Matching-adjusted indirect comparison of bleeding outcomes in severe haemophilia A: Comparing valoctocogene roxaparvovec gene therapy, emicizumab prophylaxis, and FVIII replacement prophylaxis

INTRODUCTION: Head-to-head evaluation of valoctocogene roxaparvovec, the first gene therapy approved for haemophilia A, with emicizumab is not available. Therefore, phase 3 trial data were indirectly compared. AIM: To compare bleeding rates in trials evaluating 6 × 1013  vg/kg valoctocogene roxaparvovec (GENEr8-1; NCT03370913), 1.5 mg/kg emicizumab dosed every week (HAVEN 3; NCT02847637), and FVIII prophylaxis (270-902) in participants with severe haemophilia A (FVIII ≤1 IU/dL). METHODS: Valoctocogene roxaparvovec versus emicizumab and FVIII prophylaxis as used in 270-902 versus emicizumab cross-trial comparisons were performed using matching-adjusted indirect comparison (MAIC). Individual participant data from GENEr8-1 and 270-902 were weighted to equalise aggregate participant baseline characteristics from HAVEN 3. After MAIC weighting, annualised bleeding rates (ABR) and proportions of participants without bleeds were compared for treated bleeds, all bleeds, treated joint bleeds, and treated spontaneous bleeds. RESULTS: After MAIC weighting, ABR for all bleeds was statistically significantly lower with valoctocogene roxaparvovec than emicizumab (rate ratio [95% CI], .55 [.33-.93]). Additionally, significantly higher proportions of participants had no treated joint bleeds (odds ratio [95% CI], 2.75 [1.20-6.31]) and no treated bleeds (3.25 [1.53-6.90]) with valoctocogene roxaparvovec versus emicizumab. When compared with the mainly standard half-life FVIII prophylaxis regimens in 270-902, mean ABRs (except for all bleeds) were significantly lower, and significantly higher proportions reported 0 bleeds for all outcomes with emicizumab. CONCLUSION: Valoctocogene roxaparvovec provided generally lower bleeding rates and higher probability of no bleeds, including treated joint bleeds, than emicizumab. Emicizumab was more effective than FVIII prophylaxis regimens used in 270-902

Pressure-induced radial collapse in few-wall carbon nanotubes: A combined theoretical and experimental study

Brazilian authors acknowledge funding from CNPq (grant 307317/2010-2, INCT NanoBioSimes) and Central Analítica-UFC/CT-INFRA-FINEP/Pró-Equipamentos-CAPES/CNPq-SisNano-MCTI (grant 402284/2013-5). R. S. Alencar is also in debt to Coordenação de Aperfeiçoamento de Pessoal de Nível Superior under the grant No. 99999.004227/2014-00 for financial support. Alexander Soldatov (University of Lulea, Sweden) is warmly acknowledged for discussions on the RBM Raman spectra interpretation at the collapse region

Daratumumab plus lenalidomide and dexamethasone for untreated myeloma

This is an accepted manuscript of an article published by Massachusetts Medical Society in New England Journal of Medicine on 30/05/2019, available online: https://doi.org/10.1056/NEJMoa1817249 The accepted version of the publication may differ from the final published version.Copyright © 2019 Massachusetts Medical Society. Lenalidomide plus dexamethasone is a standard treatment for patients with newly diagnosed multiple myeloma who are ineligible for autologous stem-cell transplantation. We sought to determine whether the addition of daratumumab would significantly reduce the risk of disease progression or death in this population. METHODS We randomly assigned 737 patients with newly diagnosed multiple myeloma who were ineligible for autologous stem-cell transplantation to receive daratumumab plus lenalidomide and dexamethasone (daratumumab group) or lenalidomide and dexamethasone alone (control group). Treatment was to continue until the occurrence of disease progression or unacceptable side effects. The primary end point was progression-free survival. RESULTS At a median follow-up of 28.0 months, disease progression or death had occurred in 240 patients (97 of 368 patients [26.4%] in the daratumumab group and 143 of 369 patients [38.8%] in the control group). The estimated percentage of patients who were alive without disease progression at 30 months was 70.6% (95% confidence interval [CI], 65.0 to 75.4) in the daratumumab group and 55.6% (95% CI, 49.5 to 61.3) in the control group (hazard ratio for disease progression or death, 0.56; 95% CI, 0.43 to 0.73; P<0.001). The percentage of patients with a complete response or better was 47.6% in the daratumumab group and 24.9% in the control group (P<0.001). A total of 24.2% of the patients in the daratumumab group, as compared with 7.3% of the patients in the control group, had results below the threshold for minimal residual disease (1 tumor cell per 105 white cells) (P<0.001). The most common adverse events of grade 3 or 4 were neutropenia (50.0% in the daratumumab group vs. 35.3% in the control group), anemia (11.8% vs. 19.7%), lymphopenia (15.1% vs. 10.7%), and pneumonia (13.7% vs. 7.9%).Published versio

