Statistical Analysis Plan for Clinical Study Report Ac-061A301 / Ac

Total Page:16

File Type:pdf, Size:1020Kb

Statistical Analysis Plan for Clinical Study Report Ac-061A301 / Ac STATISTICAL ANALYSIS PLAN FOR CLINICAL STUDY REPORT AC-061A301 / AC-061A302 Two multi-center, randomized, double-blind studies to compare the efficacy and safety of cadazolid versus vancomycin in subjects with Clostridium difficile-associated diarrhea (CDAD) Purpose of Analysis Clinical Study Report Investigational Drug Cadazolid NCT Numbers NCT01987895 & NCT01983683 Protocol Numbers AC-061A301 / AC-061A302 Document Status / Version Number Final Version 3 Date 19 May 2017 Confidential Property of Actelion Pharmaceuticals Ltd. May not be used, divulged, published or otherwise disclosed without the consent of Actelion Pharmaceuticals Ltd. Cadazolid (ACT-179811) Statistical Analysis Plan AC-061A301/302, Clinical Study Doc No D-17.273 Confidential Report 19 May 2017, page 2/155 TABLE OF CONTENTS 1 INTRODUCTION .......................................................................................................13 2 STUDY DESIGN AND FLOW ..................................................................................14 2.1 Study design .................................................................................................14 2.2 Study visit and assessment schedule ............................................................16 3 OBJECTIVES .............................................................................................................19 3.1 Primary objective ..........................................................................................19 3.2 Secondary objectives ....................................................................................19 3.3 Other objectives ............................................................................................19 3.3.1 Objective of the meta-analysis of AC-061A301 and AC-061A302 .....................................................................................19 3.3.2 Exploratory objective ........................................................................19 3.3.3 Safety objective .................................................................................19 3.3.4 Objective of the re-treatment extension with cadazolid ...................19 4 CHANGES OR CLARIFICATIONS TO ANALYSES PLANNED IN THE STUDY PROTOCOL .................................................................................................20 4.1 Changes related to PRO validation ...............................................................20 4.2 Changes to the analyses planned in the study protocol ................................20 4.3 Changes in the conduct of the study / data collection ..................................21 4.3.1 Clarification on wording ...................................................................21 5 DEFINITIONS OF VARIABLES ..............................................................................21 5.1 Screening failures .........................................................................................22 5.1.1 Unmet eligibility criteria ...................................................................22 5.2 Subject characteristics ..................................................................................23 5.2.1 Demographics ...................................................................................23 5.2.2 Baseline disease characteristics ........................................................23 5.2.3 Other baseline characteristics ...........................................................25 5.2.4 Medical history .................................................................................26 5.2.5 Previous and concomitant therapies .................................................27 5.2.5.1 Previous therapies .................................................................... 27 5.2.5.2 Study concomitant therapies ................................................... 27 5.2.5.3 Specific therapies .................................................................... 27 5.2.6 Procedures .........................................................................................29 5.2.6.1 Concomitant procedures .......................................................... 30 5.2.6.2 Endoscopy and imaging since first dose of study drug ........... 30 Cadazolid (ACT-179811) Statistical Analysis Plan AC-061A301/302, Clinical Study Doc No D-17.273 Confidential Report 19 May 2017, page 3/155 5.3 Study treatment exposure and compliance ...................................................30 5.3.1 Exposure ...........................................................................................30 5.3.2 Compliance with study treatment .....................................................32 5.3.3 Study treatment discontinuation .......................................................32 5.3.4 Study treatment interruptions ............................................................32 5.4 Study withdrawal ..........................................................................................33 5.5 Efficacy variables .........................................................................................33 5.5.1 Primary efficacy variable: Clinical Cure ..........................................33 5.5.1.1 Derivation details .................................................................... 34 5.5.1.2 Clinical Failure ........................................................................ 