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1. The broad spectrum of COVID-like patients initially negative at RT-PCR testing: a cohort study

Author

Valeria Caramello, Alessandra Macciotta, Fabrizio Bar, Alessandro Mussa, Anna Maria De Leo, Alessandro Vincenzo De Salve, Fabio Nota, Carlotta Sacerdote, Fulvio Ricceri, and Adriana Boccuzzi

Subjects
COVID-19, False-negative RT-PCR, Emergency department, Infection control, Isolation, Clinical judgment, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Patients that arrive in the emergency department (ED) with COVID-19-like syndromes testing negative at the first RT-PCR represent a clinical challenge because of the lack of evidence about their management available in the literature. Our first aim was to quantify the proportion of patients testing negative at the first RT-PCR performed in our Emergency Department (ED) that were confirmed as having COVID-19 at the end of hospitalization by clinical judgment or by any subsequent microbiological testing. Secondly, we wanted to identify which variables that were available in the first assessment (ED variables) would have been useful in predicting patients, who at the end of the hospital stay were confirmed as having COVID-19 (false-negative at the first RT-PCR). Methods We retrospectively collected data of 115 negative patients from2020, March 1st to 2020, May 15th. Three experts revised patients’ charts collecting information on the whole hospital stay and defining patients as COVID-19 or NOT-COVID-19. We compared ED variables in the two groups by univariate analysis and logistic regression. Results We classified 66 patients as COVID-19 and identified the other 49 as having a differential diagnosis (NOT-COVID), with a concordance between the three experts of 0.77 (95% confidence interval (95%CI) 0.66- 0.73). Only 15% of patients tested positive to a subsequent RT-PCR test, accounting for 25% of the clinically suspected. Having fever (odds ratio (OR) 3.32, (95%CI 0.97-12.31), p = 0.06), showing a typical pattern at the first lung ultrasound (OR 6.09, (95%CI 0.87-54.65), p = 0.08) or computed tomography scan (OR 4.18, (95%CI 1.11-17.86), p = 0.04) were associated with a higher probability of having COVID-19. Conclusions In patients admitted to ED with COVID-19 symptoms and negative RT-PCR a comprehensive clinical evaluation integrated with lung ultrasound and computed tomography could help to detect COVID-19 patients with a false negative RT-PCR result.

Published
2022
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2. Long-term efficacy of lipoprotein apheresis and lomitapide in the treatment of homozygous familial hypercholesterolemia (HoFH): a cross-national retrospective survey

Author

Laura D’Erasmo, Antonio Gallo, Angelo Baldassare Cefalù, Alessia Di Costanzo, Samir Saheb, Antonina Giammanco, Maurizio Averna, Alessio Buonaiuto, Gabriella Iannuzzo, Giuliana Fortunato, Arturo Puja, Tiziana Montalcini, Chiara Pavanello, Laura Calabresi, Giovanni Battista Vigna, Marco Bucci, Katia Bonomo, Fabio Nota, Tiziana Sampietro, Francesco Sbrana, Patrizia Suppressa, Carlo Sabbà, Fabio Fimiani, Arturo Cesaro, Paolo Calabrò, Silvia Palmisano, Sergio D’Addato, Livia Pisciotta, Stefano Bertolini, Randa Bittar, Olga Kalmykova, Sophie Béliard, Alain Carrié, Marcello Arca, and Eric Bruckert

Subjects
Homozygous hypercholesterolemia, Lipoprotein apheresis, Lomitapide, LDL, Therapeutics, Genetic disease, Medicine
Abstract

Abstract Background Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition that represents a therapeutic challenge. The vast majority of HoFH patients fail to achieve LDL-C targets when treated with the standard protocol, which associates maximally tolerated dose of lipid-lowering medications with lipoprotein apheresis (LA). Lomitapide is an emerging therapy in HoFH, but its place in the treatment algorithm is disputed because a comparison of its long-term efficacy versus LA in reducing LDL-C burden is not available. We assessed changes in long-term LDL-C burden and goals achievement in two independent HoFH patients’ cohorts, one treated with lomitapide in Italy (n = 30) and the other with LA in France (n = 29). Results The two cohorts differed significantly for genotype (p = 0.004), baseline lipid profile (p

