Kirk fc►r S~rif~u~ Ga~tc•o ~itestit~a Campl c~tior~~ tei~ted
`try Use «f I~ic~nsterc~~c~~l Anti-in~~rtrin~~tc~ry~ Dr~r~;s
`
`A i~~Tei<~-a►~r~ka's
`
`Sitr'ine C'.. Gtif?ricl. ~1t). tilSc: ~.ii~a J:~:~kkirniiiien, ~tS4; anci C'Iur~ C3~rnif+;~rclic~r'. ~ti)
`
`~bJectPve: 7a d~soribs the r~~ative risk for s~rinus
`~astr~irrt~stin~l complications due tc~ nanaspirin non-
`sleroidal anti-inflammatory drug (NSAI~7) exppsure
`among NSAID users as eveli as in selEct~d su~agroup~.
`Oesign: pverview and meta-an~fysis.
`Oita ldenfif}cation: A literature search of EngHsh-
`I~tngu~ge studies ~xan~ininy the ~issoci~tion b€stw~an
`NSAIas and adverse g~trointestinal events for the pe-
`ri~81975 to 1990 tden[i[ied using MEDUN~ end cpmmu-
`nl~aiing vrith three int~rrt~tion~ily ~~cagniz~d axperts.
`n &7r~ta Analysis: A qu~Atat ve summary of study char-
`aeteristics anei a critical appraisal at study qu~tity were
`done. The results of f~ primary studies were selected
`and combined stntisticaify. Sumrnriry estim~rtcs were
`wEiylit~sd by s~rnple Size and quality scorn.
`n Main Results: The overall odds ratio of the risk for
`adverse ~~s~rointestinal events related to NSAiD usb,
`surnm3rixed from 15 studies (9 case-control and 7
`cohort) w~S 2.7~i (~J5°Io GIB 2.54 tb 2.97}. The summary
`odds ratia~ were as follows: ~idQrly paEionts. (a~~d
`BO years), 5.52 SCI, 4,@3 to G,60); patients under 65
`years of agQ, 1,65 (Gi, 1,08 to 2.53j; women, 2.32 (Ci,
`t_91 to 2.82); and men, 2.40 ~Ci, 1.85 'to 3,11). The
`summary adds ratio for NSAIO ~rsers receiving cnncnrn-
`itant cbrticasferaid~ ct~mparad with NSAID users not
`receivn~7 corticosteroics was 1.83 (GE, 1.20 to 2.T8). The
`summary odds ratio for i#ie first gastrointestinal evant
`was 2.39 (Ct, 2.16 to 2.85. The relative risk far a.
`~ul~s~qu~nt fir ~,nspeeified ga~trointestinza! ~veni was
`4.7G (Ci, 4.05 to 5.59}. The summery adds r~71io for less
`than 1 month of NSAId exposure was 8.00 (CI, 8.37 to
`t0.O6j; for more than 1 month but 14ss than 3 months of
`oxposura, Zhe summery odds ratio way 3.31 (~1, 2,27 to
`4.82); and for more tM~n 3 rnonth~ of Fxpnsure, the
`summary odds ratio was 1.92 ~Ck. 1.19 to 3.'13}.
`Conctusions;Users of NSAIDs are at approxirndteCy
`throe times greatQr rel.ztive eisk for ct~vela~ing serious
`adverse ga$troinf~~tinat evor~Gs than are nonusers. Ad-
`~iitional eisk factors inek~de ~qe c~re~ier thbn 60 y€~~rs,
`pravious history of gastrofnlestinaf events, s~~d con-
`camitant corCicosiaroid ruse. Another passible r+sk fac-
`tor is tha first 3 months of NS~AID therapy. Ths risk for
`carious g~stroint~stin~l evants ~PAears to be equal
`arnang men end women. These data represent sum-
`mary statistics from f B studies and cannot be consid-
`~red ~~ner~lizab(~ to III h(SA(b ~~s~rs,
`
`rl~tturl_e oP I.niz~rn«t ~J~flieirr<~. 19`11;1t~ ~!~' ~~3(,
`
`41.. ;,~ ('htsi. acrd 11,~ti~~ t~uAirt latit5n. H w}sc~irr. Atali.
`E tU~r7 IE
`rjc±ot.a; ar.,. A1 ~~Ili-4
`(~~igptt.+[, "d irfi~ttC~, ~1n1€~r~<. F~tP Clttretti
`:wtiouP ..J.!i.~. ,.
`., ,.- encl ti~~ feel.
`
`irest~ tEruid«il Kind-init im~t7~iScjry dr~~~;~ I vSrilE)s~ ara
`ihG rtic~st wicici~' used ~attex~t~ ft~r ttr~ tt~cxUmcat of~ mus-
`cuic~~kcl~t;Al arts) tsr'thritic ~;}'nclrt~mcw (lj, Eis~ t~('thus
`a~ur~tg }t~ry hen incr~:,,.icYi:[}~ ~~~sC~~:i~G~~t( wi~l~ ~tisEr~yin-
`tc;tirtai t~s~icity, inciuclio~_ miitl citi~s~epsi:~, as will as
`mc~i~ str'i<~ti~ ~:~struintc~ii;i:~l tr:iCut~Yts such a~ hleGtlirt~;.
`~r•Kf~or~ryc~n, y~n~l other r, cau~ ic<iclin~: icy ►ic~s~iicxlii,4lit~n
`ur dr:~t~. zllttiaush r~sr:~r~~hwr~ zi~r~a ih.si atn ~n~.re€cccd
`Pi k f ~~ c,~~~rc>intc~tit~ ~l lcaxicity exists ~+'ittr tiSAIC) ~ts4.
`tfic si~o ~~t' ~trc 'rep~tirtEd ruk 3i=i5~ varied ma~htdty, ccrtGl
`~i~ee4 i~ little ~i~;r ~~ile~it nn fttu ctel nitit5r~ uf" .`kri~h risk'.
`rc t ~ ~ ; `-i9),
`~! ~ rc~. ic~t~etl Cft+~ lit~raatdne utt NSrUD~rc~lated :reia~zt's~
`r:~.t~,;int~stiitat ~~cntr. [=~r~t. ivy .~tnini.irdf~d sitody
`ctr,~.~ri<~ii~.~ic~ ttnYl a,~+~rri.c~ stu~M r~uality Wc. lht~n dicl
`,t ~i~rt~~-~nz~l}~i` a(' .III <<~ntri~llc~! trials thai Examined
`ifir risky fear serit~u~ };ti•irvintestin4~l ev~nr. ~srns~c~
`\ti.=U t7 tt~r~s. (3ur S~r~n~rit~` uhj~etivi u.rs t:r cstir~t[dc t~
`sumfl~~r}' c~~ld~ r~ua ire' E'c~~x~tT~~c r~~k iut ~~ri~~GsY ~;;~~tr~~_
`in[i:stintal 41~tn~±itct~uoiis cit~c to titmatipirin ~SA((~ c~~e~~
`tieire.
