目的:比较局部PHMB(聚己尼特)0.02%(0.2mg/ml)+丙脒0.1%(1mg/ml)[PHMB0.02%+丙脒]与PHMB0.08%(0.8mg/ml)与安慰剂[PHMB0.08%]治疗棘阿米巴角膜炎(AK)。
方法:前瞻性随机,双面蒙面,主动控制,多中心,第三阶段研究(ClinicalTrials.govNCT03274895)。
方法:135在2017年8月17日至2021年6月18日之间的六个欧洲中心。
方法:主要纳入标准:≥12岁;体内共聚焦显微镜(IVCM),临床发现与AK一致。还包括并发细菌性角膜炎的参与者,使用局部类固醇,随机化前的抗病毒和抗真菌药物。主要排除:并发疱疹或真菌性角膜炎,使用抗阿米巴治疗(AAT)。
方法:1:1计算机生成,块大小4。这是一项具有预定义的非劣效性的优势试验。130名参与者的样本量在12个月内(MCR_12)内的医学治愈率(无手术或AAT变化)的主要结果中,PHMB为0.08%检测20个百分点的优势。在停用抗炎药和AAT后90天,由临床标准定义的治愈。预先指定的多变量分析调整了影响结局的危险因素的基线失衡。
方法:MCR_12。次要结果包括最佳矫正视力(BCVA)和治疗失败率。安全性结果包括不良事件发生率。
结果:135名参与者被随机分配,在完整分析子集中提供127名(PHMB0.02%+丙脒61名,PHMB0.08%66名),在安全性分析子集中提供134名。PHMB0.02%+丙脒的调整MCR_12为86.6%(未调整88.5%),PHMB0.08%为86.7%(未调整84.9%);符合PHMB0.08%的非劣效性要求(调整后差异0.1个百分点,降低单边95%的置信区间-8.3个百分点)。两种治疗的次要结果相似,未进行统计学分析:中位BCVA为20/20,总治疗失败率为17/127(13.4%),其中8/127(6.3%)需要治疗性角膜移植术。没有发生严重的药物相关不良事件。
结论:PHMB0.08%单药治疗可能与PHMB0.02%+丙脒(一种广泛使用的治疗方法)的双重治疗一样有效(或更糟糕的是,效果差8个百分点),医学治愈率>86%,当与试验治疗交付协议一起使用时,在疾病严重程度相似的AK人群中。
OBJECTIVE: To compare topical PHMB (polihexanide) 0.02% (0.2 mg/ml)+ propamidine 0.1% (1 mg/ml) with PHMB 0.08% (0.8 mg/ml)+ placebo (PHMB 0.08%) for Acanthamoeba keratitis (AK) treatment.
METHODS: Prospective, randomized, double-masked, active-controlled, multicenter phase 3
study (ClinicalTrials.gov identifier, NCT03274895).
METHODS: One hundred thirty-five patients treated at 6 European centers.
METHODS: Principal inclusion criteria were 12 years of age or older and in vivo confocal microscopy with clinical findings consistent with AK. Also included were participants with concurrent bacterial keratitis who were using topical steroids and antiviral and antifungal drugs before randomization. Principal exclusion criteria were concurrent herpes or fungal keratitis and use of antiamebic therapy (AAT). Patients were randomized 1:1 using a computer-generated block size of 4. This was a superiority
trial having a predefined noninferiority margin. The sample size of 130 participants gave approximately 80% power to detect 20-percentage point superiority for PHMB 0.08% for the primary outcome of the medical cure rate (MCR; without surgery or change of AAT) within 12 months, cure defined by clinical criteria 90 days after discontinuing anti-inflammatory agents and AAT. A prespecified multivariable analysis adjusted for baseline imbalances in risk factors affecting outcomes.
METHODS: The main outcome measure was MCR within 12 months, with secondary outcomes including best-corrected visual acuity and treatment failure rates. Safety outcomes included adverse event rates.
RESULTS: One hundred thirty-five participants were randomized, providing 127 in the full-analysis subset (61 receiving PHMB 0.02%+ propamidine and 66 receiving PHMB 0.08%) and 134 in the safety analysis subset. The adjusted MCR within 12 months was 86.6% (unadjusted, 88.5%) for PHMB 0.02%+ propamidine and 86.7% (unadjusted, 84.9%) for PHMB 0.08%; the noninferiority requirement for PHMB 0.08% was met (adjusted difference, 0.1 percentage points; lower one-sided 95% confidence limit, -8.3 percentage points). Secondary outcomes were similar for both treatments and were not analyzed statistically: median best-corrected visual acuity of 20/20 and an overall treatment failure rate of 17 of 127 patients (13.4%), of whom 8 of 127 patients (6.3%) required therapeutic keratoplasty. No serious drug-related adverse events occurred.
CONCLUSIONS: PHMB 0.08% monotherapy may be as effective (or at worse only 8 percentage points less effective) as dual therapy with PHMB 0.02%+ propamidine (a widely used therapy) with medical cure rates of more than 86%, when used with the
trial treatment delivery protocol in populations with AK with similar disease severity.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.