Published
2021
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3. Efficacy of Long-Term Treatment of Autosomal Recessive Hypercholesterolemia With Lomitapide: A Subanalysis of the Pan-European Lomitapide Study

Author

Laura D’Erasmo, Antonina Giammanco, Patrizia Suppressa, Chiara Pavanello, Gabriella Iannuzzo, Alessia Di Costanzo, Daniele Tramontano, Ilenia Minicocci, Simone Bini, Anja Vogt, Kim Stewards, Jeanine Roeters Van Lennep, Stefano Bertolini, Marcello Arca, the Italian and European Working Group on Lomitapide in HoFH, Maurizio Averna, Eric Boersma, Katia Bonomo, Marco Bucci, Laura Calabresi, Paolo Calabrò, Angelo Baldassare Cefalù, Jaimini Cegla, Arturo Cesaro, Sergio D’Addato, Eugene Daphnis, Maria Donata Di Taranto, Avishay Ellis, Fabio Fimiani, Giuliana Fortunato, Marco Gentile, Meral Kayikcioglu, Genovefa Kolovou, Evangelos Liberopoulos, Karin Littmann, Sergio Martínez-Hervás, Tiziana Montalcini, Fabio Nota, Livia Pisciotta, Arturo Puja, Giovanni José Real, Jeanine Roeters van Lennep, Joost Rutten, Carlo Sabbà, Tiziana Sampietro, Francesco Sbrana, Kim Steward, Fulvio Ventura, Battista Vigna, and Shahenaz Walji

Subjects
Real-world study, rare disease, autosomal recessive hypercholesterolaemia, LDL-C, lomitapide, long-term, Genetics, QH426-470
Abstract

Backgroundand aim: Autosomal recessive hypercholesterolemia (ARH) is a rare autosomal recessive disorder of low-density lipoprotein (LDL) metabolism caused by pathogenic variants in the LDLRAP1 gene. Like homozygous familial hypercholesterolemia, ARH is resistant to conventional LDL-lowering medications and causes a high risk of atherosclerotic cardiovascular diseases (ASCVDs) and aortic valve stenosis. Lomitapide is emerging as an efficacious therapy in classical HoFH, but few data are available for ARH.Results: This is a subanalysis carried out on nine ARH patients included in the Pan-European Lomitapide Study. The age at starting lomitapide was 46 (interquartile range (IQR), 39.0–65.5) years, with a median treatment duration of 31.0 (IQR 14.0–40.5) months. At baseline, four (44.4%) patients had hypertension, one (11.1%) had diabetes mellitus, two (22.2%) were active smokers, and five (55.5%) reported ASCVD. The baseline LDL-C was 257.0 (IQR, 165.3–309.2) mg/dL. All patients were on statins plus ezetimibe, three were receiving Lipoprotein apheresis (LA), and one was also receiving proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). The addition of lomitapide (mean dose, 10 mg) resulted in the achievement of a median on-treatment LDL-C of 101.7 mg/dL (IQR, 71.3–138.3; 60.4% reduction from baseline), with a best LDL-C value of 68.0 mg/dL (IQR, 43.7–86.7; 73.5% reduction from baseline). During follow-up, one patient stopped both PCSK9i and LA. Recurrence of ASCVD events was reported in one patient. The median on-treatment aspartate transaminase and alanine transaminase values were 31.1 (IQR, 22.6–48.3) U/L and 31.1 (IQR, 27.2–53.8) U/L, respectively. Among six ARH patients with available fibroscan examination, liver stiffness values recorded at the last visit were within the normal range (median, 4.7 KPa; IQR, 3.6–5.3 KPa).Conclusion: Lomitapide is effective and safe in ARH therapy as well as in classical HoFH.