`
`~'tethr~dt
`
`i c<,rr~~»nc~n4ive ~U,~ri}i 'rk 4tfe r:n~li tt~l„n,~u,F~~, iitcr,.tury
`„~trt C9"1~+4u 14fXVic , i~~trdut~~e•rtusi~7c ~II`i1( [tl .incl scatch-
`'~;C }u~lclN is]~dl"IlTi~ €~I1ti-n~, l'.1Ytlni.ilui~ r.c a'~. G.,,~I-ti3~: ('S~i~
`~il~_rl „i ....~ f~.~tti;~~~.~-
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`nJ :tny s.il.3tic~n t}rit
`nUi~~r.
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`~ re rrvi< <d ~;~ ~
`_.~ i Jn~.•t~in ~I ~cula ~~e~ titlecteGl
`amrk~i~xzCel ~:~A117-ril c 1
`tf~;~urc 11, OC~c h~~iJ~ec) t~., ~, i~.~~ ,c~~.:~ mea thi°„°rit~riorr
`r'~~i. five ndcli~
`urfd tiv~rc rntcrecl int~~ •~R~tc~.n..~ 1t:-.~~ _
`ni._,~I+~~ii a+i;fY tf3tR'4.
`.~~, ~
`?Girrt:il .erti~lc5 tccrc i)n'.~'.~.~~J
`iri~c tili~Xa(trY~{."•1.v is (~ri li!n. A111, Sl i~li.~ I I..,:: cr.itl. ~~1): ii0c1
`t ;~te.l hn~gt3om,
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`n~_ic a'd«i 4~i tfic
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`:trtd C`:znR~.
`~~~,r:E tc~. i~~r ~G ~,.~..~i , , i r' .:,i~~_
`
`~;niin~ 1 ~..~ ,,. ~~.i ~l .~n 1-c~~~.'r it A5VIlh _i fti~
`~Cdcc~ Fh81
`~~u'-. `: F~cc ins :i~ ~~~i~m :~n~1 rti:lli~
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`~~U li v :nd: n~tti!c: fttl~t° ~Ty
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`.~- I ~~
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`h~,n .q ~.i~: ,iiih~~i-,
`n•, .~-f lil..ii~ ~,'- i.~f, I.I ,-: n~iu, ~~t ~~~; ~i l,_~
`_i-i:~-~.~nd pi u~.i;i ~E
`~l~rJ~n,.'.. {°cihn.~t i~~n. or .~I ~tvt
`..I ~utn~ li..i!t~~t~. iJi Iii ~_d ,:
`1 i; :i~jt 9t t'~f
`.,,. _. ~t ~. .. .I ._~J .. ,c~i:, .. .uhn; :n 1,
`,~. iz c{tr ,- ~C
`1 -:t6~ ni ..AII) ~, i- ~:~n?.c t ~. ~.=h ❑mm~m.
`ur. Ii i,ir~~ ni Ihr iuci.~ n:.;~ii.. :1
`_<
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`~ ~ .,_ . ~k :1 tk~~ ~ ~:~! 4c.~c~i ~r~~~n ~:~ r::~liartts, .1 ti„~ ,only
`cai,~
`~ 1. ~I71i: E:~~d tl Yilll'i~ ~\;tj
`.~ l~kl li=, iJf :I I
`i~~
`l r~~t) ,'. JI'. ~i) t~. .:-.
`
`~? ft~Il .1t»crit m C',~ll~':;r a( Plivsocio-~ns 787
`
`Uo~v'nloadcd I' nam: idtp:Nanualti.orq! by a Rep~•ints Ucsk User ou 113i20121t1.°+
`
`Page 1 of 10
`
`Patent Owner Ex. 2008
`CFAD v. Pozen
`PR2015-01718
`
`

`
`SEl.E~71C}N QF STUCJI~S AND REVIEWS
`saan i~. ~vpicor
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`Fi~Girs 1. ~~lc~titan ref 3tudictcmd r~~v1~,~..
`
`the ititnttliC.ills~n u1 t31i~t t'a[htt lP7aq life ~+r~scnc~ i~( ~crirws
`~ns~raintestin~sl ~o~rrplicatirfn,. !)isagr~ci~ients bct~tieen tfi~e t+ro
`rcv°ieucr~ ~verc resolved !>5' gun rnsiiv ti'ttsecn sta~cli4s +sere
`~cl~:ctcd CZ~~-3b) Et~r mct.4-;ztinlysi3 (,ree Cigurc il.
`
`41Gu~-atu~lysic
`
`l'h~ I~ilfc~+~in~ cri~aria were used t~ i<alut~tc the quaiit~ of
`the 4Curli~sinaludeil in iha met,~~ea~~ity;.ts: L~lindi~~, dr~initit~i~ cat
`ouicamc, cu~~ aclec;lion, ionlfi,i xztzciu>n, nr7tehinv t~: ~t~r~iEZ~re,
`~3ehn~ti~sn a(~zxpasurc, ~~nd rantrol for cunY~;nrcicrs f tppendix
`:U. ~t'fis M11~t}~c7ds sc~[i~n cf caih rtady .i:ti ~hc~ ~„r;; d. ~..~th
`pare t<Eken tq e~rGlude ,env rncnNon A:~f the F~u~hd>r.' n.~ni~s.
`study revutix, or jcwirn.il title. 1tt~dy qu~:lity vas nv;~fuat~d in ~
`hiindeK3 ~~sti;~n ?~y hmu of ahe incr~tis.~tars~ Qu~iity ~~ttres
`Ia its relative i~tipot~-
`~~~~I~r
`uate niwignec( Cca cR~h ~isif~rtttn
`t.An~~. A quality z~rc of Cl mai~.~.~czl ,~,.,r c~cfiniti~rt4 snJ tso
`a11cn7~at ter ,avoid hisis. anel n scare of C6 ~ndicataci !h~ ~con-
`:erse, ~S~he ~sver~r~e ~e<~rc tF+~:t~v~cn !hC h~q r~ader~) ttnrong It~c
`i~rxG sir c.~tc~;orie~ consUCutcii the M,~+o[ine secure 4'r~r the sludr~.
`(-`car aacry S ctnfoi~ndcry ids.»titiec~ in a ~rim.aey study. I k~oru~~s
`ptiiru ~vaa a~a~,irdpd, t~~ tt mssxiinurn of 5 E~>ints #car .ttid~cs sb2u
`icE4nUfied mgr's itsan i5 cc~n(aunciea'i.'LPit~ti, ~h+~ m.Gnymvrrs grie5E-
`ity scare ,~it,~im~bic was SI. A~errement.bctwecr~ she two read.
`'ts T'Cf:;srdiog the gti~2Yity s~<~Ce x~aF e~= ~Iut~iid using the ka~pDt~
`tiCatll~. (37}.
