The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.
Harrison M, Spooner L, Bansback N, Milbers K, Koehn C, Shojania K, Finckh A, Hudson M. Preventing rheumatoid arthritis: Preferences for and predicted uptake of preventive treatments among high risk individuals. PLoS ONE. 2019 Apr;14(4):e0216075.
A new publication led by Dr. Mark Harrison and co-authored by Drs. Nick Bansback and Kam Shojania describes the results of a study which aimed to understand the preferences, acceptable trade-offs, and potential uptake for preventative treatments in people at risk of developing rheumatoid arthritis (RA).
There is a window of time between three and five years before a person develops RA in which preventive treatments could be effective. There are a number of ongoing trials exploring potential preventive treatments, but this study sought to understand the treatment preferences of people at risk for RA. The research team conducted a discrete choice experiment (DCE) of people at risk of RA because they have relatives with the disease. The DCE focused on five key attributes of preventive treatments: disease reduction, type of administration (oral, injection etc.), side effect risk, certainty of evidence, and opinion of healthcare professional. These attributes were combined to create 18 distinct scenarios for a potential treatment. For example, a treatment could have moderate reduction in risk, require weekly injections, carry a small risk of irreversible side effects, have limited certainty of evidence, and be preferred by a healthcare professional. Participants completed questions comparing potential treatment scenarios; in each question, they were first asked to choose between one of the two options and then choose between their first choice and no treatment.
Results of the survey suggest that RA risk reduction is not the primary reason for preferring one treatment over another; treatment route/timing, healthcare professional preference, and side effects risk were all important. The tool allowed the researchers to predict that the treatment with highest uptake would be one that was convenient to take, offered low-to-moderate reduction in RA risk, and low risk of serious side-effects. They were also able to predict the required change in RA risk reduction conferred by a treatment to make it preferable over another treatment. For example, a drug which is administered via infusion would need to reduce the risk of RA by an additional 22 per cent to be preferable over a treatment which is taken orally. This study is a valuable addition to the literature because it can be used to inform the choice of which treatments to study and how great an effect is needed to make a treatment acceptable. It also highlights the significant impact that healthcare professionals’ opinions about a treatment can have on patient decisions and the need for decision support in this area.
Barbour SJ, Coppo R, Zhang H, Liu Z-H, Suzuki Y, et al.; International IgA Nephropathy Network. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med. 2019 Apr 13 epub ahead of print.
CHÉOS Scientist Dr. Sean Barbour led the design and development of a new statistical tool to predict disease progression and risk in patients with IgA nephropathy (IgAN), the most common form of glomerulonephritis, which affects the vessels of the kidney. Previously, there were no accurate tools available to predict kidney disease progression and guide treatment decisions in this population, which means that as many as 75% of patients who have low-risk disease may be treated unnecessarily and up to 33% of patients with high-risk disease are not being treated effectively.
Dr. Barbour led an international group of researchers and recruited a cohort of 2781 patients from Europe, China, and Japan to derive a model and a cohort of 1146 patients from other sites to validate it. The tool they designed can be used to predict the risk of either a significant decline in kidney function (50% decline in eGFR) or the development of end-stage kidney disease. The final tool accurately predicted which patients would develop more aggressive kidney disease and performed well in the validation cohort. The researchers also found that the routine clinical examination provided the information needed to measurably improve the predictive performance of the tool, meaning it can be easily implemented. Overall, development of this tool means more accurate prediction of risk after a patient is diagnosed with kidney disease. This will lead to better allocation of treatment to those who will benefit the most and improved targeted recruitment and feasibility in clinical trials. It will also allow for testing of the predictive benefit of adding new biomarkers to the statistical model in smaller studies.
Conklin AI, Yao CA, Richardson CG. Chronic sleep disturbance, not chronic sleep deprivation, is associated with self-rated health in adolescents. Prev Med. 2019;124:11-16.
Drs. Annalijn Conklin and Chris Richardson recently published an analysis of data from the BC Adolescent Substance Use Survey (BASUS) Study to determine the effect of sleep deprivation and disturbance on the self-rated health in young people. Sleep deprivation (less than 8 hours per night) and sleep disturbance (difficulty getting to or staying asleep) are common among young people and may affect mental and physical health. However, much of the data used to inform health promotion in this area are from studies using single measures of sleep quantity or quality (cross-sectional studies), most of which lack exploration of potential gender-specific effects.
Drs. Conklin and Richardson used data from the BASUS study at three time points over a year to measure cumulative sleep deprivation and disturbance to understand the longitudinal effects of these factors. Data from a total 3,104 students across 86 secondary schools in BC were included. Young people who reported chronic sleep disturbance were more likely to report non-excellent health than those who did not; 2.41 times more likely for men and 2.18 times more likely for women. However, when baseline depression status was included as a confounder, the effect of sleep disturbance on health was not seen, suggesting that mental health may be an important mediator of the relationship between health and sleep. No effect of chronic sleep deprivation on self-reported health was found in this study. The researchers concluded that further study is needed to understand the relationship between sleep disturbance and deprivation and health. For example, does poor-quality sleep affect health more than a lack of overall sleep or does it eventually lead to the development of sleep deprivation? The BASUS Study also did not measure physical activity or diet quality, factors which may have a significant impact on both sleep and health, and should be included in future research. The current analysis will help inform public health efforts to improve sleep quality and quantity in young people as well as the assessment of their overall health.