36 5.5.2 Secondary efficacy variables ............................................................37 5.5.2.1 Sustained Cure ......................................................................... 37 5.5.2.2 Time to ROD ........................................................................... 44 5.5.2.3 Change from baseline in CDI-DaySyms PRO domain scores at Day 3 ........................................................................ 44 5.5.3 Other efficacy variables ....................................................................45 5.5.3.1 Investigator’s assessment of Early Treatment Response at Visit 2 .................................................................................. 45 5.5.3.2 Investigator’s judgment of Clinical Response at Visit 4 ......... 45 5.5.3.3 Investigator’s evaluation of Clinical Cure per protocol definition ................................................................................. 46 5.5.3.4 Investigator’s judgment of Sustained Response at Visit 5 ...... 46 5.5.3.5 Investigator’s evaluation of Sustained Cure per protocol definition ................................................................................. 46 5.5.3.6 Early Clinical Cure by Day 5 .................................................. 46 5.5.3.7 Normalization of bowel movements rate ................................ 46 5.5.3.8 Time to return to usual stools .................................................. 47 5.5.3.9 Recurrence rate and adjusted recurrence rate .......................... 47 5.5.3.10 Time to recurrence ................................................................... 48 5.5.3.11 Modified Sustained Cure ......................................................... 49 5.5.3.12 CDI-DaySyms PRO response rate at Day 3 ............................ 49 5.5.4 Microbiology variables .....................................................................49 5.5.4.1 Isolation of C. difficile ............................................................ 50 5.5.4.2 Typing of C. difficile ............................................................... 51 5.5.4.3 Susceptibility of C. difficile .................................................... 52 5.5.4.4 Change from baseline in susceptibility of C. difficile ............. 53 5.5.4.5 Isolation of vancomycin-resistant enterococci ........................ 54 5.5.4.6 Vancomycin-resistant enterococci quantitative culture .......... 55 5.5.4.7 Change from baseline in vancomycin-resistant enterococci quantitative culture at Visit 3 ............................... 55 Cadazolid (ACT-179811) Statistical Analysis Plan AC-061A301/302, Clinical Study Doc No D-17.273 Confidential Report 19 May 2017, page 4/155 5.5.4.8 Susceptibility of vancomycin-resistant enterococci to different antibiotics .................................................................. 55 5.5.5 Re-treatment extension variables ......................................................56 5.6 Safety variables .............................................................................................56 5.6.1 Adverse events ..................................................................................57 5.6.1.1 Frequency of treatment-emergent adverse events ................... 58 5.6.1.2 Intensity of adverse events ...................................................... 58 5.6.1.3 Relationship of adverse events ................................................ 58 5.6.2 Deaths ...............................................................................................58 5.6.2.1 All deaths ................................................................................. 58 5.6.2.2 Adverse events with fatal outcome ......................................... 58 5.6.3 Serious adverse events ......................................................................58 5.6.4 Non-serious adverse events ..............................................................59 5.6.5 Adverse events leading to discontinuation of study treatment .........59 5.6.6 Other significant adverse events .......................................................59 5.6.7 Vital signs and body weight ..............................................................59
Recommended publications
  • WO 2015/179249 Al 26 November 2015 (26.11.2015) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2015/179249 Al 26 November 2015 (26.11.2015) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every C12N 15/11 (2006.01) A61K 38/08 (2006.01) kind of national protection available): AE, AG, AL, AM, C12N 15/00 (2006.01) AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, (21) Number: International Application DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, PCT/US2015/031213 HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, (22) International Filing Date: KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, 15 May 2015 (15.05.2015) MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, (25) Filing Language: English SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, (26) Publication Language: English TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: (84) Designated States (unless otherwise indicated, for every 62/000,43 1 19 May 2014 (19.05.2014) US kind of regional protection available): ARIPO (BW, GH, 62/129,746 6 March 2015 (06.03.2015) US GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, (72) Inventors; and TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, (71) Applicants : GELLER, Bruce, L.
