-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*Only for medical professionals to read and refer to CHANCE-2 research publication: 9 days after receiving the manuscript, the editorial department decided: send it immediately! On October 28, 2021, the New England Journal of Medicine (NEJM) published online CHANCE-2 research results of Professor Wang Yongjun's team, Dean of Beijing Tiantan Hospital Affiliated to Capital Medical University and Deputy Director of the National Neurological Diseases Clinical Medicine Research Center.
For patients with mild ischemic stroke and transient ischemic attack (TIA) who carry the CYP2C19 inactivating allele, ticagrelor combined with aspirin is more effective than clopidogrel combined with aspirin in preventing stroke recurrence, the former is better than the latter The stroke recurrence rate was reduced by 23% within 90 days
.
The results of this study are of great value for the secondary prevention of stroke in Asian populations, because about 60% of Asian populations carry the CYP2C19 inactivated allele.
After the study was published, it caused a huge sensation in the academic community
.
For this reason, Professor Wang Yongjun, the head of the "medical community" dialogue research, invited Professor Wang to give an authoritative interpretation of the research and at the same time told us the story behind the research
.
It is recommended that patients undergo bedside rapid genetic testing before medication.
According to the current guidelines, two types of people are suitable for dual antiplatelet therapy: one type is stroke onset less than 24 hours, and the National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 points The second is high-risk TIA, patients with ABCD-2 score of 4 or more.
These two groups are called high-risk non-disabling cerebrovascular disease, and they are suitable for dual antiplatelet therapy in the early stage
.
According to the results of the CHANCE-2 study, if you can accept bedside genetic testing and change the dressing under genetic guidance, the patient's prognosis will be better, and the benefit will increase by about 23%
.
Although the current evidence is not enough to support that all patients must be tested, clinical bedside genetic testing is encouraged, which may be a chance for patients to get a better prognosis
.
Professor Wang Yongjun suggested that as long as patients are using P2Y12 receptor antagonists, especially those who need to take clopidogrel, it is best to have a genetic test
.
The US FDA has added a black box warning to the clopidogrel instructions to remind patients that they need to test the genotype before using clopidogrel
.
"But they did not emphasize the'bedside'.
Cerebrovascular disease is an acute onset disease.
The treatment time window is very short.
It is best to perform rapid bedside genetic testing
.
With our rapid detection technology, the bedside test does not require blood to be drawn.
Mucosal swabs are sufficient, and results can be obtained in only 1 hour
.
” Although the CHANCE-2 study has made it clear that the combination of ticagrelor and aspirin can reduce patients with CYP2C19 inactivating alleles compared to clopidogrel and aspirin combination therapy3 Stroke recurrence rate within a month, but it is not possible to conclude that all Asian populations are more suitable to use ticagrelor
.
Like the international call, Professor Wang Yongjun's team is also calling for a head-to-head study of ticagrelor and clopidogrel for genetically normal people
.
Two highlights and one major shortcoming of CHANCE-2 The CHANCE-2 study is currently one of the best in the world in terms of sample size and overall experimental design
.
The biggest highlight of the research is that it is the world's first clinical trial in the field of precision medicine for cerebrovascular diseases, just like the first aspirin trial in 1997, with milestone significance
.
At the same time, it is also the world's first research on the use of rapid genetic testing technology in cerebrovascular diseases, and this technology is the original creation of the National Neurological Diseases Clinical Medicine Research Center
.
However, Professor Wang Yongjun also feels a little regretful about the CHANCE-2 research
.
"The biggest shortcoming is that the subjects are all from the Chinese population.
Therefore, whether the results of the study are universally applicable to the world is still a question mark
.
If it is a genetic-related global experiment, two populations of Caucasians and East Asians are generally required.
However, we did not include the Caucasian population in our study
.
"Although the CHANCE-2 study can be said to be a pioneer in this field, due to the single ethnicity of the subjects and the great influence of genes on drug treatment, the research conclusions cannot be applied globally.
People, so the European and American guidelines will not be rewritten in the short term
.
Professor Wang Yongjun explained that the fact that the Caucasian population was not included in the group was restricted by the current system in the field of scientific research in China
.
It is difficult for Chinese scientific researchers to conduct clinical trials abroad due to the difficulty of overseas research funds
.
It is also for this reason that it is difficult for the Chinese to initiate and lead the completion of the current global multi-center trials, and we can only join the research as ordinary participants
.
"If we have this condition, we must choose a country in Europe to complete the subgroup analysis of the Caucasian race, so that the research results will be more comprehensive and more universal
.
" However, foreign researchers see CHANCE-2 After the study was published, I also realized this problem and responded quickly, requesting support from Chinese researchers
.
Professor Wang Yongjun was very pleased with this: "The first email I dealt with after getting up this morning was from a German laboratory.