`tYitu frarri ;dl sirticle~ ~~crc ab~tr~ctr~ in ~tu{~licrstc ~o avvici
`etr;~i, [h ~ Itivc~ ~h .rr.cr. r,~,t7. cli~,~u.~cd c.rh iicnr, .end ic.~~lvc~3
`f~ ~1~,~.;;:r :i~7fDlS ittld cu~~:~.:'~ 11ii.d t~~~,~ o~ UiC. ,q:F,Ict~J ~1t~liY
`~~:..i~;,~;.
`-,I ~rxi ~n~ei~,d r
`cal.~~u~,n ~'~rros w~~ tl~rn c.
`~, 6~e~~r,,x,r c ~.~Lt;,~~ ~
`~
`i :si
`{GFt~CL k., C)racic f ~~rp~,~,~i
``Chi reiu~~~ et the Ih ~rirn ~ stadics wire c~>tnf~:n~~:l ~c~~~,
`fically ~rrn~ twer dd7crr,nt tc~hn~yiFrs, Fdrs~, ouc~;~U pars' c,i~-
`~Ttpi~s of thr oeld~ taUus a~it1 4C~4• ccrnfe~3~nctr in(-z~..~f~ ;(~~,~
`~a~are c'alcul3Ccd fr~~tn d~c rasp' d:At:n ~>f SRC Ib ~ti~f«tc~; •i~iJ~~~
`uxi~~~: the !~tantc~ Haanszel autistic X39). 'Ct~c sec~~n~t ~echerigiie
`irt~~of4~~~1 comf~intng !hr piihlisl'ted oticlt rau~c end C;Is ztirecNy
`wcr~,...ir„hc. i~~ ~,~~~Juct ~n avrrsdl e~~~matc of fhe cdtis ratio
`~n~l v~'; ~~I I-li}i. I he I.dter ~~~ill trere:ifter ~r~ reFcrrcd are as Ih~
`"d~r.xt" rnaihod. 1 he cliicct methnci «~+s 3tzc pnaxary s~siusti•
`cvl nn:~,.,!, itehnigo~: u•cd, rind sa11 results u~crc c:ticulaied
`using this rrtcEh~n[ unlr~;, ~,~t~~~~i~c ~tz~tcd.
`TtEe pirrposc of U~ , ~~~.~:~, ~;, waz nit Icy estinn~tt. ;~ c~3~rinu;n~
`{~,~rarrt~t~'c. ~+ut r~th~r ~ ~ e.~•mput~ ~i~a ,e3=ar:~~r ~~r ~Grrzi~2~~~r}~ ~k~-
`the CI fc;r ttti +tati~ti
`i+stiff icrc~sti the !(w electcc4 titudiE
`c~nn4[, therefore. tie gerier~lizecl beycrod she study •.,n~~sl~~.
`iAII surntn~try r+tirnates ~.~~erc ~~~ei~fl[eci by satt~~tls: , ~.c. "E~hc
`i.,~~.~1:. •,.~s
`inlluCnCc cif Stye gt~fihiv Storrs pn the ~usnm~aoti
`Ci~alu~tc~1 wing 1o~~slte-re~ression nnaiyvs ~+~it', cp~.,.!,;y ,~rvr~
`HIV ti C<l~pi`I31(:.
`(~vcra~ll ~ztFtts roan. Cnr all ~h~diec iti~Iu~Scd ire tPie rriets~•
`Rtn:dysi~ .Gs ~vcll as ucizis rea~~~ for vae~r~tis ~s~k~f;r~,~u}sg +vcre
`~ tetriatcd, '1"tic uver.tCl odds r.itir~s rctcre~d io the ~tdd. sati~~s
`
`ci~aibined him t1~c rrEain r~~,carc}~ gaestiens of each cif the
`slz~dies. 5urnrriar}~ od,l, ru~r, tvr s.~rious sub~rc~upc ~vZre 4wi1-
`cul:ited ~ri5m thnwc sUtdicv v.iuch pravidecl dt~ta en ih~sc sub-
`groupc. 7frc m¢thod of t~rc,ld~ti and l~fi~= µ~.~s used [p Itst fcrr
`honic~Fcnai~y ~~f thr >Lin~tel-F#nen~c~I ~stim^te5 t~l), `i'ect5 pit
`h~~~ni~sep~ity xcrz~ [i(scr ~~ed'<jr'mcd i~r lfae clirret methacl ac-
`epcciiag to the r[~eti~~Ht cat Circc~ni«ocl (4Ci),
`
`{~l'S11~1ti
`
`4We cfecCeet i(i sCuelics f9 c:~~~4 ci+ntrc~l ~~ni! 7 ~cihartj
`that s~ecificaNy etcurt~ned the risks fc7r clinicttt!}~ cic-
`tinrJ, ~SAt[7•rci<~tee1, ail~cr4e ~astrt~n[e:sfiinaf events
`f~l~;~Ei). `1'he r~p<~rtr~l re{.3tivc'ri~ks vari~et From @.(1 C34)
`(i~~~iacH[ing ~~s~ ~nci~;~,_~i ~i.{, Ft~r ~~strc~i~ti[~stlt7~l ~venCsl
`t<~ I3,7 (Z~li Giriclic,~~in4 ~+ risk i"or ?v5,~tkE) ~rsers 13.7
`tin~ns ~r~atcr 1li~sn ti~.t~ fie n~aeiscr~l. "("5~~~~ Ea~atenti~l
`suGir~cs crf ~~~~r<<bilitt' «ere idcrllitie<I~ dkicrsnces in
`Studv ch~+r,ict~ristics ~~n~3 dit1~~cenees in study q~aliiy.
`
`~tuciv Ctiaw.~ctcriticti
`
`tit~r<i}' char.+ctc~'isCi~s .iru vhe~tivn in Appendix k3. F~?r
`bc~?]i thu c.isc-canXrcl :+n~I cc>hc~rt sludtci, aci'iuu~ ~as-
`uu~ntcstina{ evcnti ~~~~re delincd am~ang hi~spit~l-bzrsed
`~~:~t~:s, ~rn~n~ itr~ ~r~.e-cunt€cat studies, ttGc ~scc~cZira-
`n1en1 of~ ~Rstroiiatz:~tin~ii ot~it;umc ~s~`~ not done in :r
`un l~~nn tnar~ner. (:nuointcstinal events wec4 itise~s
`P~,~~cd on ttir r4sttlt5 0~ an~~tscopy, rcrcntgcn~~~°:~~if}~, ~~r
`s~,~tccv t'`'•'St. 3z. ~~7 c,r- can =i clinirat diagnt~siti of
`t, m:~tesn~5iv ~>r mclerr~a {?~. 30-32}, ti~~rrtu easc-cc~n~rca(
`stu~ics u,c3 i<>(Ti(ttunit~t ec5ntrcrls t31. 3?, 3i). UthL•Cs
`con~ptire~ ~:~se~ ~vilh hospital c<~n[ro~~ (2~3-~fl, 12) or
`used b<~ih ~yEx~s of cuntrc~iti (2ti, ?7). 1+tc>st wttttlits
`matcEied controls d~reeCit «ith c:~ses t2(>-28, ?tl, 3I, 33).