    [Show full text]
  • CLINICAL USE of RIFABUTIN, a RIFAMYCIN-CLASS ANTIBIOTIC, for the TREATMENT of TUBERCULOSIS (A Supplement to the 2008 Revision Of“ Standards for Tuberculosis Care”)
    Kekkaku Vol. 86, No. 1: 43, 2011 43 CLINICAL USE OF RIFABUTIN, A RIFAMYCIN-CLASS ANTIBIOTIC, FOR THE TREATMENT OF TUBERCULOSIS (A supplement to the 2008 revision of“ Standards for tuberculosis care”) August, 2008 The Treatment Committee of the Japanese Society for Tuberculosis The Treatment Committee of the Japanese Society for [Dosage and administration of rifabutin] Tuberculosis published statements on the“ Standards for Rifabutin, 5 mg/kg in body weight/day, maximum 300 mg/ tuberculosis care” in April 2008. Therein we referred to day, once daily. rifampicin as follows“; Use of rifampicin requires attention The dosage of rifabutin can be increased up to the maximum because of the interactions with a number of other drugs. daily dose of 450 mg in cases where decreased rifabutin serum Particularly for HIV-infected patients who need antiviral levels are expected due to anti-HIV drugs such as efavirenz, drugs, the replacement of rifampicin by rifabutin should be and in other cases if necessary. considered”. Rifabutin, belonging to rifamycin-class antibiotics In non-HIV-infected patients, rifabutin can be used for like rifampicin, causes less significant drug-drug interactions intermittent treatment with a regimen of twice or three times a than rifampicin, and can be used in combination with antiviral week, with the same dosage as daily administration. drugs mentioned above. In July 2008, rifabutin was approved as antituberculous drug, and is expected to be added to the drug [Important points for use of rifabutin] price listing in the near future*. Therefore, to the published (1) Rifabutin causes drug interactions due to induction of opinions, we add new statements concerning the use of rifabutin hepatic enzyme though less significantly than rifampicin.
    [Show full text]
  • RIFAMPICIN Productinformation Sigma Prod
    RIFAMPICIN ProductInformation Sigma Prod. No. R3501 CH3 CH3 CAS NUMBER: 13292-46-1 HO SYNONYMS: Tubocin; Sinerdol; Rimactan; L-5103; Dione-21 Acetate; Archidyn; Arficin; 3-(4- CH3 O O OH O Methylpiperazinyliminomethyl)-rifamycin SV; NSC 113926; C OH OH CH 1 2 3 H C Rifampin ; Rifaldazine; Rifamycin AMP H3C 3 O NH H3C PHYSICAL PROPERTIES: CH3 N CH N Appearance: Orange-brown to red-brown powder.3 O OH N Molecular formula: C43H58N4O12 O Molecular weight: 823.0 O CH3 CH3 EmM (max absorbance, phosphate buffer, pH 7.38): 33.20 (237 nm); 32.10 (255 nm); 27.00 (334 nm); 15.40 (475 nm)2,4 pKa (in water):1.7 (4-hydroxyl group), 7.9 (4-piperazine nitrogen); in methylcellosolve-water (4:1): 3.6 (4- hydroxyl group), 6.7 (3-piperazine nitrogen)4 pI (in water): 4.84 25° 4 Optical rotation: [α]D =+10.6° (c=0.5% in CDCl3) Melting point: 183-188°C (dec.)2,4 METHOD OF PREPARATION: Methods of preparation have been reported.4,5 The NMR, UV, IR, Mass spectra, Thin-Layer chromatography and HPLC methods of detection have been reported.4,5,6 A colorimetric test for identification was reported.4 STABILITY / STORAGE: Rifampicin (Rif) should be stable for at least two years when stored desiccated at -20°C and protected from light.3 Rif is stable as a solid at temperatures up to 70EC.4 SOLUBILITY / SOLUTION STABILITY: Rif is soluble in dimethylsulfoxide (~100mg/mL), dimethylformamide, methanol (16 mg/ml, 25EC), chloroform (349 mg/ml, 25°C), ethyl acetate (108 mg/ml, 25°C), and acetone (14 mg/ml, 25°C).4,6,7,8,9 Rif is slightly soluble in water at 25°C: 2.5 mg/ml, pH 7.3; 1.3 mg/ml, pH 4.3; and in 95% ethanol (∼10 mg/mL).4 Rif is soluble at 37°C: in 0.1 N HCl, 200 mg/ml and in phosphate buffer pH 7.4, 9.9 mg/ml.4 R3501 Page 1 of 4 03/28/97 - ARO RIFAMPICIN Sigma Prod.