Published
2022
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4. Efficacy and safety of lomitapide in homozygous familial hypercholesterolaemia: the pan-European retrospective observational study

Author

d'Erasmo, Laura, Steward, Kim, Cefalù, Angelo Baldassare, Di Costanzo, Alessia, Boersma, Eric, Bini, Simone, Arca, Marcello, van Lennep, Jeanine Roeters, Antonina Giammanco, Maurizio Averna, Gabriella Iannuzzo, Giuliana Fortunato, Marco Gentile, Arturo Puja, Tiziana Montalcini, Chiara Pavanello, Laura Calabresi, Giovanni Battista Vigna, Marco Bucci, Katia Bonomo, Fabio Nota, Tiziana Sampietro, Francesco Sbrana, Patrizia Suppressa, Carlo Sabbà, Fabio Fimiani, Arturo Cesaro, Paolo Calabrò, Fulvio Ventura, Sergio D’Addato, Livia Pisciotta, Stefano Bertolini, Genovefa Kolovou, Evangelos Liberopoulos, Eugene Daphnis, Joost Rutten, Anja Vogt, Jaimini Cegla, Shahenaz Walji, Meral Kayikcioglu, José Real, Sergio Martínez-Hervás, Avishay Ellis, Karin Littmann, D'Erasmo, Laura, Baldassare Cefalù, Angelo, Di Costanzo, Alessia, Bini, Simone, Giammanco, Antonina, Averna, Maurizio, Iannuzzo, Gabriella, Fortunato, Giuliana, Gentile, Marco, Puja, Arturo, Montalcini, Tiziana, Pavanello, Chiara, Calabresi, Laura, Battista Vigna, Giovanni, Bucci, Marco, Bonomo, Katia, Nota, Fabio, Sampietro, Tiziana, Sbrana, Francesco, Suppressa, Patrizia, Sabbà, Carlo, Fimiani, Fabio, Cesaro, Arturo, Calabrò, Paolo, Ventura, Fulvio, D'Addato, Sergio, Pisciotta, Livia, Bertolini, Stefano, Arca, Marcello, Kolovou, Genovefa, Liberopoulos, Evangelo, Daphnis, Eugene, Roeters van Lennep, Jeanine, Rutten, Joost, Boersma, Eric, Steward, Kim, Vogt, Anja, Cegla, Jaimini, Walji, Shahenaz, Kayikcioglu, Meral, Real, José, Martínez-Hervás, Sergio, Ellis, Avishay, Littmann, Karin, Internal Medicine, Cardiology, d'Erasmo, Laura, Cefalù, Angelo Baldassare, and van Lennep, Jeanine Roeters, Antonina Giammanco, Maurizio Averna, Gabriella Iannuzzo, Giuliana Fortunato, Marco Gentile, Arturo Puja, Tiziana Montalcini, Chiara Pavanello, Laura Calabresi, Giovanni Battista Vigna, Marco Bucci, Katia Bonomo, Fabio Nota, Tiziana Sampietro, Francesco Sbrana, Patrizia Suppressa, Carlo Sabbà, Fabio Fimiani, Arturo Cesaro, Paolo Calabrò, Fulvio Ventura, Sergio D’Addato, Livia Pisciotta, Stefano Bertolini, Genovefa Kolovou, Evangelos Liberopoulos, Eugene Daphnis, Joost Rutten, Anja Vogt, Jaimini Cegla, Shahenaz Walji, Meral Kayikcioglu, José Real, Sergio Martínez-Hervás, Avishay Ellis, Karin Littmann