`.I uu cage-Ecsntrcal stud C t+t~~i a~ nest4tl e.~sc-~~tltrCrl
`
`"Cut~1e t. Study Qutdity St~grc~
`
`S[udr
`lrc!'erencei
`
`fiacellnc.
`(T:~ttfic.
`
`f;tantls
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`{1.:~rd rt:~L 9't~~.
`Neefrdail ei n1. r~ I I F
`Arm~tra~ng aqd [11~wer (2~l)
`C. n~~ICP it Pkt{ ~'illtt t,~..?`)
`Ji~k ei ;ti, f3«3)t
`1{ct.rutsr ct stl, (3b1
`
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`,x % ~,F-er4 ~".<i irJ ~~.~,rd can ~~~ cvalu.td inn .rC the Ynp
`N.,,~•[li:~
`.- c~~~nsu rs, oa~tcam~, ca s~ arxl
`~ ~}~,~,:rt ~tenss: c.i I~cil J~..n~:
`in6~;=~ ,utd ~rGateY~in~;.
`the ~.rr ~
`tn,~~ ,. ~.~„ ~.- sarll
`.,t ; ~ .re on ~hc numlaer vi' canfnun~tars.
`- ~.i; a, ..
`• 1,~ ~~.,, ~
`~.n '.I.c ,~n~fy~ix_ Se•e Cexl tat ~ilClhal of
`u hash ~, _« ~~. ~~unr:.[ f
`~. r,>~~~,; ~ti nssfgnlTa~na.
`
`Tt38
`
`15 i1'ovcmbcr IfJ91 - Arurrrts aj fn~E~rnr1 ;SI~Jr<'in~ ~ b'~,lumr I15
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`VumE~er 10
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`E)ownloadect I~rnm: http:llau~~sdv.or~/6v i Rejirintc Desk Uccc on 0;12012(!15
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`Page 2 of 10
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`Patent Owner Ex. 2008
`CFAD v. Pozen
`IPR2015-01718
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`

`
`IltdiVtdU~l ~ttidy ~d5 RdtiOS
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`3(ud~~ and
`F'i~ure 2. Indivitfu~it
`sUMtIIAPk t9(ltiS P~L~Oe. ~fi{jf t~ii~t3.i)
`4~U~~' Eh)i~". Y:IIl01 :IYi Y5E7"3 MC;Nt~ ifl
`C1(~1kY O} 1f4tYC:151t1~; SflllYp~l' SI(.0
`(1CYp in b(71111fH ), ((1{~I'~'1U~tli1~ ti~UE~Y
`f:il lt3ti tYCfC. ETCnYIiI Ccf If{ if t~
`()tt(~
`or~~in;~i tiCudrs c?i~?B, 3t5 i'?, 3:i.
`1Ei) or rtiCLGd~+tctC Cram dats~ pro-
`vi~Ee+J in prigin;ri si~~dic i'_f~, 32,
`iSl. ~f. [tidiuitluaE c1Udy tads n~-
`IIQ; ~. 5Uf1Y tItY9 P}' t}(f[35 Cii(1i7; I}iE
`~S`~'C 1; Utt ~~(~C I7 C'f If7~f C~'1~5 :IIC Ifl~{S-
`C:,tF£(~ ~Y 1~iC` L'tfCYV1:Cl~ ~ItSCw; ~ Cl)-
`flOt! tlllc~y. ~ ~'i4`4'-CO~SfC)~ 4f ilik)';
`Uc~tC$ t?tt i(~5 Stl fYl fllAF'I~Ci~ tF} {~t'
`rest" tochn~q~ie I4U3; xnirnk~ers in
`ptarenttieses .~ri• the nur~itrce of
`stuclics cUmbinecl.'t
`
`Summary Odds Ratans ~
`
`c~ ~~~a
`
`c
`i• G! bleetlrc~ci (9J
`---~-- G~ :Sur~J~Y ta>
`--~-- Gi aw7~h {a)
`
`1.0
`
`10
`
`(7dds ~fiatp
`
`20
`
`40
`
`iles~tr t31. ~3}. (3~tcsmint~tron c,t 'VSAIC} exp«zurc
`~4~rc rn~y~3e ttiv ~~tt tt~th}irtdetl review of ~liniczit [x>tes
`(28.3t1'}. ,s stri~c~uretl gtie~nonnaire G~rith inter~ir,tver~s
`w13o w~ei~~ biinclad t2E~, ~7. 32. „i3~_ c>r ,~n exttacti~n of
`preseriptiatt data tr~~tn C>lu~rmcicy cc~rnputer tiles (31. 33'),
`In a!! cahori sCtklie;`, thG ,~ti~essntenl e>t' NSs~fC) e~po-
`suee u:~, t~tiscd ~m prescription tile, 1?stim=ices c~~' the
`clttr:iliErn z~t~ ~1ti:111} exG+u~tirc vtiriect frarr~ 3() ciEys 42x,
`4S) to 9{~ d<`~y (2', 2. +1.:141. ()ne cuh~~rl ~iud~' t'S1
`eramincd dct~ths C{'cent ~;«~trointc,stin<~t c~~c~ses, ~elticrcas
`the rr~r.~in~tcr luc~kc<E pit hospitril~zauons ~tsu~e~I ~i~ gas-
`trnirt:r,~in,d ~,~mptic:~ticrnw. S.~rriples zxaminect in the
`cahrart ,tuJics inclt~clect the Graup Health C<~c>per=itiue
`ire Puget ti~fu~uf; the ('cnnsyir<~nin 4icdi4=iic1 ~ro~~h tt~r
`resict~nts ctf Sask:~~che~ti't~n, C~tsntc~Gi; tn~! the rG+idcntc
`of ttie "f~ysicl4 ft<~tiean. ~ccrtland. '~I~tte Puge.i Sound
`fircn7G~ Ffcvlah C'ooper~iti~e re~rctienEs n younger, cm-
`ployed Ex)iatilsiticrrt, tt~e ~tcclit.iiic( grt~up iti e1<Iei~l)`, .uEJ
`the T'tivsictr anal Si~~kti~cht~~~~an ~;rotip~ reE~resCnt r~.'~i•
`t~cnts c~C~~c~~r~[zl~ica6ly d~~~~rsc c}ist~icts.
`
`Study (Zuality
`
``I ihle~. l 4h~7w: t#~c study quality ~ec~r~y, 41e.tlto<lulo~.i
`,i4~cssrnent cif' the lf~ stR±dies ht>~ved ic~eptabie s~crce.
