- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06348602
Evaluation of Safety & Efficacy for the Prevention of Ocular GVHD With Ophthalmic Tacrolimus vs Cyclosporine in Allo-HSCT
Evaluation of Safety and Efficacy for the Prevention of Ocular Graft-versus-host Disease With Ophthalmic Tacrolimus vs. Ophthalmic Cyclosporine in Non-myeloablative Allogeneic Hematopoietic Stem Cell Transplant Recipients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
After being informed about the study and potential risks, all patients giving written informed consent will be assigned a participant number to anonymize their data and collect information, including age, sex, diagnosis, stage of disease, type of procedure, and conditioning chemotherapy. Additionally, an ophthalmology evaluation will be conducted in the Ophthalmology Department of the University Hospital of the U.A.N.L. by the study team of ophthalmologists, following a standardized method and using a worksheet for dry eye and ocular surface evaluation.
Participants will be randomized to receive either treatment arm A (cyclosporine eye drops) or treatment arm B (tacrolimus ointment) through a stratified method. After the hematopoietic stem cell transplant (HSCT), information will be collected, such as the transplant details (e.g., number of cluster of differentiation 34 [CD34] cells infused, cell source, and any complications during the procedure) and medications used for the systemic GVHD prophylaxis, as well as the graft date. In addition to the standard systemic management protocol for GVHD prevention of the transplant program of the Hematology Service of the Hospital University U.A.N.L. cyclosporine or tacrolimus will be administered to participants once grafting is demonstrated, defined as the presence in the blood count of a neutrophil count that is equal to or greater than to 500/mm3 and platelet count equal to or greater than 20,000/mm3.
- Treatment arm A: topical cyclosporine 0.1% ocular drops, twice daily, one drop in each eye, with a 12-hour difference between each dose, for 12 continuous months. The commercial presentation that we will use has the following formula: Each milliliter of 0.1% solution contains Cyclosporine A 10 mg, c.b.p 1.0 ml.
- Treatment arm B: tacrolimus ointment, to be applied approximately 1cm or the amount to cover the lower fornix twice a day in each eye, with a difference of 12 hours between each dose, for 12 continuous months. The presentation of the medicine in ointment has a 10 gr tube with 0.03% drug.
Ophthalmological evaluations will be carried out at the initial visit (before the bone marrow transplant) and scheduled subsequent visits: at the time of transplant graft (variable depending on the type of transplant, between days +10 and +21 approximately), and 3, 6, 9, and 12 months from the start of treatment (day of graft). Also, they will be evaluated during all follow-up visits to the transplant department of the Hematology Service, assessing adherence and tolerance to the medication through direct questioning. The severity of ocular GVHD will be established based on the NIH criteria and the severity criteria of the international consensus on the severity of chronic ocular GVHD (ICCGVHD)
Ophthalmological variables to be evaluated
- Tear breakup time, Schirmer's test, esthesiometry, Keratograph 5M Topographer Dry Eye Assessment, upper and lower tarsus Meibomian Gland imaging (Keratograph 5M), tear osmolarity, metalloproteinase 9 levels in tears.
- Corneal and conjunctival staining measured with the Oxford Scale and the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Scale and SICCA Ocular Staining Score (OSS).
Study Type
Enrollment (Estimated)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Contact
- Name: Olga Graciela Cantú Rodriguez, MD
- Phone Number: 8186939257
- Email: ogcantur@yahoo.com.mx
Study Locations
-
-
Monterrey
-
Nuevo León, Monterrey, Mexico, 66640
- Recruiting
- Hospital Universitario de la U.A.N.L.
-
Contact:
- Olga Graciela Cantú Rodriguez, MD
- Phone Number: 8186939257
- Email: ogcantur@yahoo.com.mx
-
Contact:
- David Gómez Almaguer, MD
- Phone Number: 8186756718
- Email: dgomezalmaguer@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients undergoing allogeneic HSCT.
- Patients 18 years of age or older.
- Patients who agree to participate in the study and sign the informed consent document.
Exclusion Criteria:
- Patients undergoing HSCT who do not continue their evaluation and follow-up in the Hematology Service of the University Hospital.
- Patients under 18 years of age.
- Patients who do not agree to participate in the study.
- Patients diagnosed with previous rheumatic disease.
- Patients with dermatological conditions undergoing systemic treatment.
