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Immunosuppression for Parkinson's disease - a new therapeutic strategy?
Caroline Williams-Gray is a Principal Research Associate in the Department of Clinical Neurosciences, University of Cambridge, and an honorary consultant neurologist specializing in Parkinson’s disease and movement disorders. She leads a translational research group investigating the clinical and biological heterogeneity of PD, with the ultimate goal of developing more targeted therapies for different Parkinson’s subtypes. Her recent work has focused on the theory that the immune system plays a significant role in mediating the heterogeneity of PD and its progression. Her lab is investigating this using blood and CSF -based immune markers, PET neuroimaging and neuropathology in stratified PD cohorts; and she is leading the first randomized controlled trial repurposing a peripheral immunosuppressive drug (azathioprine) to slow the progression of PD.
When to stop immune checkpoint inhibitor for malignant melanoma? Challenges in emulating target trials
Observational data have become a popular source of evidence for causal effects when no randomized controlled trial exists, or to supplement information provided by those. In practice, a wide range of designs and analytical choices exist, and one recent approach relies on the target trial emulation framework. This framework is particularly well suited to mimic what could be obtained in a specific randomized controlled trial, while avoiding time-related selection biases. In this abstract, we present how this framework could be useful to emulate trials in malignant melanoma, and the challenges faced when planning such a study using longitudinal observational data from a cohort study. More specifically, two questions are envisaged: duration of immune checkpoint inhibitors, and trials comparing treatment strategies for BRAF V600-mutant patients (targeted therapy as 1st line, followed by immunotherapy as 2nd line, vs. immunotherapy as 2nd line followed by targeted therapy as 1st line). Using data from 1027 participants to the MELBASE cohort, we detail the results for the emulation of a trial where immune checkpoint inhibitor would be stopped at 6 months vs. continued, in patients in response or with stable disease.
Leadership Support and Workplace Psychosocial Stressors
Research evidence indicates that psychosocial stressors such as work-life stress serves as a negative occupational exposure relating to poor health behaviors including smoking, poor food choices, low levels of exercise, and even decreased sleep time, as well as a number of chronic health outcomes. The association between work-life stress and adverse health behaviors and chronic health suggests that Occupational Health Psychology (OHP) interventions such as leadership support trainings may be helpful in mitigating effects of work-life stress and improving health, consistent with the Total Worker Health approach. This presentation will review workplace psychosocial stressors and leadership training approaches to reduces stress and improve health, highlighting a randomized controlled trial, the Military Employee Sleep and Health study.
Impact evaluation for COVID-19 non-pharmaceutical interventions: what is (un)knowable?
COVID-19 non-pharmaceutical intervention (NPI) policies have been one of the most important and contentious decisions of our time. Beyond even the "normal" inherent difficulties in impact evaluation with observational data, COVID-19 NPI policy evaluation is complicated by additional challenges related to infectious disease dynamics and lags, lack of direct observation of key outcomes, and a multiplicity of interventions occurring on an accelerated time scale. Randomized controlled trials also suffer from what is feasible and ethical to randomize as well as the sheer scale, scope, time, and resources required for an NPI trial to be informative (or at least not misinformative). In this talk, Dr. Haber will discuss the challenges in generating useful evidence for COVID-19 NPIs, the landscape of the literature, and highlight key controversies in several high profile studies over the course of the pandemic. Chasing after unknowables poses major problems for the metascience/replicability movement, institutional research science, and decision makers. If the only choices for informing an important topic are "weak study design" vs "do nothing," when is "do nothing" the best choice?