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三期随机研究:含地塞米松的管内留置治疗变应性结膜炎的疗效与安全性

Phase 3 Randomized Study of Efficacy and Safety of a Dexamethasone Intracanalicular Insert in Patients With Allergic Conjunctivitis.

机构信息

From the Total Eye Care, PA (E.B.M., D.E.), Memphis, Tennessee 38119, USA.

Philadelphia Eye Associates (C.S.R.), Philadelphia, Pennsylvania 19148, USA.

出版信息

Am J Ophthalmol. 2021 Sep;229:288-300. doi: 10.1016/j.ajo.2021.03.017. Epub 2021 Mar 25.

Abstract

PURPOSE

The purpose of this study was to evaluate the efficacy and safety of a dexamethasone intracanalicular ocular insert for the treatment of allergic conjunctivitis.

DESIGN

Multicenter, randomized, double-masked, placebo-controlled, Phase 3 clinical trial.

METHODS

Subjects with allergic conjunctivitis were randomized 1:1 to receive a dexamethasone insert or a placebo insert in both eyes and were evaluated using a modified version of the conjunctival allergen challenge (CAC) model. After inserts were placed in office, a series of 4 closely spaced post-insertion CACs were conducted at weeks 1, 2, and 4 across approximately 30 days. Primary efficacy endpoints, assessed at week-1 CAC-day 8, were reported by subjects of ocular itching at 3, 5, and 7 minutes post CAC and investigator-evaluated conjunctival redness at 7, 15, and 20 minutes post CAC.

RESULTS

For the primary endpoints, dexamethasone inserts showed statistically significantly lower mean ocular itching scores than placebo at all time points (P <.001), with differences favoring dexamethasone inserts over placebo (0.86, 0.98, and 0.96 units at 3, 5, and 7 minutes, respectively) and statistically significantly lower conjunctival redness scores at 20 minutes (P <.05) but not at 7 or 15 minutes (P ≥.05). Results also showed statistically significantly less itching and conjunctival redness at 31 and 29 of 33 other time points, respectively (P <.05). There were no serious adverse events; 1 subject had elevated intraocular pressure in both eyes.

CONCLUSIONS

Data presented in this study demonstrate the potential for a single, physician-administered dexamethasone intracanalicular insert to provide relief of ocular itching for up to 4 weeks in subjects with allergic conjunctivitis, while maintaining a favorable safety profile.

摘要

目的

本研究旨在评估地塞米松管内眼用植入剂治疗过敏性结膜炎的疗效和安全性。

设计

多中心、随机、双盲、安慰剂对照、3 期临床试验。

方法

过敏性结膜炎患者按 1:1 随机分为地塞米松植入组和安慰剂植入组,双眼接受治疗,并采用改良结膜过敏原挑战(CAC)模型进行评估。植入后在诊室进行 4 次紧密间隔的植入后 CAC,在大约 30 天内于第 1、2 和 4 周进行。主要疗效终点在第 1 周 CAC 天 8 时由患者报告,评估指标为 CAC 后 3、5 和 7 分钟时的眼部瘙痒程度,以及 CAC 后 7、15 和 20 分钟时的研究者评估的结膜充血程度。

结果

对于主要终点,地塞米松植入剂在所有时间点的平均眼部瘙痒评分均显著低于安慰剂(P <.001),且地塞米松植入剂优于安慰剂(3、5 和 7 分钟时分别为 0.86、0.98 和 0.96 单位),20 分钟时的结膜充血评分也显著降低(P <.05),但 7 分钟和 15 分钟时无显著差异(P ≥.05)。在 33 个其他时间点中的 29 个时间点,分别有更多的患者报告瘙痒和结膜充血程度显著降低(P <.05)。无严重不良事件;1 例患者双眼眼压升高。

结论

本研究的数据表明,在过敏性结膜炎患者中,单次由医生给予地塞米松管内眼用植入剂,可能在长达 4 周的时间内缓解眼部瘙痒,同时保持良好的安全性。

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