Subjects
Adult, Homozygous Familial Hypercholesterolemia, Settore MED/09 - Medicina Interna, Epidemiology, Anticholesteremic Agents, Homozygote, Medium-term efficacy, Cholesterol, LDL, Medium-term safety, Benzimidazole, Lomitapide, atherosclerosis, lomitapide, medium-term efficacy, medium-term safety, Hyperlipoproteinemia Type II, Homozygous familial hypercholesterolaemia, Retrospective Studie, Atherosclerosi, Anticholesteremic Agent, Humans, Benzimidazoles, Cardiology and Cardiovascular Medicine, Retrospective Studies, Human
Abstract

Aims Lomitapide is a lipid-lowering agent indicated as an adjunct therapy for adult homozygous familial hypercholesterolaemia (HoFH). This study evaluated the medium-term effectiveness and safety of lomitapide in a large cohort of HoFH patients in Europe. Methods and results In a multicentre retrospective, observational study including 75 HoFH patients treated with lomitapide in a real-world clinical setting from 9 European countries, low-density lipoprotein cholesterol (LDL-C) changes, adverse events (AEs), and major adverse cardiovascular events (MACE) were assessed. After a median 19 months (interquartile range 11–41 months) of treatment with a mean dosage of 20 mg of lomitapide. Low-density lipoprotein cholesterol decreased by 60%, from baseline 280.5 mg/dL (191.8–405.0 mg/dL) to 121.6 mg/dL (61.0–190.5 mg/dL). At the last visit, 32.0% of patients achieved LDL-C Conclusion In this medium-term real-world experience, lomitapide proved to be very effective in reducing LDL-C in HoFH. Gastrointestinal AEs were common, but liver safety was reassuring with no sign of increased risk of liver fibrosis. A signal of cardiovascular protection was also observed.

Published
2022

5. Efficacy of Long-Term Treatment of Autosomal Recessive Hypercholesterolemia With Lomitapide: A Subanalysis of the Pan-European Lomitapide Study

Author

Marcello Arca, Maurizio Averna, Stefano Bertolini, Simone Bini, Eric Boersma, Katia Bonomo, Marco Bucci, Laura Calabresi, Paolo Calabrò, Angelo Baldassare Cefalu', Jaimini Cegla, Arturo Cesaro, Sergio D'Addato, Eugene Daphnis, Alessia Di Costanzo, Laura D'Erasmo, Maria Donata Di Taranto, Avishay Ellis, Fabio Fimiani, Giuliana Fortunato, Antonina Giammanco, Marco Gentile, Gabriella Iannuzzo, Meral Kayikcioglu, Genovefa Kolovou, Evangelos Liberopoulos, Karin Littmann, Sergio Martínez-Hervás, Tiziana Montalcini, Fabio Nota, Chiara Pavanello, Livia Pisciotta, Arturo Puja, Giovanni José Real, Jeanine Roeters van Lennep, Joost Rutten, Carlo Sabbà, Tiziana Sampietro, Francesco Sbrana, Kim Steward, Patrizia Suppressa, Fulvio Ventura, Battista Vigna, Anja Vogt, Shahenaz Walji, Marcello Arca, Maurizio Averna, Stefano Bertolini, Simone Bini, Eric Boersma, Katia Bonomo, Marco Bucci, Laura Calabresi, Paolo Calabrò, Angelo Baldassare Cefalu', Jaimini Cegla, Arturo Cesaro, Sergio D'Addato, Eugene Daphnis, Alessia Di Costanzo, Laura D'Erasmo, Maria Donata Di Taranto, Avishay Ellis, Fabio Fimiani, Giuliana Fortunato, Antonina Giammanco, Marco Gentile, Gabriella Iannuzzo, Meral Kayikcioglu, Genovefa Kolovou, Evangelos Liberopoulos, Karin Littmann, Sergio Martínez-Hervás, Tiziana Montalcini, Fabio Nota, Chiara Pavanello, Livia Pisciotta, Arturo Puja, Giovanni José Real, Jeanine Roeters van Lennep, Joost Rutten, Carlo Sabbà, Tiziana Sampietro, Francesco Sbrana, Kim Steward, Patrizia Suppressa, Fulvio Ventura, Battista Vigna, Anja Vogt, Shahenaz Walji, and Internal Medicine

