0.08%的Polihexanide (PHMB)与目前使用的棘阿米巴角膜炎治疗方法:间接治疗比较。

IF 2 Q2 OPHTHALMOLOGY
Vincenzo Papa, Carlotta Galeone, Maria De Francesco, Danielle H Bodicoat, Rita Alves, Erik Spaepen, John K G Dart, Carlos Arteaga
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引用次数: 0

摘要

背景/目的:棘阿米巴角膜炎是一种罕见的严重角膜感染。在欧洲药品管理局(European Medicines Agency)最近批准0.08%的polihexanide (PHMB)之前,没有获得许可的医疗疗法,目前的治疗依赖于标签外或复合产品。本研究的目的是评估0.08% PHMB与现有治疗方法的相对疗效。方法:患者水平的间接治疗比较(ITC)比较了0.08% PHMB的关键试验数据和当前治疗的回顾性现实世界研究:(1)任何抗阿米巴治疗(AAT), (2) 0.02% PHMB加0.1%二胺(丙帕脒或己胺)和(3)氯己定(CXL) 0.02%单独或联合二胺。主要观察指标为12个月内无需手术的临床缓解率(CRR)。采用倾向评分分析实施ITCs,并对协变量(年龄、性别、疾病分期、治疗延迟、先前使用皮质类固醇或抗病毒药物)进行重叠加权和调整。结果:PHMB 0.08%组的CRR为84.8% (n=66),任何AAT组的CRR为43.6% (n=227), PHMB 0.02%加二胺组的CRR为55.0% (n=111), CXL 0.02%加二胺组的CRR为40.0% (n=35)。在非加权分析中,支持PHMB 0.08%的绝对差异(95% CI)为41.2% (28.8%,51.2%;结论:这些结果表明,在不进行手术的情况下,采用推荐方案给予0.08%的PHMB比目前使用的治疗方法更有效。研究的局限性包括招募期、诊断标准和给药方法的差异,以及可能导致残留混淆的ITC调整措施的局限性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Polihexanide (PHMB) 0.08% versus currently used treatments for Acanthamoeba keratitis: indirect treatment comparisons.

Background/aims: Acanthamoeba keratitis is a rare, severe corneal infection. Until the recent approval of polihexanide (PHMB) 0.08% by the European Medicines Agency, there were no licensed medical therapies and current treatments relied on off-label or compounded products. The purpose of this study is to estimate the relative efficacy of PHMB 0.08% compared with current treatments.

Methods: A patient-level indirect treatment comparison (ITC) compared data from a pivotal trial of PHMB 0.08% and a retrospective real-world study of current treatments: (1) any anti-amoebic treatment (AAT), (2) PHMB 0.02% plus a diamidine (propamidine or hexamidine) 0.1% and (3) chlorhexidine (CXL) 0.02% alone or in combination with a diamidine. The primary outcome was the clinical resolution rate (CRR) without surgery within 12 months. ITCs were implemented using propensity scoring analysis with overlap weighting and adjustment for covariates (age, sex, disease stage, treatment delay, prior use of corticosteroid or antiviral).

Results: The CRR was 84.8% for PHMB 0.08% (n=66), 43.6% for any AAT (n=227), 55.0% for PHMB 0.02% plus a diamidine (n=111) and 40.0% for CXL 0.02% with or without a diamidine (n=35). In the unweighted analysis, the absolute difference (95% CI) in favour of PHMB 0.08% was 41.2% (28.8%, 51.2%; p<0.001) compared with any AAT, 29.9% (14.5%, 42.1%; p<0.001) compared with PHMB 0.02% plus a diamidine and 44.8% (23.9%, 62.3%; p<0.001) compared with CXL 0.02% with or without a diamidine. Similar results were observed in the weighted analyses.

Conclusions: These results suggest that PHMB 0.08% when delivered with the recommended protocol is significantly more effective than currently used treatments in achieving clinical resolution without surgery. The study limitations include differences in recruitment periods, diagnostic criteria and drug delivery methodology, as well as limitations of the ITC adjustment measures which can lead to residual confounding.

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来源期刊
BMJ Open Ophthalmology
BMJ Open Ophthalmology OPHTHALMOLOGY-
CiteScore
3.40
自引率
4.20%
发文量
104
审稿时长
20 weeks
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