They hoped to repeat the CHANCE-2 study, but Germany does not have our rapid testing equipment
.
I will definitely support Germany to carry out this test.
Go ahead
.
If the results of CHANCE-2 can be replicated in Germany, our research conclusions can be applied globally, not just in Asia
.
"This means that the results of the CHANCE-2 study will be of great significance to the treatment of cerebrovascular diseases in all human beings
.
Professor Wang Yongjun also revealed a small inside story: "It is very difficult for Chinese researchers to publish articles internationally, unless the research design or conclusion It is extremely novel and irreplaceable like CHANCE-2, it is difficult to score high
.
Wherever there is a simultaneous global multi-center study in the world, CHANCE-2 has a high probability of not being published in NEJM
.
"If the results of the CHANCE-2 study in the Caucasian race are predicted, Professor Wang Yongjun believes that theoretically it will also be a positive result
.
Because the CYP2C19 loss-of-function allele was first discovered in France, the initial research is basically It was done on white people
.
Since the CHANCE study was published in NEJM in 2013, the world, especially Western countries, has always had a high voice for CHANCE-2 research.
The academic community generally believes that anti-platelet therapy debates need to wait for CHANCE-2 results.
After I came out, it subsided
.
What is proud of is that this research was finally done by the Chinese
.
As for why foreign countries did not take the lead in conducting CHANCE-2 research, Professor Wang Yongjun believes that there are many reasons
.
The limitation of rapid genetic testing at the bedside is also an important reason
.
"It took us two or three years to achieve a breakthrough in this technology, and finally let it enter clinical applications
.
In addition, the carrying rate of CYP2C19 inactivated alleles in Europeans and Americans is only over 20%, while our carrying rate is close to 60%, so this is not a particularly serious problem for them, and it is not easy to raise research funds
.
"In 9 days, the NEJM editorial department decided to publish it
.
Within 3 months, Professor Wang Yongjun shared with the "medical community" several interesting things during the submission period .
"When we submitted the manuscript, the NEJM editorial department said,'You have to be mentally prepared.
Recently, we have to read almost 100 manuscripts related to COVID-19 every day, and other articles are also quite full
.
'But after the article was submitted, it only stayed in the editorial department for 4 days before being sent for external review.
The three external review experts quickly reported back to the editorial department after a total of 5 days of review
.
After just 9 days, the editorial department gave the final decision and let us supplement the data
.
This means that the submission has been accepted
.
The team hurriedly added 20 sets of data and met the editorial department's requirements
.
According to the normal five-month rhythm, the manuscript was submitted in July and will be published in early December.
The editorial department also replied that the schedule may be the first half of December
.
However, the occurrence of another incident promoted the publication process of the article
.
It
coincided with the World Stroke Conference (WSC), and a subgroup analysis of the CHANCE-2 study was given the opportunity to report at the conference
.
"At this time, I must edit with NEJM.
The Ministry greeted me.
If I speak at the conference before the article has been published, it means that the data has been released in advance, and the magazine is not allowed
.
I will inform the editorial department that on October 28th, the WSC conference, I originally planned to report the data of CHANCE-2, do I need to cancel it? The editorial department responded that an issue of the magazine will be published on October 28th, which will coincide with the speeches at the conference
.
In this way, the subgroup analysis that was originally scheduled to be reported was directly replaced by the main report
.
I will speak at the conference at 6:40, and the research will be published in NEJM at 6:45.
.
"It's all so coincidental and smooth, as if it was God's will
.
CHANCE-2 shined at the WSC meeting and became the most important research at the meeting.
It was also selected as one of the five breakthrough research studies of the year (CHANCE-2 study is still The only research published in the top issue of NEJM); there are also several accounts on the foreign website Twitter that simultaneously broadcast the report of Professor Wang Yongjun, so that our Chinese research is in the international limelight
.
"Thrifty" Chinese researcher, Hua Small money for big things, Professor Wang Yongjun also mentioned that, despite the success of CHANCE-2 research, it actually “not cost much money
.
”
Clinical research is very expensive , tens of millions or even hundreds of millions of dollars at every turn, but CHANCE-2 This project is not expensive, so it must be calculated carefully, and every penny is spent on the edge
.
He laughed and said, "I told the foreigner that our research cost less than 40 million yuan, which is more than 5 million US dollars.
They didn't believe it.
, But that’s how it saves
.
Chinese clinicians are very cute.
With such a small amount of money, a large-scale clinical trial involving more than 6,000 people has been launched, and the initial screening reached 11,255.
It took more than a year for the screening alone
.
This is simply impossible abroad
.
"Next, the team has several research projects proceeding in an orderly manner
.
One of the largest antiplatelet drug trials so far has just ended; the world's largest trial of a new domestic thrombolytic drug has enrolled 80% of patients, and it is expected to be the first time next year.
