SCALA:在进展期多发性硬化症患者中比较皮下注射和静脉注射阿仑妥珠单抗的随机 I 期试验。

IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY
Therapeutic Advances in Neurological Disorders Pub Date : 2024-11-06 eCollection Date: 2024-01-01 DOI:10.1177/17562864241291655
Xavier Montalban, Breogan Rodriguez-Acevedo, Carlos Nos, Mireia Resina, Mireia Forner, Yanzhen Wu, Magdalena Chirieac
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引用次数: 0

摘要

背景:阿来珠单抗用于复发缓解型多发性硬化症(RRMS)的静脉注射(IV)治疗,皮下注射(SC)治疗的研究有限:我们试图评估进行性多发性硬化症(PMS)患者皮下注射阿利珠单抗的药效学(PD)、药代动力学(PK)和安全性:SCALA是一项I期、开放标签、随机、平行组研究,为期两个12个月,安全监测期为60个月:在29名经过筛选的参与者中,24人被纳入研究,并按2:1的比例随机分配到两种12毫克/天的阿仑妥珠单抗治疗中(总剂量分别为60毫克和36毫克;皮下注射:静脉注射)。主要纳入标准年龄⩾18 岁,确诊为 PMS。主要排除标准包括 RRMS 诊断和既往接受过抗 CD52 抗体治疗。主要终点:CD3+ 淋巴细胞计数。次要终点:PD 和 PK 参数:结果SC治疗组(16人)和IV治疗组(8人)参与者的人口统计学特征大致相似;接受SC治疗的原发性PMS患者(44%)多于接受IV治疗的患者(25%)。第一个疗程结束后,两个治疗组的平均 CD3+ 细胞计数/µL 在第 1 个月都有所下降(SC:基线(BL)1326 至 48 vs IV:基线(BL)1155 至 84)。到第 12 个月时,淋巴细胞计数部分恢复,平均 CD3+ 细胞计数/µL(SC:599 对 IV:528)。在第二个疗程结束后的第 13 个月,两组的平均淋巴细胞计数/µL 都再次下降(SC:90 对 IV:129),到第 24 个月时又有部分恢复。相对于静脉注射,经皮下注射的阿仑珠单抗血清浓度较低,生物利用度为32%。没有出现导致永久中断治疗或死亡的不良事件:在SCALA中,接受皮下注射或静脉注射阿仑珠单抗的参与者的淋巴细胞耗竭和再填充模式相似。两组患者的阿仑珠单抗安全性均在可控范围内,没有出现新的安全问题。在60个月内观察到的神经系统结果总体稳定,强调了阿仑珠单抗治疗的潜在长期益处:试验注册:Clinicaltrials.gov identifier:试验注册:Clinicaltrials.gov identifier:NCT02583594。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
SCALA: a randomized phase I trial comparing subcutaneous and intravenous alemtuzumab in patients with progressive multiple sclerosis.

Background: Alemtuzumab is administered intravenously (IV) for relapsing-remitting multiple sclerosis (RRMS), with limited studies of subcutaneous (SC) treatment.

Objectives: We sought to evaluate the pharmacodynamics (PD), pharmacokinetics (PK), and safety profile of SC-administered alemtuzumab in people with progressive multiple sclerosis (PMS).

Design: SCALA was a phase I, open-label, randomized, parallel-group study with two 12-month periods and a safety monitoring phase to 60 months.

Methods: Of 29 screened participants, 24 were enrolled and randomized 2:1 to two 12 mg/day alemtuzumab treatments (60 and 36 mg total; SC:IV). Key inclusion criteria: ⩾18 years with a PMS diagnosis. Key exclusion criteria included RRMS diagnosis and prior treatment with anti-CD52 antibodies. Primary endpoint: CD3+ lymphocyte count. Secondary endpoints: PD and PK parameters.

Results: Demographics were broadly similar for participants in the SC (16) and IV (8) arms; more participants with primary PMS received SC (44%) versus IV (25%) treatment. After the first course, the mean CD3+ cell count/µL was reduced at month 1 in both arms (SC: baseline (BL) 1326 to 48 vs IV: BL 1155 to 84). Lymphocyte counts partially repopulated by month 12, with mean CD3+ cell counts/µL of SC 599 versus IV 528. The mean lymphocyte counts/µL decreased again after the second course at month 13 in both arms (SC: 90 vs IV: 129), with partial repopulation by month 24. Alemtuzumab serum concentrations were lower following SC administration relative to IV, with 32% bioavailability. There were no adverse events leading to permanent treatment discontinuation or death.

Conclusion: In SCALA, there were similar patterns of lymphocyte depletion and repopulation for participants receiving SC or IV alemtuzumab. In both arms, alemtuzumab had a manageable safety profile, with no emerging safety concerns. The general stabilization of neurological outcomes observed over 60 months underscores the potential long-term benefits of alemtuzumab treatment.

Trial registration: Clinicaltrials.gov identifier: NCT02583594.

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来源期刊
CiteScore
8.30
自引率
1.70%
发文量
62
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Neurological Disorders is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of neurology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in neurology, providing a forum in print and online for publishing the highest quality articles in this area.
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