority (86%) were subsp. abscessus. The primary infections were of pulmonary origin (67%) and the median (IQR) duration of OMC therapy was 5.3 (3.2-9.4) months. Most isolates did not have OMC susceptibility conducted (87%), while the majority did for tigecycline (90%). Clinical success was reported in 81% of the population. Most patients were on combination antimicrobial therapy, and 39% of patients reported an adverse effect while on OMC (58% gastrointestinal distress). The majority of patients were prescribed OMC due to ease of administration (61%) and antimicrobial resistance to previous antibiotics (42%). Conclusion OMC may be a potential option for the therapy of NTM infections. Prospective, randomized clinical trials are needed to confirm our preliminary findings. Disclosures Julie V. Philley, MD, Paratek Pharmaceuticals (Advisor or Review Panel member)Paratek Pharmaceuticals, Inc. (Consultant) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support) Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)

scholarly journals 1290. Real-World Experience with Omadacycline for Nontuberculous Mycobacterial and Gram-Negative Infections: A Multicenter Evaluation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S660-S660
Author(s):  
Taylor Morrisette ◽  
Julie V Philley ◽  
Carly Sigler ◽  
Jeremy J Frens ◽  
Andrew J Webb ◽  
...  
Keyword(s):  
Real World ◽  
Primary Outcome ◽  
Clinical Success ◽  
Outpatient Setting ◽  
Mycobacterium Abscessus ◽  
Oral Agent ◽  
Gram Negative ◽  
Gastrointestinal Distress ◽  
Gram Negative Organisms

Abstract Background Omadacycline (OMC) is an aminomethylcycline antibiotic in the tetracycline class that has been Food and Drug Administration-approved for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. OMC has been shown to have potent in vitro activity against a broad-spectrum of Gram-positive and Gram-negative organisms, as well as Nontuberculous Mycobacteria (NTM). Due to it’s unique activity and availability as an oral agent, off-label use of OMC has been increasing. We evaluated the real-world effectiveness and safety of OMC for a variety of infections. Methods This was a multicenter, retrospective, observational study that was conducted from January 2020 to June 2020. We included all patients ≥ 18 years of age that received OMC for ≥ 72 hours for any indication and/or pathogen. The primary outcome was clinical success, defined as a lack of 30-day (non-NTM) or 90-day (NTM) mortality or microbiologic recurrence and absence of therapy escalation or alteration. Reasons for OMC utilization and incidence of potential adverse effects attributable to OMC were also analyzed. Results A total of 18 patients were included from six geographically distinct academic health systems (median age: 56 (IQR, 49-60.5) years; 61% male; 72% Caucasian). The majority of OMC use was in NTM (61%; 100% Mycobacterium abscessus) and in Acinetobacter baumannii (22%) for bone/joint (39%) and respiratory tract (33%) infections. OMC was used primarily in the outpatient setting alone (83%) and most isolates did not have OMC susceptibility conducted (89%). Clinical success was reported in 83% of the total population (71% non-NTM and 91% NTM). The majority of patients were prescribed OMC due to antimicrobial resistance to previous antibiotic(s) (61%) and/or due to OMC’s availability as an oral agent (44%). Three patients experienced side effects while on therapy (serum creatinine elevation, AST/ALT increase, and gastrointestinal distress). Conclusion OMC appears to be effective and well-tolerated for a variety of infections caused by various pathogens, including M. abscessus and A. baumannii. Disclosures Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)

scholarly journals Monoclonal Antibodies Targeting CGRP: From Clinical Studies to Real-World Evidence—What Do We Know So Far?

2021 ◽  
Vol 14 (7) ◽  
pp. 700
Author(s):  
Theodoros Mavridis ◽  
Christina I. Deligianni ◽  
Georgios Karagiorgis ◽  
Ariadne Daponte ◽  
Marianthi Breza ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Real World ◽  
Large Scale ◽  
Randomized Clinical Trials ◽  
Clinical Investigation ◽  
Phase Iii ◽  
Real World Evidence ◽  
Symptomatic Management ◽  
Repurposed Drugs ◽  
Cephalic Pain

Now more than ever is the time of monoclonal antibody use in neurology. In headaches, disease-specific and mechanism-based treatments existed only for symptomatic management of migraines (i.e., triptans), while the standard prophylactic anti-migraine treatments consist of non-specific and repurposed drugs that share limited safety profiles and high risk for interactions with other medications, resulting in rundown adherence rates. Recent advances in headache science have increased our understanding of the role of calcitonin gene relate peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP) pathways in cephalic pain neurotransmission and peripheral or central sensitization, leading to the development of monoclonal antibodies (mAbs) or small molecules targeting these neuropeptides or their receptors. Large scale randomized clinical trials confirmed that inhibition of the CGRP system attenuates migraine, while the PACAP mediated nociception is still under scientific and clinical investigation. In this review, we provide the latest clinical evidence for the use of anti-CGRP in migraine prevention with emphasis on efficacy and safety outcomes from Phase III and real-world studies.