Enrollment can be completed in the first quarter; CHANCE-3, a companion chapter of CHANCE-2 research, is also under planning
.
Finally, I sincerely wish that the research of Professor Wang Yongjun's team can be successfully published, so that the Chinese research results will continue to show off on the world stage!
For patients with mild ischemic stroke and transient ischemic attack (TIA) who carry the CYP2C19 inactivating allele, ticagrelor combined with aspirin is more effective than clopidogrel combined with aspirin in preventing stroke recurrence, the former is better than the latter The stroke recurrence rate was reduced by 23% within 90 days
.
The results of this study are of great value for the secondary prevention of stroke in Asian populations, because about 60% of Asian populations carry the CYP2C19 inactivated allele.
After the study was published, it caused a huge sensation in the academic community
.
For this reason, Professor Wang Yongjun, the head of the "medical community" dialogue research, invited Professor Wang to give an authoritative interpretation of the research and at the same time told us the story behind the research
.
It is recommended that patients undergo bedside rapid genetic testing before medication.
According to the current guidelines, two types of people are suitable for dual antiplatelet therapy: one type is stroke onset less than 24 hours, and the National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 points The second is high-risk TIA, patients with ABCD-2 score of 4 or more.
These two groups are called high-risk non-disabling cerebrovascular disease, and they are suitable for dual antiplatelet therapy in the early stage
.
According to the results of the CHANCE-2 study, if you can accept bedside genetic testing and change the dressing under genetic guidance, the patient's prognosis will be better, and the benefit will increase by about 23%
.
Although the current evidence is not enough to support that all patients must be tested, clinical bedside genetic testing is encouraged, which may be a chance for patients to get a better prognosis
.
Professor Wang Yongjun suggested that as long as patients are using P2Y12 receptor antagonists, especially those who need to take clopidogrel, it is best to have a genetic test
.
The US FDA has added a black box warning to the clopidogrel instructions to remind patients that they need to test the genotype before using clopidogrel
.
"But they did not emphasize the'bedside'.
Cerebrovascular disease is an acute onset disease.
The treatment time window is very short.
It is best to perform rapid bedside genetic testing
.
With our rapid detection technology, the bedside test does not require blood to be drawn.
Mucosal swabs are sufficient, and results can be obtained in only 1 hour
.
” Although the CHANCE-2 study has made it clear that the combination of ticagrelor and aspirin can reduce patients with CYP2C19 inactivating alleles compared to clopidogrel and aspirin combination therapy3 Stroke recurrence rate within a month, but it is not possible to conclude that all Asian populations are more suitable to use ticagrelor
.
Like the international call, Professor Wang Yongjun's team is also calling for a head-to-head study of ticagrelor and clopidogrel for genetically normal people
.
Two highlights and one major shortcoming of CHANCE-2 The CHANCE-2 study is currently one of the best in the world in terms of sample size and overall experimental design
.
The biggest highlight of the research is that it is the world's first clinical trial in the field of precision medicine for cerebrovascular diseases, just like the first aspirin trial in 1997, with milestone significance
.
At the same time, it is also the world's first research on the use of rapid genetic testing technology in cerebrovascular diseases, and this technology is the original creation of the National Neurological Diseases Clinical Medicine Research Center
.
However, Professor Wang Yongjun also feels a little regretful about the CHANCE-2 research
.
"The biggest shortcoming is that the subjects are all from the Chinese population.
Therefore, whether the results of the study are universally applicable to the world is still a question mark
.
If it is a genetic-related global experiment, two populations of Caucasians and East Asians are generally required.
However, we did not include the Caucasian population in our study
.
"Although the CHANCE-2 study can be said to be a pioneer in this field, due to the single ethnicity of the subjects and the great influence of genes on drug treatment, the research conclusions cannot be applied globally.
People, so the European and American guidelines will not be rewritten in the short term
.
Professor Wang Yongjun explained that the fact that the Caucasian population was not included in the group was restricted by the current system in the field of scientific research in China
.
It is difficult for Chinese scientific researchers to conduct clinical trials abroad due to the difficulty of overseas research funds
.
It is also for this reason that it is difficult for the Chinese to initiate and lead the completion of the current global multi-center trials, and we can only join the research as ordinary participants
.
"If we have this condition, we must choose a country in Europe to complete the subgroup analysis of the Caucasian race, so that the research results will be more comprehensive and more universal
.
" However, foreign researchers see CHANCE-2 After the study was published, I also realized this problem and responded quickly, requesting support from Chinese researchers
.
Professor Wang Yongjun was very pleased with this: "The first email I dealt with after getting up this morning was from a German laboratory.
They hoped to repeat the CHANCE-2 study, but Germany does not have our rapid testing equipment
.
I will definitely support Germany to carry out this test.
Go ahead
.
If the results of CHANCE-2 can be replicated in Germany, our research conclusions can be applied globally, not just in Asia
.