    [Show full text]
  • Rifabutin (Mycobutin) Reference Number: HIM.PA.12 Effective Date: 09.04.18 Last Review Date: 11.19 Revision Log Line of Business: HIM
    Clinical Policy: Rifabutin (Mycobutin) Reference Number: HIM.PA.12 Effective Date: 09.04.18 Last Review Date: 11.19 Revision Log Line of Business: HIM See Important Reminder at the end of this policy for important regulatory and legal information. Description Rifabutin (Mycobutin®) is a derivative of rifamycin, an antimycobacterial agent. FDA Approved Indication(s) Mycobutin is indicated for the prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection. Policy/Criteria Provider must submit documentation (such as office chart notes, lab results or other clinical information) supporting that member has met all approval criteria. It is the policy of health plans affiliated with Centene Corporation® that Mycobutin is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Mycobacterium avium Complex Prophylaxis (must meet all): 1. Prescribed by or in consultation with an HIV or infectious disease specialist; 2. Age ≥ 18 years; 3. Failure of azithromycin or clarithromycin, unless contraindicated or clinically significant adverse effects are experienced; 4. Dose does not exceed 300 mg per day. Approval duration: 12 months B. Tuberculosis (must meet all): 1. Diagnosis of tuberculosis infection; 2. Prescribed by or in consultation with an HIV or infectious disease specialist; 3. Documentation of current treatment with protease inhibitors or non-nucleoside reverse transcriptase inhibitors (NNRTIs) for the treatment of HIV infection; 4. Age ≥ 18 years; 5. Dose does not exceed 5 mg/kg per day. Approval duration: 12 months C. Other diagnoses/indications 1. Refer to the off-label use policy for the relevant line of business if diagnosis is NOT specifically listed under section III (Diagnoses/Indications for which coverage is NOT authorized): HIM.PHAR.21 for health insurance marketplace.
    [Show full text]
  • AMEG Categorisation of Antibiotics
    12 December 2019 EMA/CVMP/CHMP/682198/2017 Committee for Medicinal Products for Veterinary use (CVMP) Committee for Medicinal Products for Human Use (CHMP) Categorisation of antibiotics in the European Union Answer to the request from the European Commission for updating the scientific advice on the impact on public health and animal health of the use of antibiotics in animals Agreed by the Antimicrobial Advice ad hoc Expert Group (AMEG) 29 October 2018 Adopted by the CVMP for release for consultation 24 January 2019 Adopted by the CHMP for release for consultation 31 January 2019 Start of public consultation 5 February 2019 End of consultation (deadline for comments) 30 April 2019 Agreed by the Antimicrobial Advice ad hoc Expert Group (AMEG) 19 November 2019 Adopted by the CVMP 5 December 2019 Adopted by the CHMP 12 December 2019 Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2020. Reproduction is authorised provided the source is acknowledged. Categorisation of antibiotics in the European Union Table of Contents 1. Summary assessment and recommendations .......................................... 3 2. Introduction ............................................................................................ 7 2.1. Background ........................................................................................................