`menl ~ctti~~~en t~vcr c~~servurs f'or ttae s~~~ st~icly ct~alit~~
`~<tt4E;c~rie~, cv~ilu<aecE (mean kappa. t1,i11; minimum. [).SG;
`m.~xirnurn. [l,$3}. `fhe rn~nn kr~p~~a f~~r the qutdity rate.
`yt~rp' tai` blinding ~.+5 Q.F? (~r~inirrtiia~m. ~.t1: mz+xinurm.
`1.11; f~~rr ea44 s~lcatiorr, 0.'~4 (minirr~um, t~:6~a; m.i~ime~~tt,
`9.9C1): for cUntrai 4sicwt~on. C~.En~ (rniniruiirn, t1.4; rnraxi-
`
`mum, l.i)7; fo~~ deiiniiiorr of c~p~sum.. t}.74 (~riinirrturtti,
`g,59; rnr«ime~m. 11.9(~~: t'c~e rnzttehing t~tPtniquL, ~.~~
`tminirr~urii, li.f;~?; ir~c~~irnun~, 1.p1, sinid far definitrc~n oi'
`c~utc~me. (1.~(~ tnrir~imi.~m, ff.t1; mc~~imtim, I,t~l). t)is-
`.~geeernent~ reg~r`dit~~ c«nt~e~J i~f ~t~~fpur~deeg +vcre rc-
`4'X[lR14t1C<~ FlllG~ FC~U~Vf[~ h{+ wCtiFl~t`. tl$li':. ~~hk. `ifC tiitl{~1~5
`wiit~ the 1~i~,he r quality scores were ca~c•e~ntrc>I stuff.
`ie~ {"f" iblc 1}. `[ hc~e >tu+,lies gave moire explicit ~fefi~ -
`ti~nc of ~a~e~. ~ontrofs, tiracf cxpct,~tre end nscd biindiag
`more Feequenfl~~.7 he study quality 5cc~re was not tpanct
`to bG a sib nificr+nE ct7v<iri.~t~ in the rc~;rcSei~T1 ~rii>ilek
`
`Siiriamar>~ ()cids itatic~s
`
`!'4it>lished o~3d+ r:iti~~s anti surrzrn irY c~Jds ratrc7~ fr~yrri
`the primary studies arc 4h~wn in ~ik~t~re ~. T~~G overall
`~ntii rt~ti~5 ot` the risi~ fc}r 4~ilvccsc ~aatr~rin(c~tirtts! ct~errtti
`ratr~ter~ Ct~ NSr1tD ~~ve fcurrMrrixa~izect front (b easww~c~n-
`Ceal and cah~~rt sfuJiesj it ?.7~5 {(;(, t.SJ in >.97). `['he
`stirnmt~ry c>dcis n~tlic, {cvr~~biaed from E3 studic.~) Ct+r tt~
`derly per4~ns fis S,5? dC~. Q.G3 tt~ b.t~(!j. In the cohun
`Stu<kies, th+: leerri "cicicrty,< refers to persons b5 yetiCS oil
`a};i ~~t` ti(eicP. (n ih~ rs~si`-ccintrt}I sit~dies. "'Eltt~rly" ri-
`I'ers to pers~ns fd~ y'4.;rs ~rf ~+~,c or ul4~fer. `C"tie summary
`c~~~~is ratio Cor non~idcrty pertir~ns, combirtcd from ~
`stu<lics, is 1.(~~ (C'1. C.t)`s. 2.i3). `Chew data shcnv a
`~rCt~tcr tti.~n threefold inrre<~« in ri~lative risk Car Seri•
`i~u~ ~:;+str~intcatinal ~ve;rty ;~mmnc~n~ ei~teely NSAC[~ uctrx
`when ~~rrip~rcii ~~FittY [~anet~lezly ust~'s.
`C)JcSs ratios ~4'ere ~~bdi4i~icd by k~s~rtitinlcslinai utii-
`
`f5 I~ov~trrtser ir:~!)
`
`~Irr~aals uJ Irr7rrnEil .t1er11<ir~c ~ Vr~lunte Its ~ NuniE~tr 1~ ~$~
`
`Do~cnlua~led [~ronr. hkkp:(lanunls.orgl6y :~ Reprints Uesic lfs~r on U3f2{i/2015
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`Page 3 of 10
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`Patent Owner Ex. 2008
`CFAD v. Pozen
`IPR2015-01718
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`'fab4e 2. C~~nip~ri~on of Sunienary° adds satins and CcSntideaer ►nterrais flbtsinecl tky "I'w~~ lkteihodc
`
`C'utcgor~r
`
`~
`
`F;umt~r of Siud{cs
`Corr~bi~cd
`
`summary (7dds (tatia
`
`45~r Ct
`
`OFer~11
`Natient k f~(1 years ~f,oge
`Patient -= GQ yeses of ~gc
`Cias[rointestirinl bleeding
`G ~s[ruintcstinaii wurgery
`Ciaslroint«tin:il c~ett~C o(` Jct+tft
`t!nspccifted zidverse X,3stcninte5tin~~l cvcnt
`
`f~"IC6f'
`G~~
`J3
`7~`R
`3?1
`3'A
`:~`3
`
`2:fi6'r~,1d~
`6.?a1~.S~
`3.t)71t.fi5
`«,~lr'..';iz)
`7.Q-tr7.i
`5.214.79
`~.fiH~'1;79
`
`2,62 to 3_i2's x,54 to ".97?
`S.~t to 7,~IFS; 4.f3 tq G.6t1
`1.62 tc~ 5.82; I.ON to 2,51
`2.'6 kt+ 3.2d; :.11 tc7 ?.7P
`5.30 [v X1.:9: 5.~3 u~ itJ.31
`?.24 [0 5.54; 3.frd !u t. a
`~.~2 to'_.9$; 1.7(1 to t,90
`
`1.~J.'. (CI. 1.19 tc~ 3.i3), Thi highest ocl~is ratios were
`~ht.~incc! trc~rrr stu~li~s in which the cFurRition of NSAID
`cunsumplioi~ ~v~c Ise th:it~ 1 month.
`[1.tE<< wcr~ alsrs {ub~iiuidecl try ~;astr~intestinal c;vent
`and ~gG (~Tahie 3l. Che rclati~~e risk for g~~tre~intestinR~i
`~ur~,ery for hc~n~lderiv inctiw[duals, corobin~d t~r<~m ih7ee
`studies. was 0,~4 (Gt, ~1.~9 to O,6fi), wt~ere~e the Fisk fee
`g<istrpintcstini surgery^ ~~rtic>ng cicicrly~ x;rsans, eont-
`bined frbnr three st~xli~~, w;rs 10.4 (Cl, 7:4Q tc~ I~1.6fiq.
`These d~~t.E ~~i~~;est x re~(bt~{ incrc~se iiE relative risk Por
`~;~rst~•c~ ntestinr~i su~4ery among elderly t~ crs ~vhcn cam.
