马拉利西他与奥维西他治疗进行性家族性肝内胆汁淤积症的间接比较。

IF 3.6 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Guy Lacey, Toby Gosden, Oliver Darlington, Elise Evers, Robin Howard, Lucia Quadrado
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引用次数: 0

摘要

目的:最近的临床试验提供了2种回肠胆汁酸转运蛋白抑制剂,马力西巴和奥维西巴治疗进行性家族性肝内胆汁淤积症(PFIC)儿童的有效性和安全性的证据。然而,目前还没有对这两种治疗方法的疗效进行正面对照试验。本研究的目的是对马拉利西巴和奥维西巴的比较疗效和安全性进行评估,为治疗PFIC儿童提供最佳方案。方法:两项3期随机安慰剂对照试验,MARCH-PFIC(马拉利西巴:n = 16;安慰剂:n = 19)和PEDFIC-1 (odevixibat: n = 42;安慰剂组:n = 20),被纳入由每个试验的安慰剂组锚定的间接治疗比较(ITC)。使用来自mar - pfic的患者水平数据和来自PEDFIC-1的已发表的汇总数据,我们对试验之间一致的终点的比较疗效进行了估计,包括达到血清胆汁酸(sBA)反应的患者比例和sBA浓度从基线的变化。结果:sBA应答者比例的比较表明,马拉利西巴显著优于奥维西巴(120µg/kg),估计治疗差异为32.3% (95% CI, 1.1%至63.4%,P = 0.043)。此外,sBA浓度和总胆红素从基线变化的点估计倾向于马拉利西他。这些发现对于调整试验之间患者人口学特征的不平衡是强有力的。在丙氨酸转氨酶、天冬氨酸转氨酶或γ -谷氨酰转移酶方面没有观察到统计学上的显著差异。马拉利西巴和奥维西巴的安全性具有可比性,尽管与马拉利西巴相关的不良事件通常比与奥维西巴相关的不良事件轻(轻:75% vs 45%;中度:25% vs 31%;严重:0% vs 7%)。意义:这些发现表明,在增加sBA应答者比例方面,与奥维西巴相比,马拉利西巴为PFIC儿童提供了额外的临床益处。需要进一步的研究来比较马拉利西巴和奥维西巴减少瘙痒和改善长期预后的能力,包括患者的生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Indirect Comparison of Maralixibat and Odevixibat for the Treatment of Progressive Familial Intrahepatic Cholestasis.

Purpose: Recent clinical trials provide evidence of the efficacy and safety of 2 ileal bile acid transporter inhibitors, maralixibat and odevixibat, for the treatment of children with progressive familial intrahepatic cholestasis (PFIC). However, no head-to-head trial currently exists assessing the efficacy of these 2 treatments. The objective of this study was to generate estimates of comparative efficacy and safety between maralixibat and odevixibat to inform optimal practices for the treatment of children with PFIC.

Methods: Two phase 3 randomized placebo-controlled trials, MARCH-PFIC (maralixibat: n = 16; placebo: n = 19) and PEDFIC-1 (odevixibat: n = 42; placebo: n = 20), were included in an indirect treatment comparison (ITC) anchored by the placebo arms of each trial. Using patient-level data from MARCH-PFIC and published aggregate data from PEDFIC-1, we generated estimates of comparative efficacy for endpoints that were consistent between trials, including the proportion of patients achieving a serum bile acid (sBA) response and change from baseline in sBA concentration.

Findings: Comparisons of the proportion of sBA responders indicated that maralixibat was significantly more efficacious than odevixibat (120 µg/kg), with an estimated treatment difference of 32.3% (95% CI, 1.1% to 63.4%, P = 0.043). In addition, point estimates for change from baseline in sBA concentration and total bilirubin trended in favor of maralixibat. These findings were robust to adjustments for imbalances in patient demographic characteristics between trials. No statistically significant differences were observed for alanine transaminase, aspartate transaminase, or gamma-glutamyl transferase. The safety profiles of maralixibat and odevixibat were comparable, although adverse events associated with maralixibat were typically milder than those with odevixibat (mild: 75% vs 45%; moderate: 25% vs 31%; severe: 0% vs 7%).

Implications: These findings suggest that maralixibat provides additional clinical benefit for children with PFIC compared with odevixibat in terms of increasing the proportion of sBA responders. Further studies are needed to compare the ability of maralixibat and odevixibat to reduce pruritus and improve long-term outcomes, including patients' quality of life.

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来源期刊
Clinical therapeutics
Clinical therapeutics 医学-药学
CiteScore
6.00
自引率
3.10%
发文量
154
审稿时长
9 weeks
期刊介绍: Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.
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