    [Show full text]
  • RIFABUTIN Rifabutin Must Be Taken Regularly to Higher Risk of Bacterial Infection), Or Be Effective and to Prevent the Anemia (A Reduced Number of Red
    RIFABUTIN Rifabutin must be taken regularly to higher risk of bacterial infection), or be effective and to prevent the anemia (a reduced number of red development of resistance. Take all blood cells that can make you feel Other NAMES: Mycobutin of your doses even if you begin to tired and short of breath). In rare feel better. cases it can also cause WHY is this drug prescribed? thrombocytopenia (a reduced What should you do if you number of platelets so that you bleed Rifabutin is an antibacterial drug used to FORGET a dose? or bruise more easily), or changes in prevent or treat Mycobacterium avium liver function . Blood tests will be complex (MAC) infection. When used If you miss a dose of rifabutin, take it done regularly to check for any to treat MAC, it is usually used in as soon as possible. However, if it is changes in these values. Inform combination with other agents. time for your next dose, do not your doctor or pharmacist if you have double the dose, just carry on with symptoms such as fever, chills, Rifabutin may also be used to treat other your regular schedule. shortness of breath, racing types of infections, including heartbeat, fatigue, bleeding or tuberculosis. What ADVERSE EFFECTS can this bruising. drug cause? What should you do HOW should this drug be taken? about them? Rifabutin may cause uveitis (an inflammation of the eye causing When used to prevent or treat MAC, the Most adverse effects of rifabutin are pain, redness and loss of vision). It usual dose is 300mg once daily.
    [Show full text]
  • EMA/CVMP/158366/2019 Committee for Medicinal Products for Veterinary Use
    Ref. Ares(2019)6843167 - 05/11/2019 31 October 2019 EMA/CVMP/158366/2019 Committee for Medicinal Products for Veterinary Use Advice on implementing measures under Article 37(4) of Regulation (EU) 2019/6 on veterinary medicinal products – Criteria for the designation of antimicrobials to be reserved for treatment of certain infections in humans Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2019. Reproduction is authorised provided the source is acknowledged. Introduction On 6 February 2019, the European Commission sent a request to the European Medicines Agency (EMA) for a report on the criteria for the designation of antimicrobials to be reserved for the treatment of certain infections in humans in order to preserve the efficacy of those antimicrobials. The Agency was requested to provide a report by 31 October 2019 containing recommendations to the Commission as to which criteria should be used to determine those antimicrobials to be reserved for treatment of certain infections in humans (this is also referred to as ‘criteria for designating antimicrobials for human use’, ‘restricting antimicrobials to human use’, or ‘reserved for human use only’). The Committee for Medicinal Products for Veterinary Use (CVMP) formed an expert group to prepare the scientific report. The group was composed of seven experts selected from the European network of experts, on the basis of recommendations from the national competent authorities, one expert nominated from European Food Safety Authority (EFSA), one expert nominated by European Centre for Disease Prevention and Control (ECDC), one expert with expertise on human infectious diseases, and two Agency staff members with expertise on development of antimicrobial resistance .
    [Show full text]
  • MEPRON® (Atovaquone) Suspension
    NDA 20-500/S-010 Page 3 PRESCRIBING INFORMATION MEPRON® (atovaquone) Suspension DESCRIPTION MEPRON (atovaquone) is an antiprotozoal agent. The chemical name of atovaquone is trans- 2-[4-(4-chlorophenyl)cyclohexyl]-3-hydroxy-1,4-naphthalenedione. Atovaquone is a yellow crystalline solid that is practically insoluble in water. It has a molecular weight of 366.84 and the molecular formula C22H19ClO3. The compound has the following structural formula: MEPRON Suspension is a formulation of micro-fine particles of atovaquone. The atovaquone particles, reduced in size to facilitate absorption, are significantly smaller than those in the previously marketed tablet formulation. MEPRON Suspension is for oral administration and is bright yellow with a citrus flavor. Each teaspoonful (5 mL) contains 750 mg of atovaquone and the inactive ingredients benzyl alcohol, flavor, poloxamer 188, purified water, saccharin sodium, and xanthan gum. MICROBIOLOGY Mechanism of Action: Atovaquone is a hydroxy-1,4-naphthoquinone, an analog of ubiquinone, with antipneumocystis activity. The mechanism of action against Pneumocystis carinii has not been fully elucidated. In Plasmodium species, the site of action appears to be the cytochrome bc1 complex (Complex III). Several metabolic enzymes are linked to the mitochondrial electron transport chain via ubiquinone. Inhibition of electron transport by atovaquone will result in indirect inhibition of these enzymes. The ultimate metabolic effects of such blockade may include inhibition of nucleic acid and ATP synthesis. Activity In Vitro: Several laboratories, using different in vitro methodologies, have shown the IC50 (50% inhibitory concentration) of atovaquone against rat P. carinii to be in the range of 0.1 to 3.0 mcg/mL.