`~arcd with yoim~~r uxers<
`F,st nratcs cif the ~r~:v.ilencc of s~r~ous ~;tisCrointestitt~l
`cwents amc~n~ NSAlt) i~~ers ~w~~.re s~amm.~ri~eJ from four
`c~~~hoct studies (7. ~~. ?5. ~#4}, "1'ltt sirmmtiry, t-Year
`p~e+alence 7ntnng ~~S~1C[7 i~ trs wits E per 1tXl(}; the;
`prey alence :rman~t ticic:rC}r u~cis f':" 65 years <rf age) w`~ss
`:i.« per lfHk}: a~cE the prcv~lencG arn<an~; younger tr«rs
`( r: bS years c~C ag~.:l~ was t1,~9 pCr dC)(lt).
`
`Sourcca aC' Fletcro~,4:neity
`Irsls fi)r hc~mcigeneity ~4e~e 4t4tti5tically significant
`(t' ~ ~.US) Cor :dl €~nalyrs~s, indie~tun~ l~i:tt 1h€ diL`~er.
`
`Sumrtavy t7a:ts Rncios, Risk Factors
`-M- ov,~-~ [ ~ ~>
`
`•
`
`~ Ea rr tai
`
`-t--- Y+crnn+'~ C3i
`~ ___. urn [a~
`-s- ~~ ~a a,~+ ka7
`i- _ fuiweeerXrA nr u+eU~~fNN Gi N.+~tX (k`3'!
`
`Os.rat+nn at NSAtb Ccxns~n ,+tbn
`
`---r--- v3 ma~'xs fri
`
`~
`
`- z t, <~ ma,vn cry
`
`<., noninSep -
`
`14tnntet•Neenszcl technique for erase-en~[r~~! stud~as t~nly
`S f7ircct tctihttiquc ri~n~ri«A c~i Gree~~tr~nd jrefGrcnc€ adr.
`
`~onie, "I'tre tr~~is ratio for gustroint€:s~inaf bieedin~, c+~m-
`birred from nine ~uitlies, s~~s 2.3~ tCl, 2.t1 to 2.7U).
`t'he oci~s ratio fur ~<esCri~iritestinsxl sur~Zcry. combined
`t'r~~~tt Chrc~ studies, vas 7,?S (C[. 5.83 tc~ l0.3!), "the
`summary ~idds ratio Cor ~,tlstr~intestinul cic~eth, cony
`binccl t'rom t'onr staciies, way A.7~} ECJ. 3.(v# t~ 6.~2).
`"1`hus, the relative risk for surgical or 1`:rt~il t~uicrarr~es
`<~nicm~ i~SA[[) users is ?- <>r 3-fi>Id higher th~Yn the
`relaCive risk f<~r gasteoinitstinaf hiee~ft`n~;.
`'~h+~ sum~~ary ~cict5 colic for women ws~s ~.3~ (GI.
`k.t)1 try 2.8?)„ whereas She 4urnmary gttc64 ratin fc~r~ ni~n
`ryas 2.4D (fit. ].~iS Cc~ T,1 l j. 'The summary adds r.~"tio Fcrr
`~~~orr7cn ~crnpare~i +vith i~en was L!5 tG~. 11.89 to J,5O).
`lltese dais deg nc~t sup~~R ~en~1~r a~ ~n indcpenctent
`risk' factor, `CY~e risk f'ur fiG•st eUrnpared with suF~seyuent
`y;<istr~int~stinal c~cnt ~v~~s sit o ex~minc<I. 'I'tre ~unittis~ry
`tad ratio t'p~ the ti~~+t ~,t~stri~intestiq~+l went, ~t~~ibinca
`feont siK etuciics, wris 2.39 (C1. 2, iti t~ 'z..bS?. '[ hc, rely-
`tivc rrsk fir .wubsegucnt i~r tinsreeifit~i ~;<~strc~intestint~l
`event, curnbiri~d ir~nt the rcm<<ining !0 stueli~s, vas
`4.76 (t'[, d.(}5 tc~ 5.49). `I'hcst t~~il.G sGi~gcst that {~ iticnts
`u°ikh a tristury ot~ ~a~trointc4~inal events mxy have ~n
`in~;rcascd rel4~tive risk i'c~~ further e~vct~t5, "I~he ~is~ uF
`c~~Goirttattt cortiC~titcrcii€Is was tJso e~tunincct. "Ct~e
`9arnrn~ry adds rntio for NSAIU users receiving cori-
`c~nrit:~nt r~7rticn!:teraiclti ~orn~tizrecl ~ti~ith NtiAI[l users
`nc~t recEiving cc~nicustcrUi~ts vas 1 ~x3 {G t, 1.2f~ tea 2.~$).
`"C'his fin~lin~ tii~k~ests r~r~ ap~rr~~ximately' twaf`t~l~! increase
`in ttit reEativ~ riik at~~c~ng NSAI[) uY~rt wht~ €tre rtcev~
`ing corti~osteroids enmpar~d ti~°its i~14~tCa ti~~t'+ rant
`i°t~ci~~iog corticoxterc~itfs.
`5u~nn~ar} crctds r<<tivs ~er~ t~Iyo e~hleined using the
`hfantel•itaensref statistic. A cumpari:san cif the rc:sutts
`c~bTain~d by the two ctatistiaa) techniq~cs slt~~GVCtI Ihsz~
`the direct e~~;the~d err~~b(~cl the use of clt~iv from rr~arc
`stud cs. rt:sulti~x~ in n~rrca+~vcr C'is. Sunio~r~~~y adds ratios
`Lay t~~th methctids «~er~ simiil7r in most cati~goric;s (Gak~Ie
`).
`Si~mm~r}° odJe ratios c~Icul~Ced act<~reling tc~ ~rrilivid-
`ua! NS,^1tC~ uxecE :rrttl ~turetic~n of" NSACD +:xpvsurc ~vcr~
`as faltow5: ~irbxic~nz. 17.12. ~Cl, x:19 tc~ 2R ~3~~ indc~-
`mctha~in, ~1.Ci4 4C"1,~2.97 to 7.A1): aspirin. 3.~h (C'1. 2.26
`to 5.(lt}; n7~r~rcn, 2.f~4 (C`(. L6S [i~ 4.~3?'): and if~ir-
`7t'c>fen, ?.27 tt`[, I,$5 to '.Ff9). "[`here is sut~~t;~Mia)
`overlap in the CI5 amon~c NSrYI~~. The dar~+tir~>ri cif'
`I~ES~I[3 cansun~ptic~n m.ay be related to the size of the
`adds r~iEia (~''i~urc 3}. "~'he summary odds ra1i~ f~~r is<~
`th ere ! xnanth eE ~SA[C) exposu€c wns FS.6(~ iCte b•?7 tc~
`[(1.(167: for {on~er eta~n 1 n~ontf~ but lass lheri 3 rn~nths.
