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多中心四期临床试验,旨在研究新的重组人生长激素液体配方在生长激素缺乏症成人中的免疫原性。

Multi-centre phase IV trial to investigate the immunogenicity of a new liquid formulation of recombinant human growth hormone in adults with growth hormone deficiency.

机构信息

Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 41 315, Gothenburg, Sweden.

Merck KGaA, Darmstadt, Germany.

出版信息

J Endocrinol Invest. 2018 Aug;41(8):919-927. doi: 10.1007/s40618-017-0818-4. Epub 2018 Feb 27.

Abstract

PURPOSE

To investigate whether a new liquid formulation of recombinant human growth hormone (r-hGH) induces the production of binding antibodies (BAbs) in adults with congenital or adult-onset growth hormone deficiency (GHD).

METHODS

Men or women aged 19-65 years with adult growth hormone deficiency who were r-hGH-naïve or had stopped treatment ≥ 1 month before screening were treated with between 0.15 and 0.30 mg/day r-hGH liquid formulation for 39 weeks. The primary endpoint was the proportion of patients who developed BAbs at any time. Secondary endpoints were the proportion of patients with BAbs who became positive for neutralising antibodies, the effects on biomarkers of r-hGH exposure, safety, and adherence to treatment downloaded from the easypod™ connect software.

RESULTS

Seventy-eight patients (61.5% men) with mean age 44.5 years (range 21-65) started and 68 (87.2%) completed the 39-week treatment period. 82.1% were treatment naïve; all were negative for BAbs to r-hGH at baseline. The median (interquartile range) duration of treatment [273 (267.0-277.0) days] was consistent with patients receiving the required doses, and mean treatment adherence measured using easypod™ connect was 89.3%. The proportion of patients who developed BAbs was 0% (95% confidence interval 0-4.68%) and biomarker profiles were consistent with exposure to r-hGH. 92.3% of patients reported ≥ 1 adverse event during treatment. Most events were mild or moderate and no new safety concerns were detected.

CONCLUSIONS

The low immunogenicity profile of the liquid formulation was consistent with that for the freeze-dried formulation, and no new safety concerns were reported.

摘要

目的

研究新的重组人生长激素(r-hGH)液体制剂是否会在先天性或成人发病的生长激素缺乏症(GHD)患者中诱导产生结合抗体(BAb)。

方法

19-65 岁、r-hGH 初治或筛选前≥1 个月停止治疗的成年生长激素缺乏症男性或女性患者,接受 0.15-0.30mg/天 r-hGH 液体制剂治疗 39 周。主要终点为任何时间发生 BAb 的患者比例。次要终点为 BAb 阳性转为中和抗体阳性的患者比例、r-hGH 暴露的生物标志物的影响、安全性和 easypod™ connect 软件下载的治疗依从性。

结果

78 例(61.5%为男性)患者平均年龄为 44.5 岁(范围 21-65 岁),开始并完成了 39 周的治疗期。82.1%为初治患者;所有患者基线时均对 r-hGH 无 BAb。中位(四分位间距)治疗持续时间[273(267.0-277.0)天]与接受所需剂量的患者一致,使用 easypod™ connect 测量的平均治疗依从性为 89.3%。发生 BAb 的患者比例为 0%(95%置信区间 0-4.68%),且生物标志物谱与 r-hGH 暴露一致。92.3%的患者在治疗期间报告了≥1 次不良事件。大多数事件为轻度或中度,未发现新的安全性问题。

结论

液体制剂的低免疫原性与冻干制剂一致,且未报告新的安全性问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/74ce/6061248/5becd2a03846/40618_2017_818_Fig1_HTML.jpg

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