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A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease

Biologics are increasingly used to treat Vogt-Koyanagi-Harada disease, but head-to-head comparisons with conventional immunosuppressants are lacking. Here in this randomized trial (Chinese Clinical Trial Registry, ChiCTR2100043061), we assigned 110 patients (27 early-phase and 83 late-phase) to cycl...

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Autores principales: Zhong, Zhenyu, Dai, Lingyu, Wu, Qiuying, Gao, Yu, Pu, Yanlin, Su, Guannan, Lu, Xiaorong, Zhang, Fuxiang, Tang, Chong, Wang, Yao, Zhou, Chunjiang, Yang, Peizeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290648/
https://www.ncbi.nlm.nih.gov/pubmed/37355662
http://dx.doi.org/10.1038/s41467-023-39483-5
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author Zhong, Zhenyu
Dai, Lingyu
Wu, Qiuying
Gao, Yu
Pu, Yanlin
Su, Guannan
Lu, Xiaorong
Zhang, Fuxiang
Tang, Chong
Wang, Yao
Zhou, Chunjiang
Yang, Peizeng
author_facet Zhong, Zhenyu
Dai, Lingyu
Wu, Qiuying
Gao, Yu
Pu, Yanlin
Su, Guannan
Lu, Xiaorong
Zhang, Fuxiang
Tang, Chong
Wang, Yao
Zhou, Chunjiang
Yang, Peizeng
author_sort Zhong, Zhenyu
collection PubMed
description Biologics are increasingly used to treat Vogt-Koyanagi-Harada disease, but head-to-head comparisons with conventional immunosuppressants are lacking. Here in this randomized trial (Chinese Clinical Trial Registry, ChiCTR2100043061), we assigned 110 patients (27 early-phase and 83 late-phase) to cyclosporine-based immunosuppressant strategy (N = 56) or adalimumab-based biologic strategy (N = 54), each combined with a modified corticosteroid regimen. The primary outcome is change from baseline in best-corrected visual acuity at week 26. The margin of non-inferiority for cyclosporine is −7 letters. The primary outcome is 11.2 letters (95% CI, 7.5 to 14.9) in the cyclosporine group and 6.3 letters (95% CI, 3.1 to 9.6) in the adalimumab group (difference, 4.9; 95% CI, 0.2 to 9.5; P < 0.001 for non-inferiority). The between-group difference is −0.8 letters (95% CI, −6.1 to 4.5) in early-phase disease and 5.7 letters (95% CI, 0.2 to 11.2) in late-phase. Serious adverse events are reported less frequently in the cyclosporine group than in the adalimumab group (0.70 vs. 1.21 events per patient-year). Here, we report that combined with a non-standard corticosteroid regimen, cyclosporine-based immunosuppressant strategy is non-inferior to adalimumab-based biologic strategy by 26 weeks for visual improvement in a cohort of patients with Vogt-Koyanagi-Harada disease, 75% of whom have a late-phase disease.
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spelling pubmed-102906482023-06-26 A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease Zhong, Zhenyu Dai, Lingyu Wu, Qiuying Gao, Yu Pu, Yanlin Su, Guannan Lu, Xiaorong Zhang, Fuxiang Tang, Chong Wang, Yao Zhou, Chunjiang Yang, Peizeng Nat Commun Article Biologics are increasingly used to treat Vogt-Koyanagi-Harada disease, but head-to-head comparisons with conventional immunosuppressants are lacking. Here in this randomized trial (Chinese Clinical Trial Registry, ChiCTR2100043061), we assigned 110 patients (27 early-phase and 83 late-phase) to cyclosporine-based immunosuppressant strategy (N = 56) or adalimumab-based biologic strategy (N = 54), each combined with a modified corticosteroid regimen. The primary outcome is change from baseline in best-corrected visual acuity at week 26. The margin of non-inferiority for cyclosporine is −7 letters. The primary outcome is 11.2 letters (95% CI, 7.5 to 14.9) in the cyclosporine group and 6.3 letters (95% CI, 3.1 to 9.6) in the adalimumab group (difference, 4.9; 95% CI, 0.2 to 9.5; P < 0.001 for non-inferiority). The between-group difference is −0.8 letters (95% CI, −6.1 to 4.5) in early-phase disease and 5.7 letters (95% CI, 0.2 to 11.2) in late-phase. Serious adverse events are reported less frequently in the cyclosporine group than in the adalimumab group (0.70 vs. 1.21 events per patient-year). Here, we report that combined with a non-standard corticosteroid regimen, cyclosporine-based immunosuppressant strategy is non-inferior to adalimumab-based biologic strategy by 26 weeks for visual improvement in a cohort of patients with Vogt-Koyanagi-Harada disease, 75% of whom have a late-phase disease. Nature Publishing Group UK 2023-06-24 /pmc/articles/PMC10290648/ /pubmed/37355662 http://dx.doi.org/10.1038/s41467-023-39483-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Zhong, Zhenyu
Dai, Lingyu
Wu, Qiuying
Gao, Yu
Pu, Yanlin
Su, Guannan
Lu, Xiaorong
Zhang, Fuxiang
Tang, Chong
Wang, Yao
Zhou, Chunjiang
Yang, Peizeng
A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease
title A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease
title_full A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease
title_fullStr A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease
title_full_unstemmed A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease
title_short A randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for Vogt-Koyanagi-Harada disease
title_sort randomized non-inferiority trial of therapeutic strategy with immunosuppressants versus biologics for vogt-koyanagi-harada disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290648/
https://www.ncbi.nlm.nih.gov/pubmed/37355662
http://dx.doi.org/10.1038/s41467-023-39483-5
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