Subjects
safety, lomitapide, long-term, Settore MED/09 - Medicina Interna, efficacy, rare disease, Real-world study, SDG 3 - Good Health and Well-being, Settore BIO/14 - Farmacologia, Genetics, Molecular Medicine, LDL-C, autosomal recessive hypercholesterolaemia, Genetics (clinical)
Abstract

Backgroundand aim: Autosomal recessive hypercholesterolemia (ARH) is a rare autosomal recessive disorder of low-density lipoprotein (LDL) metabolism caused by pathogenic variants in the LDLRAP1 gene. Like homozygous familial hypercholesterolemia, ARH is resistant to conventional LDL-lowering medications and causes a high risk of atherosclerotic cardiovascular diseases (ASCVDs) and aortic valve stenosis. Lomitapide is emerging as an efficacious therapy in classical HoFH, but few data are available for ARH.Results: This is a subanalysis carried out on nine ARH patients included in the Pan-European Lomitapide Study. The age at starting lomitapide was 46 (interquartile range (IQR), 39.0–65.5) years, with a median treatment duration of 31.0 (IQR 14.0–40.5) months. At baseline, four (44.4%) patients had hypertension, one (11.1%) had diabetes mellitus, two (22.2%) were active smokers, and five (55.5%) reported ASCVD. The baseline LDL-C was 257.0 (IQR, 165.3–309.2) mg/dL. All patients were on statins plus ezetimibe, three were receiving Lipoprotein apheresis (LA), and one was also receiving proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). The addition of lomitapide (mean dose, 10 mg) resulted in the achievement of a median on-treatment LDL-C of 101.7 mg/dL (IQR, 71.3–138.3; 60.4% reduction from baseline), with a best LDL-C value of 68.0 mg/dL (IQR, 43.7–86.7; 73.5% reduction from baseline). During follow-up, one patient stopped both PCSK9i and LA. Recurrence of ASCVD events was reported in one patient. The median on-treatment aspartate transaminase and alanine transaminase values were 31.1 (IQR, 22.6–48.3) U/L and 31.1 (IQR, 27.2–53.8) U/L, respectively. Among six ARH patients with available fibroscan examination, liver stiffness values recorded at the last visit were within the normal range (median, 4.7 KPa; IQR, 3.6–5.3 KPa).Conclusion: Lomitapide is effective and safe in ARH therapy as well as in classical HoFH.

Published
2022

6. Long-term efficacy of lipoprotein apheresis and lomitapide in the treatment of homozygous familial hypercholesterolemia (HoFH): a cross-national retrospective survey

