Co-developing a drug with a diagnostic to create a stratified medicine - a therapy that is targeted to a specific patient population on the basis of a clinical characteristic such as a biomarker that predicts treatment response - presents challenges for product developers, regulators, payers and physicians. With the aim of developing a shared framework and tools for addressing these challenges, here we present an analysis using data from case studies in oncology and Alzheimer's disease, coupled with integrated computational modelling of clinical outcomes and developer economic value, to quantify the effects of decisions related to key issues such as the design of clinical trials. This illustrates how such analyses can aid the coordination of diagnostic and drug development, and the selection of optimal development and commercialization strategies. It also illustrates the impact of the interplay of these factors on the economic feasibility of stratified medicine, which has important implications for public policy makers.
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http://dx.doi.org/10.1038/nrd3557 | DOI Listing |
JAMA Netw Open
January 2025
Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
Importance: The open-label randomized phase 2 LACOG0415 trial evaluated 3 treatment strategies for patients with advanced castration-sensitive prostate cancer (CSPC): androgen deprivation therapy (ADT) plus abiraterone acetate and prednisone (AAP), apalutamide (APA) alone, or APA plus AAP.
Objective: To investigate the association of ADT plus AAP, APA alone, or APA plus AAP with health-related quality of life (HRQOL) in patients with advanced CSPC in the LACOG0415 trial.
Design, Setting, And Participants: The LACOG0415 randomized clinical trial comprised 128 patients with advanced CSPC who were randomized (1:1:1) to 1 of 3 treatment arms from October 16, 2017, to April 23, 2019.
Neurology
January 2025
The Dubowitz Neuromuscular Centre, Developmental Neurosciences Department, University College London, Great Ormond Street Institute of Child Health, United Kingdom.
Background And Objectives: Safety and efficacy of IV onasemnogene abeparvovec has been demonstrated for patients with spinal muscular atrophy (SMA) weighing <8.5 kg. SMART was the first clinical trial to evaluate onasemnogene abeparvovec for participants weighing 8.
View Article and Find Full Text PDFEur Heart J
January 2025
Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
Background And Aims: Current heart failure (HF) risk stratification strategies require comprehensive clinical evaluation. In this study, artificial intelligence (AI) applied to electrocardiogram (ECG) images was examined as a strategy to predict HF risk.
Methods: Across multinational cohorts in the Yale New Haven Health System (YNHHS), UK Biobank (UKB), and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), individuals without baseline HF were followed for the first HF hospitalization.
J Spinal Cord Med
January 2025
Faculty of Human Sciences, University of Tsukuba, Bunkyo, Japan.
Objective: To identify the factors associated with home discharge in individuals with cervical spinal cord injuries (cSCI) according to age group.
Design: Cross-sectional study.
Setting: Hospital or rehabilitation centers specializing in spinal cord injuries in Japan.
Ophthalmic Physiol Opt
January 2025
Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.
Purpose: This study evaluated the effects of orthokeratology and 0.01% atropine on corneal biomechanical properties (CBPs) and myopia progression in children, focusing on their association with axial length (AL) changes and treatment outcomes.
Methods: In this 1-year prospective study, 53 children (aged 8-17 years) were enrolled, with 30 undergoing orthokeratology and 23 receiving 0.
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