A Clinical Trial Comparing the Safety and Efficacy of Topical Tacrolimus versus Methylprednisolone in Ocular Graft-versus-Host Disease
| Autor: | Ujwala S. Saboo, Pedram Hamrah, Francisco Amparo, Thomas H. Dohlman, Reza Dana, Tulio B. Abud, Antonio Di Zazzo, Joseph B. Ciolino |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Intraocular pressure Administration Topical Anti-Inflammatory Agents Graft vs Host Disease Methylprednisolone Gastroenterology Conjunctival Diseases Tacrolimus Article Corneal Diseases law.invention 03 medical and health sciences 0302 clinical medicine Double-Blind Method Randomized controlled trial law Internal medicine Humans Medicine Ocular Surface Disease Index Prospective Studies Adverse effect Prospective cohort study Aged business.industry Middle Aged eye diseases Surgery Ophthalmology 030104 developmental biology Tolerability 030221 ophthalmology & optometry Female business Immunosuppressive Agents medicine.drug |
| Zdroj: | Ophthalmology. 123:1449-1457 |
| ISSN: | 0161-6420 |
| DOI: | 10.1016/j.ophtha.2016.02.044 |
| Popis: | Purpose To evaluate the safety and efficacy of topical tacrolimus 0.05% versus topical methylprednisolone 0.5% in patients with ocular graft-versus-host disease (GVHD). Design Phase 1/2 prospective, randomized, double-masked clinical trial. Participants Eighty eyes of 40 patients diagnosed with chronic ocular GVHD were enrolled. Methods Forty patients with ocular GVHD were randomized; 24 patients were treated with topical tacrolimus 0.05% and 16 patients were treated with topical methylprednisolone 0.5% twice daily for 10 weeks, in addition to continuing their baseline treatment regimen. Main Outcome Measures Safety was evaluated based on occurrence of adverse events. Tolerability was assessed based on subject reports of discomfort after drop instillation. Intraocular pressure (IOP) was monitored. The main efficacy end points were corneal fluorescein staining (CFS), tear film break-up time (TBUT), Schirmer test results, and expression of the ocular surface inflammatory markers human leukocyte antigen-DR (HLA-DR) and intercellular adhesion molecule-1 (ICAM-1). Symptoms were evaluated using the Ocular Surface Disease Index (OSDI). Results After 10 weeks of treatment, no major adverse events occurred in either treatment group, and there was no significant difference in the composite tolerability scores between the 2 groups ( P = 0.06). However, burning sensation was more pronounced with tacrolimus ( P = 0.002). Topical tacrolimus was more effective than methylprednisolone in reducing the CFS score at week 10 (55% vs. 23% reduction, respectively; P = 0.01) and achieved significant improvement in TBUT when compared with baseline ( P P = 0.02), but was marginal with methylprednisolone (32% reduction; P = 0.06). Expression of ICAM-1 by ocular surface epithelium decreased significantly in both groups (tacrolimus, P = 0.003; methylprednisolone, P = 0.008), whereas HLA-DR expression decreased significantly only in the tacrolimus group ( P = 0.03). Schirmer test scores did not change significantly in either group during the study; IOP increased significantly with methylprednisolone at week 10 ( P = 0.04). Conclusions Topical tacrolimus 0.05% is safe, generally well tolerated, and effective for the treatment of ocular GVHD without the hypertensive effects of topical corticosteroids. |
| Databáze: | OpenAIRE |
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