Author

Tiziana Sampietro, Marcello Arca, Paolo Calabrò, Olga Kalmykova, Livia Pisciotta, Stefano Bertolini, Gabriella Iannuzzo, Francesco Sbrana, Fabio Nota, Antonio Gallo, Carlo Sabbà, Patrizia Suppressa, Arturo Cesaro, Giuliana Fortunato, Randa Bittar, Arturo Puja, Marco Bucci, Katia Bonomo, Angelo B. Cefalù, Samir Saheb, Maurizio Averna, Tiziana Montalcini, Alessio Buonaiuto, Sergio D'Addato, Alain Carrié, Chiara Pavanello, Sophie Béliard, Alessia Di Costanzo, S. Palmisano, Eric Bruckert, Giovanni Battista Vigna, Antonina Giammanco, Laura Calabresi, Fabio Fimiani, Laura D'Erasmo, D'Erasmo L., Gallo A., Cefalu A.B., Di Costanzo A., Saheb S., Giammanco A., Averna M., Buonaiuto A., Iannuzzo G., Fortunato G., Puja A., Montalcini T., Pavanello C., Calabresi L., Vigna G.B., Bucci M., Bonomo K., Nota F., Sampietro T., Sbrana F., Suppressa P., Sabba C., Fimiani F., Cesaro A., Calabro P., Palmisano S., D'Addato S., Pisciotta L., Bertolini S., Bittar R., Kalmykova O., Beliard S., Carrie A., Arca M., Bruckert E., D'Erasmo, L., Gallo, A., Cefalu, A. B., Di Costanzo, A., Saheb, S., Giammanco, A., Averna, M., Buonaiuto, A., Iannuzzo, G., Fortunato, G., Puja, A., Montalcini, T., Pavanello, C., Calabresi, L., Vigna, G. B., Bucci, M., Bonomo, K., Nota, F., Sampietro, T., Sbrana, F., Suppressa, P., Sabba, C., Fimiani, F., Cesaro, A., Calabro, Paolo, Palmisano, S., D'Addato, S., Pisciotta, L., Bertolini, S., Bittar, R., Kalmykova, O., Beliard, S., Carrie, A., Arca, M., Bruckert, E., Calabro, P., Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Laboratoire d'Imagerie Biomédicale [Paris] (LIB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Università degli studi di Palermo - University of Palermo, University of Naples Federico II = Università degli studi di Napoli Federico II, CEINGE - Biotecnologie Avanzate, Università degli Studi 'Magna Graecia' di Catanzaro = University of Catanzaro (UMG), Università degli Studi di Milano = University of Milan (UNIMI), Università degli Studi di Ferrara = University of Ferrara (UniFE), Università degli studi 'G. d'Annunzio' Chieti-Pescara [Chieti-Pescara] (Ud'A), Ospedale San Luigi Gonzaga, Fondazione Toscana Gabriele Monasterio, University of the Study of Campania Luigi Vanvitelli, Policlinico S. Orsola-malpighi, Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO)-Servizio sanitario regionale Emilia-Romagna, Università degli studi di Genova = University of Genoa (UniGe), Ospedale Policlinico San Martino [Genoa], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Hôpital de la Conception [CHU - APHM] (LA CONCEPTION)

Subjects
medicine.medical_specialty, Settore MED/09 - Medicina Interna, [SDV]Life Sciences [q-bio], Lipoproteins, Genetic disease, Therapeutics, Familial hypercholesterolemia, Disease, Lipoprotein apheresi, LDL, Hyperlipoproteinemia Type II, chemistry.chemical_compound, Lipoprotein apheresis, Retrospective survey, Internal medicine, Cholesterol burden, Homozygous hypercholesterolemia, Lomitapide, Benzimidazoles, Homozygote, Humans, Retrospective Studies, Anticholesteremic Agents, Blood Component Removal, medicine, Pharmacology (medical), Genetics (clinical), medicine.diagnostic_test, business.industry, Research, General Medicine, medicine.disease, cholesterol burden, genetic disease, homozygous hypercholesterolemia, lipoprotein apheresis, lomitapide, therapeutics, chemistry, Cohort, Medicine, Lipid profile, business, Cross national
Abstract

Abstract Background Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition that represents a therapeutic challenge. The vast majority of HoFH patients fail to achieve LDL-C targets when treated with the standard protocol, which associates maximally tolerated dose of lipid-lowering medications with lipoprotein apheresis (LA). Lomitapide is an emerging therapy in HoFH, but its place in the treatment algorithm is disputed because a comparison of its long-term efficacy versus LA in reducing LDL-C burden is not available. We assessed changes in long-term LDL-C burden and goals achievement in two independent HoFH patients’ cohorts, one treated with lomitapide in Italy (n = 30) and the other with LA in France (n = 29). Results The two cohorts differed significantly for genotype (p = 0.004), baseline lipid profile (p padj = 0.004). Yearly on-treatment LDL-C padj = 0.002). A trend towards fewer total cardiovascular events was observed in the Lomitapide than in the LA cohort. Conclusions In comparison with LA, lomitapide appears to provide a better control of LDL-C in HoFH. Further studies are needed to confirm this data and establish whether this translates into a reduction of cardiovascular risk.

Published
2021

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