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals 1323. Substantial Doses of Daptomycin and Rifampin Eradicate S. epidermidis Biofilm in an In Vitro Pharmacodynamic (IVPD) Model

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S672-S673
Author(s):  
Emily C Piehl ◽  
Kathryn E Daffinee ◽  
Kerry LaPlante
Keyword(s):  
Limit Of Detection ◽  
Growth Control ◽  
Panel Member ◽  
Biofilm Reactor ◽  
Reactor Model ◽  
Combination Model ◽  
Device Infection ◽  
Site Of Action ◽  
Research Grant

Abstract Background The concentration of antibiotics at the site of action needed to eradicate biofilm is currently unknown. Studies have previously suggested that bacteria in biofilms are 1000-fold more resistant to antibiotics than free-floating planktonic bacteria. We sought to describe concentrations of daptomycin alone and in combination with rifampin in relation to the pharmacodynamic exposures for biofilm eradication. Methods We utilized a methicillin-resistant high biofilm-forming S. epidermidis strain RP62a (ATCC® 35984) over a 48-hour in vitro PD biofilm model. The Centers for Disease Control (CDC) Biofilm Reactor model was used with chromium cobalt materials to simulate an orthopedic device infection. The reactor was inoculated and underwent a 24-hr growth phase and 16-hr conditioning phase to form biofilm on the chromium cobalt coupons, and then a 48-hr PK-PD phase was run. The daptomycin MIC for RP62a was 0.5 mg/L and the rifampin MIC was 0.015 mg/L. We modeled a growth control of the isolate alone, a 12 mg/kg regimen of daptomycin (fCmax: 14.7 mg/L, Ke 0.09), a daptomycin concentration of 1000 mg/L (2000x MIC), and a combination model of daptomycin 1000 mg/L with rifampin 15 mg/L (1000x MIC). Coupons with bacteria embedded in biofilm were sonicated, vortexed, and plated on Tryptic Soy Agar for colony counts read at 24 hrs. Bactericidal activity was defined as ≥ 3-log10 CFU/mL reduction from the initial inoculum. Results The simulated humanized dosing regimen of daptomycin 12 mg/kg (fAUC0-24/MIC: 204) was similar to the growth control model. Bactericidal kill was demonstrated at 24hr and 48hr in the daptomycin 1000 mg/L model (fAUC0-24/MIC: 20,248) but did not fall beneath the limit of detection. The daptomycin and rifampin combination model demonstrated bactericidal kill at 24hr and 48hr and went below the limit of detection. Conclusion This study demonstrated that significantly higher concentrations of antibiotics are needed at the site of action to eradicate biofilm than what maximum systemic dosing can provide. Identifying these concentrations provides a foundation for localized antibiotic therapy and further studies are needed to elucidate these concentrations for a variety of antibiotics and biofilm-forming organisms. Disclosures Kerry LaPlante, PharmD, Merck (Advisor or Review Panel member, Research Grant or Support)Ocean Spray Cranberries, Inc. (Research Grant or Support)Pfizer Pharmaceuticals (Research Grant or Support)Shionogi, Inc. (Research Grant or Support)

scholarly journals Targeting Glioblastoma Signaling and Metabolism with A Re-Purposed Brain-Penetrant Drug

2021 ◽  
Author(s):  
Junfeng Bi ◽  
Atif Khan ◽  
Jun Tang ◽  
Sihan Wu ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Drug Target ◽  
Randomized Clinical Trials ◽  
Tumor Regression ◽  
Standard Of Care ◽  
Egfr Signaling ◽  
Real World Evidence ◽  
Daunting Challenge

The highly lethal brain cancer glioblastoma (GBM) poses a daunting challenge because the blood-brain barrier renders potentially druggable amplified or mutated oncoproteins relatively inaccessible. Here, we identify SMPD1, an enzyme that regulates the conversion of sphingomyelin to ceramide and a critical regulator of plasma membrane structure and organization, as an actionable drug target in glioblastoma. We show that the safe and highly brain-penetrant antidepressant fluoxetine, potently inhibits SMPD1 activity, killing GBMs, in vitro and in patient-derived xenografts, through inhibition of EGFR signaling and via activation of lysosomal stress. Combining fluoxetine with the chemotherapeutic agent temozolomide, a standard of care for GBM patients, causes massive increases in GBM cell death, and complete and long-lived tumor regression in mice. Incorporation of real-world evidence from electronic medical records from insurance databases, reveals significantly increased survival in glioblastoma patients treated with fluoxetine, which was not seen in patients treated with other SSRI anti-depressants. These results nominate the repurposing of fluoxetine as a potentially safe and promising therapy for GBM patients and suggest prospective randomized clinical trials.