- Patients with uncontrolled thyroid disease.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Topical cyclosporine
Topical cyclosporine ophthalmic solution 0.1%, with a dosage of 1 drop in each eye every 12 hours, continued for a duration of 12 continuous months. Composition: Each ml contains Cyclosporine A 0.1% w/v (1 mg/ml) in a sterile aqueous vehicle q.s. |
Ophthalmic prophylaxis begins once engraftment is documented, with a dose of 1 drop in each eye every 12 hours, continued for a duration of 12 continuous months
|
Experimental: Topical tacrolimus
Topical tacrolimus ophthalmic ointment 0.03%, with a dosage of approximately 1 cm or the necessary amount to cover the lower fornix, every 12 hours, continued for a duration of 12 continuous months Composition: Each gram contains Tacrolimus 0.03% w/w (0.3 mg/g) in a sterile ointment base q.s.
|
Ophthalmic prophylaxis begins once engraftment is documented, with a dose of approximately 1 cm or the necessary amount to cover the lower fornix, every 12 hours, continued for a duration of 12 continuous months
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of ocular graft-versus-host disease in patients undergoing allo-HSCT receiving topical prophylaxis with Cyclosporine A or Tacrolimus as assessed by the International Consensus Criteria on chronic ocular graft-versus-host disease.
Time Frame: 2.5 years
|
Severity based on an aggregate of scores of the following parameters: Schirmer's test [mm] (0, >15; 1, 11-15; 2, 6-10; 3, ≤5), Corneal fluorescein staining [points] (0, 0; 1, <2; 2, 2-3; 3, ≥4), Ocular Surface Disease Index [points] (0, <13; 1, 13-22; 2, 23-32; 3, ≥33), Conjunctival injection [points] (0, None; 1, Mild/Moderate; 2, Severe).
Graded as none (0-4 points), mild/moderate (5-8 points) and severe (9-11 points), where higher scores mean a worse outcome.
|
2.5 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of ocular graft-versus-host disease in patients undergoing allo-HSCT receiving topical prophylaxis with Cyclosporine A or Tacrolimus as assessed by the National Institutes of Health Consensus Development Projects on Chronic GVHD scoring system.
Time Frame: 2.5 years
|
Severity graded from 0 to 3 as follows: 0: No symptoms; 1: mild dry eye symptoms not affecting activity of daily living (requiring eye drops ≤3 x per day); 2: Moderate dry eye symptoms partially affecting activity of daily living (requiring eye drops >3 x per day or punctal plugs) WITHOUT new vision impairment due to keratoconjunctivitis sicca; 3: Severe dry eye symptoms significantly affecting activity of daily living (special eyewear to relieve pain) OR unable to work because of ocular symptoms OR loss of vision due to keratoconjunctivitis sicca.
Note: higher scores mean a worse outcome.
|
2.5 years
|
Prevalence of ocular GVHD based on historical records in the hematology service of the University Hospital U.A.N.L. in patients without prophylactic treatment as assessed by the International Consensus Criteria on chronic ocular graft-versus-host disease
Time Frame: 10 years
|
Severity based on an aggregate of scores of the following parameters: Schirmer's test [mm] (0, >15; 1, 11-15; 2, 6-10; 3, ≤5), Corneal fluorescein staining [points] (0, 0; 1, <2; 2, 2-3; 3, ≥4), Ocular Surface Disease Index [points] (0, <13; 1, 13-22; 2, 23-32; 3, ≥33), Conjunctival injection [points] (0, None; 1, Mild/Moderate; 2, Severe).
Graded as none (0-4 points), mild/moderate (5-8 points) and severe (9-11 points), where higher scores mean a worse outcome.
|
10 years
|
Severity of ocular GVHD based on historical records in the hematology service of the University Hospital U.A.N.L. in patients without prophylactic treatment, as assessed by the International Consensus Criteria on chronic ocular graft-versus-host disease.
Time Frame: 10 years
|
Severity based on an aggregate of scores of the following parameters: Schirmer's test [mm] (0, >15; 1, 11-15; 2, 6-10; 3, ≤5), Corneal fluorescein staining [points] (0, 0; 1, <2; 2, 2-3; 3, ≥4), Ocular Surface Disease Index [points] (0, <13; 1, 13-22; 2, 23-32; 3, ≥33), Conjunctival injection [points] (0, None; 1, Mild/Moderate; 2, Severe).
Graded as none (0-4 points), mild/moderate (5-8 points) and severe (9-11 points), where higher scores mean a worse outcome.
|
10 years
|
Prevalence of ocular GVHD based on historical records in the hematology service of the University Hospital U.A.N.L. in patients without prophylactic treatment, as assessed by the National Institutes of Health Consensus on Chronic GVHD scoring system.