    [Show full text]
  • E3 Appendix 1 (Part 1 of 2): Search Strategy Used in MEDLINE
    This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact CJHP at [email protected] Appendix 1 (part 1 of 2): Search strategy used in MEDLINE # Searches 1 exp *anti-bacterial agents/ or (antimicrobial* or antibacterial* or antibiotic* or antiinfective* or anti-microbial* or anti-bacterial* or anti-biotic* or anti- infective* or “ß-lactam*” or b-Lactam* or beta-Lactam* or ampicillin* or carbapenem* or cephalosporin* or clindamycin or erythromycin or fluconazole* or methicillin or multidrug or multi-drug or penicillin* or tetracycline* or vancomycin).kf,kw,ti. or (antimicrobial or antibacterial or antiinfective or anti-microbial or anti-bacterial or anti-infective or “ß-lactam*” or b-Lactam* or beta-Lactam* or ampicillin* or carbapenem* or cephalosporin* or c lindamycin or erythromycin or fluconazole* or methicillin or multidrug or multi-drug or penicillin* or tetracycline* or vancomycin).ab. /freq=2 2 alamethicin/ or amdinocillin/ or amdinocillin pivoxil/ or amikacin/ or amoxicillin/ or amphotericin b/ or ampicillin/ or anisomycin/ or antimycin a/ or aurodox/ or azithromycin/ or azlocillin/ or aztreonam/ or bacitracin/ or bacteriocins/ or bambermycins/ or bongkrekic acid/ or brefeldin a/ or butirosin sulfate/ or calcimycin/ or candicidin/ or capreomycin/ or carbenicillin/ or carfecillin/ or cefaclor/ or cefadroxil/ or cefamandole/ or cefatrizine/ or cefazolin/ or cefixime/ or cefmenoxime/ or cefmetazole/ or cefonicid/ or cefoperazone/
    [Show full text]
  • Short-Course Rifamycin-Based Regimens for TB Infection (LTBI): Why Countries Should Scale up This Silver Bullet for TB Prevention Among PLHIV
    Short-course rifamycin-based regimens for TB infection (LTBI): Why countries should scale up this silver bullet for TB prevention among PLHIV TB/HIV Research Meeting organized by WHO In conjunction with CROI, Boston, MA, USA March 4, 2018 Presented by: Kelly Dooley MD, PhD Johns Hopkins University School of Medicine D I V I S I O N O F CLINICAL PHARMACOLOGY 1 Latent TB infection (LTBI) About 1 in 4 persons Houben and Dodd. PLoS Med 2016;13(10):e1002152 http://www.who.int/tb/challenges/ltbi_factsheet_25nov15.pdf?ua=1; 2 http://www.results.org.au/living-with-hiv-dying-of-tb/; https://msdh.ms.gov/msdhsite/_static/14,0,150,728.html Treatment of LTBI reduces risk of TB disease & death in patients with HIV infection, independent of ART 0.25 0.20 Did not start IPT Started IPT 0.15 0.10 Cumulative of probability tuberculosis 0.05 Risk of TB diseaseRisk Risk of death Risk 0.00 1 mo 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr Years since PPD+ Number at risk (events) Did not start IPT 1222 (58) 400 (14) 318 (9) 241 (1) 168 (2) 123 (2) 84 (0) 62 Started IPT 732 (7) 1470 (12) 1506 (12) 1437 (2) 1149 (5) 790 (3) 414 (0) 189 IPT for 6 months Temprano IPT for 6 months HIV+, TST+ , Rio de Janeiro ANRS Study HIV+, TST not done, Côte d’Ivoire 3 Golub et al CID 2015 Badje et al., Lancet Global Health, 2017 Not prescribed, not taken Completion rates varied from 6% to 94% “… and were inversely proportional to the duration of treatment” WHO 2018 Guidelines on the management of latent tuberculosis infection Fox et al 2017 IJID 4 Whither shorter-course rifamycin-based
    [Show full text]
  • Strong Selective Agents Determine Resistance Evolution in a Multidrug