scholarly journals Outcomes of Hydroxychloroquine Treatment Among Hospitalized COVID-19 Patients in the United States- Real-World Evidence From a Federated Electronic Medical Record Network

2020 ◽  
Author(s):  
Shailendra Singh ◽  
Ahmad Khan ◽  
Monica Chowdhry ◽  
Arka Chatterjee
Keyword(s):  
Electronic Medical Records ◽  
Real World ◽  
Medical Records ◽  
Treatment Strategies ◽  
The United States ◽  
Matched Cohort ◽  
Real World Data ◽  
Real World Evidence ◽  
Clinical Data Analysis

On March 28, 2020, in response to the rapidly accelerating COVID-19 pandemic, U.S FDA issued emergency use authorization for hydroxychloroquine (HCQ) in hospitalized COVID-19 patients based on limited in-vitro and anecdotal clinical data. Analysis of the accumulated real-world data utilizing electronic medical records (EMR) could indicate HCQ therapy benefits as we await the results of clinical trials. However, any such analysis of retrospective observational data should account for variables such as demographics and comorbidities that could affect treatment strategies or outcomes. Therefore, we report the outcomes of HCQ treatment in a propensity-matched cohort of COVID-19 hospitalized patients. Our analysis of a large retrospective cohort of hospitalized COVID-19 patients treated with HCQ did not show benefits in mortality or the need for mechanical ventilation when compared to a matched cohort of patients who did not receive HCQ.

Real-world evidence of male breast cancer (BC) patients treated with palbociclib (PAL) in combination with endocrine therapy (ET).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1055-1055 ◽  
Author(s):  
Cynthia Huang Bartlett ◽  
Jack Mardekian ◽  
Michelle Yu-Kite ◽  
Matthew James Cotter ◽  
Sindy Kim ◽  
...  
Keyword(s):  
Real World ◽  
Randomized Clinical Trials ◽  
Treatment Guidelines ◽  
Healthcare Providers ◽  
First Line ◽  
Duration Of Treatment ◽  
Real World Data ◽  
The Real ◽  
Real World Evidence ◽  
Line Setting

1055 Background: The rarity of BC in men limits the feasibility of randomized clinical studies in this population. Treatment guidelines recommend that men with BC be treated similarly to postmenopausal women. PAL, a cyclin-dependent kinase 4/6 inhibitor, is used in men with metastatic BC (mBC) in real-world clinical practice, presenting an opportunity to utilize real-world evidence to enable healthcare providers to assess novel agents in this space. Methods: Two parallel approaches were taken. In the first approach, pharmacy and medical claims data from IQVIA Inc were retrospectively analyzed to describe the treatment patterns and duration of PAL + ET (aromatase inhibitor or fulvestrant) compared to ET in men with mBC. The second approach was a retrospective analysis of data derived from electronic health records in the Flatiron Health database to understand real-world clinical response to PAL + ET vs ET alone. Median duration of treatment (mDOT) was estimated by the Kaplan-Meier method. Results: Between Feb 2015 and Apr 2017, 12.9% (147/1139 [IQVIA dataset]) of men receiving treatment for mBC were prescribed PAL + ET for any line of therapy. The mDOT in the first-line setting was numerically longer in the PAL cohort (n=37) compared with the non-PAL cohort (n=214; 8.5 vs 4.3 mo, respectively). In particular, mDOT in the first-line setting was longer with PAL + letrozole (LET; n=26) than with LET alone (n=63; 9.4 vs 3.0 mo, respectively). In the Flatiron Health dataset between Feb 2015 and July 2017, the real-world maximum response rate in the PAL + ET cohort across all lines of therapy in the mBC setting (n=12) was 33.3% (2 complete responses [CR], 2 partial responses [PR]) vs 12.5% (0 CR, 1 PR) for the ET alone cohort (n=8). Conclusions: The real-world data sources used in this study support that men with mBC derive clinical benefit from the addition of PAL to ET. Given the challenges of conducting randomized clinical trials in men with mBC, noninterventional, real-world evidence data appear to be useful to delineate the benefit of such therapies in this setting. Funding: Pfizer.

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