Molecular platforms for targeted drug delivery

The targeted delivery of bioactive molecules to the appropriate site of action, one of the critical focuses of pharmaceutical research, improves therapeutic outcomes and increases safety at the same time; a concept envisaged by Ehrlich over 100 years ago when he described the "magic bullet" model. In the following decades, a considerable amount of research effort combined with enormous investment has carried selective drug targeting into clinical practice via the advent of monoclonal antibodies (mAbs) and antibody-drug conjugates derivatives. Additionally, a deeper understanding of physiopathological conditions of disease has permitted the tailored design of targeted drug delivery platforms that carry drugs, many copies of the same drug, and different drugs in combination to the appropriate site of action least selectively or preferentially. The acquired know-how has provided the field with the design rationale to develop a successful delivery system that will provide new and improved means to treat many intractable diseases and disorders. In this review, we discuss a wide range of molecular platforms for drug delivery, and focus on those with more success in the clinic, given their potential for targeted therapies

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Régulations épigénétiques et rôles de la protéine Btk dans l'expression du TNF-α par la voie des TLRs

Bruton tyrosine kinase, or Btk, is a protein whose role in the maturation of B cells has been known for several years. However, its role in the control of innate immunity is less established. We have shown that, in response to Toll like Receptors pathway or TLRs, Btk regulates the stability of the mRNA of TNF-α via the TTP or Tristetraprolin protein. Furthermore, we showed that the expression of microRNA, the miR-346, negatively regulated the Btk protein and thus the synthesis of TNF-α. Upregulation of miR-346 by transfection act as an anti-TNF-α and anti-Btk drugs, especially in the cellular model of rheumatoid arthritis.Finally, we showed that, in response to TLRs, the modulation of the expression of TNF-α according to the state of DNA methylation and histone acetylation depended directly on crosstalk beetween miR-346 and Btk. Btk is a key protein in the control of inflammation by epigenetic mechanisms such as miRNAs, DNA methylation and histone acetylation. As therapeutic interest, inhibition of Btk by those different regulatory mechanisms seems to be very interesting, both in inflammatory and neoplastic diseases.La Bruton tyrosine kinase ou Btk est une protéine dont le rôle dans la maturation des lymphocytes B est connu depuis plusieurs années. Par contre, son rôle dans le contrôle de l’immunité innée est moins établi. Nous avons montré que, en réponse à la voie des Toll like Receptors ou TLRs, Btk régule la stabilité de l’ARN messager du TNF-α par l’intermédiairede la protéine TTP ou Tristétraproline. Par ailleurs, nous avons montré que l’expression d’un microARN, le miR-346, régulait négativement la protéine Btk et donc la synthèse de TNF-α. L’amplification de l’expression de ce miR-346 par transfection permet d’avoir un effet anti-TNF-α et anti-Btk interessant notamment dans le modèle cellulaire de la polyarthrite rhumatoïde. Enfin, nous avons montré que, en réponse au TLRs, la modulation de l’expression du TNF-α en fonction de l’état de méthylation de l’ADN et d’acétylation des histones dépendait directement de l’expression du couple miR-346 et Btk. Btk est donc une protéine charnière dans le contrôle de l’inflammation par les mécanismes épigénétiques que sont les miARNs, la méthylation de l’ADN et l’acétylation des histones. Sur le plan thérapeutique, l’inhibition de cette protéine par ces différents mécanismes de régulation semble donc être très interessante, à la fois dans les maladies inflammatoires et néoplasiques

Epigenetics regulations and role of Btk protein in TNF-α expression by TLR pathway

La Bruton tyrosine kinase ou Btk est une protéine dont le rôle dans la maturation des lymphocytes B est connu depuis plusieurs années. Par contre, son rôle dans le contrôle de l’immunité innée est moins établi. Nous avons montré que, en réponse à la voie des Toll like Receptors ou TLRs, Btk régule la stabilité de l’ARN messager du TNF-α par l’intermédiairede la protéine TTP ou Tristétraproline. Par ailleurs, nous avons montré que l’expression d’un microARN, le miR-346, régulait négativement la protéine Btk et donc la synthèse de TNF-α. L’amplification de l’expression de ce miR-346 par transfection permet d’avoir un effet anti-TNF-α et anti-Btk interessant notamment dans le modèle cellulaire de la polyarthrite rhumatoïde. Enfin, nous avons montré que, en réponse au TLRs, la modulation de l’expression du TNF-α en fonction de l’état de méthylation de l’ADN et d’acétylation des histones dépendait directement de l’expression du couple miR-346 et Btk. Btk est donc une protéine charnière dans le contrôle de l’inflammation par les mécanismes épigénétiques que sont les miARNs, la méthylation de l’ADN et l’acétylation des histones. Sur le plan thérapeutique, l’inhibition de cette protéine par ces différents mécanismes de régulation semble donc être très interessante, à la fois dans les maladies inflammatoires et néoplasiques.Bruton tyrosine kinase, or Btk, is a protein whose role in the maturation of B cells has been known for several years. However, its role in the control of innate immunity is less established. We have shown that, in response to Toll like Receptors pathway or TLRs, Btk regulates the stability of the mRNA of TNF-α via the TTP or Tristetraprolin protein. Furthermore, we showed that the expression of microRNA, the miR-346, negatively regulated the Btk protein and thus the synthesis of TNF-α. Upregulation of miR-346 by transfection act as an anti-TNF-α and anti-Btk drugs, especially in the cellular model of rheumatoid arthritis.Finally, we showed that, in response to TLRs, the modulation of the expression of TNF-α according to the state of DNA methylation and histone acetylation depended directly on crosstalk beetween miR-346 and Btk. Btk is a key protein in the control of inflammation by epigenetic mechanisms such as miRNAs, DNA methylation and histone acetylation. As therapeutic interest, inhibition of Btk by those different regulatory mechanisms seems to be very interesting, both in inflammatory and neoplastic diseases