    bioRxiv preprint doi: https://doi.org/10.1101/2020.12.01.406181; this version posted December 2, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Title: Strong Selective Agents Determine Resistance Evolution in a Multidrug Therapeutic Regime Authors: Johannes Cairns1,2*, Florian Borse1, Tommi Mononen1, Teppo Hiltunen2,3*, Ville Mustonen1,4*. 5 Affiliations: 1Organismal and Evolutionary Biology Research Programme (OEB), Department of Computer Science, 00014 University of Helsinki, Helsinki, Finland. 2Department of Microbiology, 00014 University of Helsinki, Helsinki, Finland. 3Department of Biology, 20014 University of Turku, Turku, Finland. 10 4Helsinki Institute for Information Technology, Institute of Biotechnology, 00014 University of Helsinki, Helsinki, Finland. *Correspondence to: [email protected] or [email protected] or v.mustonen@hel- sinki.fi. ORCIDs: JC, 0000-0003-1329-2025; FB, 0000-0003-4232-257X; TM, 0000-0002-3603-0813; 15 TH, 0000-0001-7206-2399; VM, 0000-0002-7270-1792. Abstract: Multidrug regimes have been considered to constrain selection for resistance compared to monotherapy. However, drug resistance trajectories are influenced by a wide range of conditions which can cause opposing outcomes. Here we employed an in vitro model system to investigate differences in resistance dynamics between mono-, combination and alternating regimes. Across 20 regimes involving three drugs and phage, selection for resistance was decreased in multidrug re- gimes compared to monotherapy. Surprisingly, across regimes, two out of the four agents used to impose selection had a dominant effect on the overall outcome. Resistance to these agents either caused cross-resistance or obscured the phenotypic effect of other resistance mutations.
    [Show full text]
  • Customs Tariff - Schedule
    CUSTOMS TARIFF - SCHEDULE 99 - i Chapter 99 SPECIAL CLASSIFICATION PROVISIONS - COMMERCIAL Notes. 1. The provisions of this Chapter are not subject to the rule of specificity in General Interpretative Rule 3 (a). 2. Goods which may be classified under the provisions of Chapter 99, if also eligible for classification under the provisions of Chapter 98, shall be classified in Chapter 98. 3. Goods may be classified under a tariff item in this Chapter and be entitled to the Most-Favoured-Nation Tariff or a preferential tariff rate of customs duty under this Chapter that applies to those goods according to the tariff treatment applicable to their country of origin only after classification under a tariff item in Chapters 1 to 97 has been determined and the conditions of any Chapter 99 provision and any applicable regulations or orders in relation thereto have been met. 4. The words and expressions used in this Chapter have the same meaning as in Chapters 1 to 97. Issued January 1, 2019 99 - 1 CUSTOMS TARIFF - SCHEDULE Tariff Unit of MFN Applicable SS Description of Goods Item Meas. Tariff Preferential Tariffs 9901.00.00 Articles and materials for use in the manufacture or repair of the Free CCCT, LDCT, GPT, UST, following to be employed in commercial fishing or the commercial MT, MUST, CIAT, CT, harvesting of marine plants: CRT, IT, NT, SLT, PT, COLT, JT, PAT, HNT, Artificial bait; KRT, CEUT, UAT, CPTPT: Free Carapace measures; Cordage, fishing lines (including marlines), rope and twine, of a circumference not exceeding 38 mm; Devices for keeping nets open; Fish hooks; Fishing nets and netting; Jiggers; Line floats; Lobster traps; Lures; Marker buoys of any material excluding wood; Net floats; Scallop drag nets; Spat collectors and collector holders; Swivels.
    [Show full text]