`3.31 tC'I. 2,~7 to ~1.kS?); +r~Q ti,r lnng~r thin l mouths,
`
`~.0
`
`2
`
`5
`a
`tkid!s Rat4o, (7ir@ct hlAttrcKf
`Figure 3. Snmmnry Mids ratite and rtxk fattor~. (?. Summary
`u~lds r<~t o; the 45~%c eonii~lt~tcc inlccvats .arc i~Edica~cd by tt~e
`~xtendc[f lire; numbers ire ~arent}~e~es arc the number of stud•
`(l'S Ctl~1~7111NLIr)
`
`s
`
`~o
`
`7141
`
`1 t ~vovember I ll
`
`A«naTs of tntenccr! b~ledicine
`
`V9f~ime I15
`
`f`~um~er 1Cl
`
`llorr~ulosutcd L~ rum: Irtt~r//annal+.urg( lr~~ a Rrprints llcslc User on 031211l2i115
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`Page 4 of 10
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`Patent Owner Ex. 2008
`CFAD v. Pozen
`IPR2015-01718
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`

`
`cncc4 ~m<~ri~; the results c>f' inciiti~icivai sCudics are ~reatcr
`4hzuk can be expected on the ba~i~ iit' chance :done.
`Wa did t~4o ciift~ecn€ tt~~e~ cst .~rt~Iyses to identify
`s~urets cif h~tcra~rntit}~, ficterc~~;eneit}~ ~Groxs se~i<lics
`is cc~m~osed r>f intrustucf~~ 6etercrgert~ity and iater~study'
`hetert~~,eneity. [n .~n %tt'eirt ro dc~:cribe in[rct•s€udy Het-
`eKo~cnehy, tests cit` he~mog~neity +~°ere conducted for
`sevcrtrE sub~rc~ups ac~c~ss atuclies. `I'hcse ~uhc;rui~p wer<
`~u~Zd~uidec! ~ec~r~in~ to ~ustraintestin.zl vntCaa~~, zige.
`ale at~ei ga~trainte4tinat ~utt:orne. and use t~f` i+~dividt~al
`1`3SAIIJs, ~~ch of Chew suh~;roups a~c;aurated for n ~o_r-
`tion ~I~ the ~ariahility~ thuk recfi~iClrlg i~~ Ce~f >tslistie for'
`homc~gen~it}r. 'I`hcrC ~tac, how~vcr, na sut~group idca~li-
`f~cel Chat ~iccoi~mted i"or mos; pf T}i~ ob~Cr~ed hetcroge-
`r~eity. (n ten etTvrt to ilcscrihc inter turfy heterogeneity.
`+„~c clid <! rttt~ICiv~friate €~e~;r~ss arr .~rlt~ly~~ c u4inc the 1«g
`of ilroe study odds ratio m the dcpcn~ent v.tt~iEil~le arc!
`stucC}~ zi~tii~n, dur:~ti~7n oC d~l51t1t3 use, ga~trc~intestin ~l
`ctiitcc~me, and at~r,~~c ~~;e as the inclupc~dent vari;ihlc~,
`The ribr~;ssiaR µ,~~ ~ti~°Cicthtett using the indi+id~,E31 swdk
`varitin~cs. T'hc fc)ur in~Ec~~nd~n~ ~a[irbles accounted fur
`:~~pf4xini~Ge[y h.~ilf c~i' the interstuciy u,~ri~~biliiy~
`
`C}iscucsit~re
`
`Cw~r r~st.~cch c[esigns h~+vG k?ci;tt used 1c~ study th
`risk Cor ~;astFoin~ertinal cventx r~la~ed ~u NSk\lC:) ahem
`.gyp}~; rctrosptcuve cohort .and c,+sc•contr~l -stud~ts.
`Must uf" the cohort sttidics used secondary ~~Kt;iky~is t~f
`health insur;u~ce r4~istric~ ~ which ~1a1.t a<ere ~ollrcted
`prtm~rily fczr billing; pur~~~„~:. 'I'hc coni~ut~ri~ed care
`definition f~~i• gsivtr<ain~estinal events is sut?jec.t to st~h-
`st~snlial ttti~cl<~tsiiii:e~tic~n (~.'.=44i. titi~Glsi~~ifi~~ti~m r.~tt4
`vC yap to .".~I~"c ~teri~ n~tcd rn stuctics utiing rCtrc~spcctivc
`~hnrx r~4i4w° to ec~nfirm carnput~;rited di~gn~ies t~3~ 31,
`34). n salting in iontz~minaCivn of ttr~ disc ~rrtti~ 6y.
`controls ;tn~ ~f the etsntrul group b}~ cases :end thtr
`re<lu~in~; ;he rc:la4i~c-t'isk 4+timaie. ~imil~Grly, thG inf~pr-
`i~atron ors *is,0.t1;) exp~~ure ~~k~t~ine~! €rom these r~~is-
`Iries rtj~y~ not have bc~n of c~pCirnal quaEity. "Ific dur.~-
`tit~n cif' AiS,~1tI~ c~posur~ is crf'ten tmkn~avrt uncl
`trsStirnptions ,~r~ mitcl~ from ~rc~scri~iian rc~is[ric~ re-
`g;ar~lna~t-the .~F~er~t~c dur~ticx~ ctf ~VSr11I~ nse.:S~me ~tud-
`iev e t ntaiGd an :+vee~~~e pretitriptic>n ~uratit~rt of alt}
`d~iys Frith full ps~N~nt ~ompliK4rree (23.:YE, 3~7). Srich ~n
`assumption niay c~ver~:stimat~ the ciiar~~tivn cif N;ir11[]
`~~~x~s¢irc, hia~ r~~ the results tir~vtirtl t I'~Isely Ia~a vela-
`tivcrisk, "fhe Irec~itcney i~f i~.'5AIf~ use in €e tuc{y satn-
`plc ~tetermine~ t►re ~a~ver u1` fryer stu~i~~ te+ clet~~.t a
`st~itisticalle' s ~;nifi~[~nt relative risfc t45?. ~crosttrc>idal
`anti-inflarnm~ite+ry dnig uv~, arn~n~ ~SatEcnts ~+~ith prep~+icl
`he~ltb pftins may bi l:xu~cr than that of tht~ ~encr;~l
`p~>palatir~n, ~i~rthcr unef~resrimatirtg t►i~ r~la~tive, risk,
`~Phese fstct~r3 conEributc to the Ivtiver ~;lati~~ risks r~-
`~nrted f~~ the 4ohort~sttidi~s when cctiT~ps}recC ~~~ith thy.
`c.~ce-ecrntrUl studieti.