Epigenetics regulations and role of Btk protein in TNF-α expression by TLR pathway

La Bruton tyrosine kinase ou Btk est une protéine dont le rôle dans la maturation des lymphocytes B est connu depuis plusieurs années. Par contre, son rôle dans le contrôle de l’immunité innée est moins établi. Nous avons montré que, en réponse à la voie des Toll like Receptors ou TLRs, Btk régule la stabilité de l’ARN messager du TNF-α par l’intermédiairede la protéine TTP ou Tristétraproline. Par ailleurs, nous avons montré que l’expression d’un microARN, le miR-346, régulait négativement la protéine Btk et donc la synthèse de TNF-α. L’amplification de l’expression de ce miR-346 par transfection permet d’avoir un effet anti-TNF-α et anti-Btk interessant notamment dans le modèle cellulaire de la polyarthrite rhumatoïde. Enfin, nous avons montré que, en réponse au TLRs, la modulation de l’expression du TNF-α en fonction de l’état de méthylation de l’ADN et d’acétylation des histones dépendait directement de l’expression du couple miR-346 et Btk. Btk est donc une protéine charnière dans le contrôle de l’inflammation par les mécanismes épigénétiques que sont les miARNs, la méthylation de l’ADN et l’acétylation des histones. Sur le plan thérapeutique, l’inhibition de cette protéine par ces différents mécanismes de régulation semble donc être très interessante, à la fois dans les maladies inflammatoires et néoplasiques.Bruton tyrosine kinase, or Btk, is a protein whose role in the maturation of B cells has been known for several years. However, its role in the control of innate immunity is less established. We have shown that, in response to Toll like Receptors pathway or TLRs, Btk regulates the stability of the mRNA of TNF-α via the TTP or Tristetraprolin protein. Furthermore, we showed that the expression of microRNA, the miR-346, negatively regulated the Btk protein and thus the synthesis of TNF-α. Upregulation of miR-346 by transfection act as an anti-TNF-α and anti-Btk drugs, especially in the cellular model of rheumatoid arthritis.Finally, we showed that, in response to TLRs, the modulation of the expression of TNF-α according to the state of DNA methylation and histone acetylation depended directly on crosstalk beetween miR-346 and Btk. Btk is a key protein in the control of inflammation by epigenetic mechanisms such as miRNAs, DNA methylation and histone acetylation. As therapeutic interest, inhibition of Btk by those different regulatory mechanisms seems to be very interesting, both in inflammatory and neoplastic diseases

Focus on musculoskeletal health in women with bleeding disorders

Maintaining good musculoskeletal health, including good oral health, is as important for women with bleeding disorders (WBD) as it is for men. Many people with bleeding disorders ignore bleeding from their gums, believing it to be part of their condition. However, it may be a sign of periodontal disease, which left untreated can lead to accelerated tooth loss and infection, adversely affecting overall health. A good diet and access to good dental care from childhood are important to maintaining good oral health in WBD. Joint bleeding and degeneration are not limited to people with more severe forms of haemophilia; joint-related diagnoses have been shown to be twice as common among haemophilia carriers and women with mild haemophilia than in the general population. Women with type 3 von Willebrand disease experience comparable joint outcomes to younger intensively treated patients with severe haemophilia. Neither gum nor joint bleeds should ever be considered normal, as both can be treated to avoid progressive disease. Dental and joint specialists and physiotherapists should work closely with haemophilia teams to ensure optimal care for long-term preservation of musculoskeletal health

Prise en charge de l'amylose AL en 2009 (revue de la littérature et évaluation de l'intérêt des traitements par bortezomib et lenalidomide à partir de l'étude de 2 cohortes de patients suivis en France.)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF