Evaluation of 0.05% CsA and 0.1% FK506 Eye Drops in Ocular GVHD Treatment

NCT ID: NCT05294666

Last Updated: 2022-03-24

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 89 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-04-01
• Study Completion Date: 2021-07-01

Brief Summary

It is planned to explore the efficacy and safety of local 0.05% cyclosporine eye drops in the treatment of chronic graft-versus-host eye disease. Through the comparative study with 0.1% tacrolimus eye drops, to clarify the short-term and long-term efficacy of 0.05% CSA in these patients, and to explore the benefits of long-term maintenance of local cyclosporine to patients.

Detailed Description

Chronic graft-versus-host disease (GVHD) is a common and serious complication after allogeneic hematopoietic stem cell transplantation. Its clinical presentation is similar to that of an autoimmune disease and can affect many organs, including the skin, liver, gastrointestinal tract, lungs and eyes. Ocular GVHD occurs in 30-60% of patients undergoing hematopoietic stem cell transplantation and 60-90% of patients with other systemic GVHD. Chronic ocular GVHD usually occurs 9-24 months after hematopoietic stem cell transplantation and mainly affects the cornea, conjunctiva, lacrimal gland, eyelid and meibomian gland, and leads to inflammation and fibrosis of these tissues. The characteristic manifestations of chronic GVHD include dry keratoconjunctivitis, cicatric conjunctivitis, punctate keratopathy, corneal ulcer and perforation. Severe dry eye is the most common manifestation of ocular GVHD. Patients have burning sensation, foreign body sensation, photophobia, dry eye, itching and other symptoms. This is associated with reduced tear secretion due to damage to the lacrimal gland as well as with goblet cell loss and tear film instability due to meibomian gland dysfunction. Chronic eye GVHD has the potential to cause severe visual impairment and significantly reduce the patient's quality of life. The principle of topical treatment of ocular GVHD is to lubricate the ocular surface, reduce ocular surface inflammation, prevent tear evaporation, and promote epithelial repair. Specific local treatment options include glucocorticoids, immunosuppressants, growth factors and artificial tears. Local glucocorticoids are the first-line treatment at the present stage, but the side effects of hormone therapy are relatively large. Long-term use can lead to damaged epithelial formation, thinning of the cornea, increased intraocular pressure, cataract, infectious keratitis, etc. Therefore, it is necessary to closely monitor the treatment period and minimize the use time. At present, the most commonly used topical immunosuppressants are tacrolimus (FK506) and cyclosporine (CsA). Both belong to calcineurin inhibitors, which can inhibit the activation of calcium-dependent T cells, thus exerting immunosuppressive effect. 0.05% CsA is an eye drop mainly used for the treatment of moderate and severe dry eye, with good therapeutic effect and tolerability [18-23], but slow onset of effect. In the treatment of patients with chronic ocular GVHD, previous studies have shown that cyclosporine eye drops can improve patients' dry eye symptoms, reduce corneal fluorescence staining, and increase tear film rupture time. However, the number of clinical studies on the treatment of chronic ocular GVHD with 0.05% CsA eye drops is limited, with a small number of patients enrolled and relatively short follow-up time. The immunosuppressive effect of tacrolimus is significantly higher than cyclosporine, which is 100 times higher than reported in literature. Therefore, tacrolimus is mainly used for the treatment of rejection after corneal transplantation and immune-related ocular surface diseases. What is the efficacy and tolerability of such a powerful immunosuppressant in treating GVHD? There are few literature reports, but long-term ocular application can reduce local immunity and increase the risk of local infection. At the same time, tacrolimus is very irritating, and some patients cannot tolerate it and choose to stop using the drug. At present, there is still a lack of clinical evidence to compare the efficacy of cyclosporine and tacrolimus eye drops in patients with chronic ocular GVHD. Therefore, by comparing the effectiveness, safety and tolerance of 0.05% CsA eye drops and 0.1% tacrolimus eye drops in the treatment of chronic eye graft-versus host eye disease, this study aims to explore a reasonable treatment plan for chronic eye GVHD and provide theoretical basis for clinical application.

Conditions

Graft Versus Host Disease in Eye

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

cyclosporine group

The chronic ocular GVHD patients in cyclosporine group received local 0.05% cyclosporine 4 times/day for 3 months, and then changed to 0.05% cyclosporine for 2 times/day for 3 months

Group Type: EXPERIMENTAL

Cyclosporine

Intervention Type: DRUG

The chronic ocular GVHD patients in cyclosporine group received local 0.05% cyclosporine 4 times/day for 3 months, and then changed to 0.05% cyclosporine for 2 times/day for 3 months

tacrolimus group

The chronic ocular GVHD patients in tacrolimus group received local 0.05% tacrolimus 2 times/day for 3 months, and then changed to 0.05% cyclosporine for 2 times/day for 3 months

Group Type: EXPERIMENTAL

tacrolimus

Intervention Type: DRUG

The chronic ocular GVHD patients in tacrolimus group received local 0.05% tacrolimus 2 times/day for 3 months, and then changed to 0.05% cyclosporine for 2 times/day for 3 months

Interventions

Cyclosporine

The chronic ocular GVHD patients in cyclosporine group received local 0.05% cyclosporine 4 times/day for 3 months, and then changed to 0.05% cyclosporine for 2 times/day for 3 months

Intervention Type: DRUG

tacrolimus

The chronic ocular GVHD patients in tacrolimus group received local 0.05% tacrolimus 2 times/day for 3 months, and then changed to 0.05% cyclosporine for 2 times/day for 3 months

Intervention Type: DRUG

Other Intervention Names

CsA; FK506

Eligibility Criteria

Inclusion Criteria

• Diagnosed as chronic ocular GVHD
• Did not receive eye local immunosuppressive therapy
• Non pregnant patients

Exclusion Criteria

• Have a history of eye surgery in the past six months
• Suffering from other eye diseases (autoimmune diseases, glaucoma, serious infection, retinopathy, allergy, cataract, eye trauma, etc.)
• Hormones or immunosuppressants were used before enrollment

• Minimum Eligible Age: 4 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Peking University Third Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Peking University Third Hospital

Beijing, Beijing Municipality, China

Countries

China

Other Identifiers

99304

Identifier Type: -

Identifier Source: org_study_id