"This means that the results of the CHANCE-2 study will be of great significance to the treatment of cerebrovascular diseases in all human beings
.
Professor Wang Yongjun also revealed a small inside story: "It is very difficult for Chinese researchers to publish articles internationally, unless the research design or conclusion It is extremely novel and irreplaceable like CHANCE-2, it is difficult to score high
.
Wherever there is a simultaneous global multi-center study in the world, CHANCE-2 has a high probability of not being published in NEJM
.
"If the results of the CHANCE-2 study in the Caucasian race are predicted, Professor Wang Yongjun believes that theoretically it will also be a positive result
.
Because the CYP2C19 loss-of-function allele was first discovered in France, the initial research is basically It was done on white people
.
Since the CHANCE study was published in NEJM in 2013, the world, especially Western countries, has always had a high voice for CHANCE-2 research.
The academic community generally believes that anti-platelet therapy debates need to wait for CHANCE-2 results.
After I came out, it subsided
.
What is proud of is that this research was finally done by the Chinese
.
As for why foreign countries did not take the lead in conducting CHANCE-2 research, Professor Wang Yongjun believes that there are many reasons
.
The limitation of rapid genetic testing at the bedside is also an important reason
.
"It took us two or three years to achieve a breakthrough in this technology, and finally let it enter clinical applications
.
In addition, the carrying rate of CYP2C19 inactivated alleles in Europeans and Americans is only over 20%, while our carrying rate is close to 60%, so this is not a particularly serious problem for them, and it is not easy to raise research funds
.
"In 9 days, the NEJM editorial department decided to publish it
.
Within 3 months, Professor Wang Yongjun shared with the "medical community" several interesting things during the submission period .
"When we submitted the manuscript, the NEJM editorial department said,'You have to be mentally prepared.
Recently, we have to read almost 100 manuscripts related to COVID-19 every day, and other articles are also quite full
.
'But after the article was submitted, it only stayed in the editorial department for 4 days before being sent for external review.
The three external review experts quickly reported back to the editorial department after a total of 5 days of review
.
After just 9 days, the editorial department gave the final decision and let us supplement the data
.
This means that the submission has been accepted
.
The team hurriedly added 20 sets of data and met the editorial department's requirements
.
According to the normal five-month rhythm, the manuscript was submitted in July and will be published in early December.
The editorial department also replied that the schedule may be the first half of December
.
However, the occurrence of another incident promoted the publication process of the article
.
It
coincided with the World Stroke Conference (WSC), and a subgroup analysis of the CHANCE-2 study was given the opportunity to report at the conference
.
"At this time, I must edit with NEJM.
The Ministry greeted me.
If I speak at the conference before the article has been published, it means that the data has been released in advance, and the magazine is not allowed
.
I will inform the editorial department that on October 28th, the WSC conference, I originally planned to report the data of CHANCE-2, do I need to cancel it? The editorial department responded that an issue of the magazine will be published on October 28th, which will coincide with the speeches at the conference
.
In this way, the subgroup analysis that was originally scheduled to be reported was directly replaced by the main report
.
I will speak at the conference at 6:40, and the research will be published in NEJM at 6:45.
.
"It's all so coincidental and smooth, as if it was God's will
.
CHANCE-2 shined at the WSC meeting and became the most important research at the meeting.
It was also selected as one of the five breakthrough research studies of the year (CHANCE-2 study is still The only research published in the top issue of NEJM); there are also several accounts on the foreign website Twitter that simultaneously broadcast the report of Professor Wang Yongjun, so that our Chinese research is in the international limelight
.
"Thrifty" Chinese researcher, Hua Small money for big things, Professor Wang Yongjun also mentioned that, despite the success of CHANCE-2 research, it actually “not cost much money
.
”
Clinical research is very expensive , tens of millions or even hundreds of millions of dollars at every turn, but CHANCE-2 This project is not expensive, so it must be calculated carefully, and every penny is spent on the edge
.
He laughed and said, "I told the foreigner that our research cost less than 40 million yuan, which is more than 5 million US dollars.
They didn't believe it.
, But that’s how it saves
.
Chinese clinicians are very cute.
With such a small amount of money, a large-scale clinical trial involving more than 6,000 people has been launched, and the initial screening reached 11,255.
It took more than a year for the screening alone
.
This is simply impossible abroad
.
"Next, the team has several research projects proceeding in an orderly manner
.
One of the largest antiplatelet drug trials so far has just ended; the world's largest trial of a new domestic thrombolytic drug has enrolled 80% of patients, and it is expected to be the first time next year.
Enrollment can be completed in the first quarter; CHANCE-3, a companion chapter of CHANCE-2 research, is also under planning
.
Finally, I sincerely wish that the research of Professor Wang Yongjun's team can be successfully published, so that the Chinese research results will continue to show off on the world stage!