`lit t~ac, cac~•cc~~trol s~ttcliss, diftereni i~chnic~uc~, weee
`itscd to cicterminc \l.~,t10E7 cx~t>surc intun~, c~7sc pa-
`ticntti ant cantrr~lti (2£t. ?')l. Pti}~sicit~ns ht~~nitaii'tin~ {ass•
`ti~nis kith ~;a~Cr'c~anlE~tinf~C ~le~ding xt m~rre iik~l4 Icy
`inquire about NSAID uc~ thin ~~rc phytiic;~~ins <~uest <~rc-
`ing ccsntrpl~+ or Ch~rr r<~lativ4e. Such cfiH'~rences in the
`
`detcrrrin:ttiure crf' NS~1IC) e~pc~sure hias Clie resu{ts
`tow~~rd a I,tlsely I irgt rel~iti~~ risk. "i'hr ~ssc ~f a slruc-
`tur~c~ ir~teCview €idministcred b)~ EtR im~~stivatOr whc~ Ls
`t+liii~ic~ to the tatu5 (case ~t~tiznt ur ci~ntroli ~f (hc
`paticnC resutts in more valid estim~~tes of rcfativ~ ask
`tll, '~6t. FVell~ctesigned, nc~tc~l, cas~-Cc~ntrol stt~dic
`r~ii~rriize the yelettian bias, inP~erc nt in hc~spit~~l~hrised
`case-cantr~l ttu~i~ (33},
`~ithou~.h thin: hi~vc been many studies ~xs~minin~
`the ~~tstruinteslinai risks nt" VS,~][) us4, ini}~ort~~nt
`m~thndUi~gic Gnrit~~i~n~ r~rid difft~r~nccc in study s;h~r-
`acterisGics ~nntriluta to the convicting r~sulk~. 12ctro-
`4pectivc colic+rt studies prc~E~abiy uird~restirr~titc the rel-
`ati~e risk, «~hereas tibnie ctv~e~contr9] atuelies pra6at~ly
`~o~resurn€ate it. "i-hc:~ n~re~=r~iarx cif the results Crc~n~
`c~btierr~~ion~l sCudics is cc~ritr~versiFd ld~i). "[`he strcen-
`~caC slitctes <irc ttio~e tkr€tt d~fin~d c.~scs. c~~ntrols. out-
`corn~, r+nd ~sFc~sur~c aceurz~tclY end rcpra(luci~Zly f2f,.
`?J. 3?. 3~, ;i5). ~5 r~ticcte~:I by file gE~r~lii}~-E~~tes~mcnt
`cures in this ntata ~utai}'sis CCt~1~ic t},
`4b'e Conducted t~ structured cvervie~v aC ill pre~~ioits
`r~^4i~w~ ~f NSftfD-related acivcrs~ ga~tr~intesti~rGd
`c~enis. Chc quality cif !hc Its r~~'ic~4~ selcel~tl (~. 6•(W.
`I$. 19) u~ ~s asses yet trct•~>rclin{~ [~~ teuer<+I e:e~te~tia: the
`co~ns7rch~nwiveni:ss of the literature s~ arch, the minimi-
`ct~iigq oP L~ir~s in [he selection of primary ~wJies, the
`:~s~essnien€ af' tN~ ~~~ralitY oC tfi~ pr~im~ey su~dies, the
`~ipproprit~t~n~ss ~(~ 1P~c tcchniqu<;s iEs~cl in Baia s}nthc~
`s~4, <~nd the a'tiliclity cal` rile ~iancftisi~7ns rnsicle hy~ tEtc:
`uthdrs to suppc~rt~d by thc~ du~a.. ~it~st tit' the ~ublishcd
`reviews can this ic'~~~ic city: poly a purti~rn of the av~~iluble
`litcriture, tic~ ncrt pr~iG=itCc s~ ~riticat ass~s~merit of the
`c~urylitp~ nt~ the studicv eit~d, and f.3it Yo ee~mbine the
`r«ttlts t~f` tfi~e~~ sFuclteti statsticalty. (}nty I uf" ttt~: E()
`id4iew~ u~~d a elearly eJefined, eorra~~ecfiansiwc search
`~tn~tcg} f6). lnelusiz~n cnC~riu ~4~re ~tercel k~or 2 ~f` tY~e
`IC1 rcviev~4 f{i. $}. :1 qurility :~ssessmcnt a~f the sturli~;s
`e~.as cltznc in curtly i rcti~~e~~~ (Ci'}, Ap~re~pri<ite. cxplici~ly
`started mcthocts o~ data .ynihesis +ere ~iv~n in only ?
`ecaictiv~ lei, [~).
`
`'['able 3. Subgrou{~ t)d~ts K~tios (:orn►rtiied fro~~~ L:a~
`Gonlrat .+nd t;c~l~or6 ~tudics C~~ie~g the+ "direct" 24felhod*
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`Uo~v~do~idc4 From: http:Uannnls.or;f be i~ ltcprinix llcslc Uxcr oo 113121Y/201i
`
`Pace 5 of 10
`
`Patent Owner Ex. 2008
`CFAD v. Pozen
`IPR2015-01718
`
`

`
`1,tet=t-anal4~sis it ~i systenrtti~, qu intitat vc, strategy
`cif ecvic~ving xnd suinmaririn~ data f~r~m tt~c litcrirture
`to :+ddress a spccitie r~4c~trctr yu~+ti~>n. It dithers 1'r~~m
`thy. tr.ictit opal revit~+~ .rrtic(e in thF~t wt uteti cxpk c t
`ioelusion And exclu~ic~n criteria, iric~rpnratis a Stan-
`tlat'diaetii qu~slity ttilcstimcnt, ;ind ~ar'~~vides a q~~<~ti~it~i~
`tine estimate af~ c tl~ect site. to thi> >v<~u, ~ti~ t ~-r+rialy~is
`~zh~c~s the pc~tentie( fir eeror rirnf bi<it inapiicit in the
`tratlitie~n~il revic~v :Etticle (47).
`5~t~t:~ <<n<<lys~s It~vc bs4n 4ritGized f<>r their crn{~hasis
`nn <t~tisEicsl teehnigaes Ynd #heir lark ~~f' ~tt~iition Co
`ct~itical deseript arcs of nr~[h<~dulti~:ie :inct suh~Cantive i~-
`~,us di~cttsc<i in tltc incl~~~idt~+t Gtudie4. "1'Ire "hest-
`evidcnce synthcci~'° cnethc~ci evmbi~es i~ic ~tr~rt~th5 ~E
`tt~chn~yuea wide dciF~iled,
`c~u<<ntittitive tncta-ar~aly€iG
`t{tafllit~etive an~Ey~~is ~f study eriar<ict~ristics t~'p~cak ~f
`tr~ciitic~nail review u~`tiWl~s {~8?- L4`c have ~xamin4zf crEt-
`i~allY [hc sCutly' ch iractcrist~cw .end yu~~tit}~ t4nd htiue
`pravidec~ ri yu~ntit~sti~e siimrri~ry c~l~ the rci itivc risks.
`F~eesit~ e rttkta anal}'pis is z~ retrospective f«rnl cif r%-
`s~arch, it i> Iimite~I try .tiny t~~ase< +tt