Time Frame: 10 years
|
Severity graded from 0 to 3 as follows: 0: No symptoms; 1: mild dry eye symptoms not affecting activity of daily living (requiring eye drops ≤3 x per day); 2: Moderate dry eye symptoms partially affecting activity of daily living (requiring eye drops >3 x per day or punctal plugs) WITHOUT new vision impairment due to keratoconjunctivitis sicca; 3: Severe dry eye symptoms significantly affecting activity of daily living (special eyewear to relieve pain) OR unable to work because of ocular symptoms OR loss of vision due to keratoconjunctivitis sicca.
Note: higher scores mean a worse outcome.
|
10 years
|
Severity of ocular GVHD based on historical records in the hematology service of the University Hospital U.A.N.L. in patients without prophylactic treatment, as assessed by the National Institutes of Health Consensus on Chronic GVHD scoring system.
Time Frame: 10 years
|
Severity graded from 0 to 3 as follows: 0: No symptoms; 1: mild dry eye symptoms not affecting activity of daily living (requiring eye drops ≤3 x per day); 2: Moderate dry eye symptoms partially affecting activity of daily living (requiring eye drops >3 x per day or punctal plugs) WITHOUT new vision impairment due to keratoconjunctivitis sicca; 3: Severe dry eye symptoms significantly affecting activity of daily living (special eyewear to relieve pain) OR unable to work because of ocular symptoms OR loss of vision due to keratoconjunctivitis sicca.
Note: higher scores mean a worse outcome.
|
10 years
|
Number of participants requiring adjuvant treatment for ocular GVHD in patients receiving prophylactic tacrolimus or cyclosporine for ocular GVHD.
Time Frame: 2.5 years
|
e.g topical corticosteroids
|
2.5 years
|
Number of participants requiring adjuvant treatments for the Dry Eye Disease
Time Frame: 2.5 years
|
e.g.eye lubricant, artificial tears, autologous serum or autologous platelet-rich plasma in drops.
|
2.5 years
|
Incidence of other manifestations of acute and chronic GVHD, local or systemic, in patients receiving prophylactic treatment for ocular GVHD.
Time Frame: 2.5 years
|
With The National Institutes of Health (NIH) consensus criteria used to diagnose GVHD
|
2.5 years
|
Number of participants with topical tacrolimus related adverse events as assessed by a questionnaire for evaluation of adverse drug events
Time Frame: 1 year
|
Variables: frequency and severity (0-100) of burning sensation, pain, itching, discomfort, blurred vision, foreign body sensation, others.
|
1 year
|
Number of participants with topical cyclosporine related adverse events as assessed by a questionnaire for evaluation of adverse drug events
Time Frame: 1 year
|
Variables: frequency and severity (0-100) of burning sensation, pain, itching, discomfort, blurred vision, foreign body sensation, others.
|
1 year
|
Prevalence of Dry Eye Disease prior to the HSCT.
Time Frame: 2.5
|
Evaluation of dry eye symptoms with the ocular surface disease index (OSDI), National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), tear breakup time, schirmer test.
|
2.5
|
Subtypes of Dry Eye Disease prior to the HSCT
Time Frame: 2.5
|
Evaluation of dry eye symptoms with the ocular surface disease index (OSDI), National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), tear breakup time, schirmer test.
|
2.5
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of ocular GVHD in patients receiving prophylactic treatment for ocular GVHD.
Time Frame: 2.5 years
|
Assessed by the Ocular Graft Versus Host Disease diagnostic criteria and grading scale according to the NIH criteria 2014 and the International Consensus Criteria on chronic ocular graft versus host disease (ICCGVHD)
|
2.5 years
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, Palmer J, Weisdorf D, Treister NS, Cheng GS, Kerr H, Stratton P, Duarte RF, McDonald GB, Inamoto Y, Vigorito A, Arai S, Datiles MB, Jacobsohn D, Heller T, Kitko CL, Mitchell SA, Martin PJ, Shulman H, Wu RS, Cutler CS, Vogelsang GB, Lee SJ, Pavletic SZ, Flowers ME. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015 Mar;21(3):389-401.e1. doi: 10.1016/j.bbmt.2014.12.001. Epub 2014 Dec 18.
- Cantu-Rodriguez OG, Vazquez-Mellado A, Gonzalez-Trevino JL, Martinez-Garza DM, Gomez-De Leon A, Hawing-Zarate JA, Jaime-Perez JC, Gutierrez-Aguirre CH, Garza-Acosta AC, Mancias-Guerra C, Gonzalez-Llano O, Gonzalez-Cantu GA, Herrera-Rojas MA, Sada-Ovalle I, Gomez-Almaguer D. Cyclosporine A for the Prevention of Ocular Graft versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients Is Safe and Feasible. Acta Haematol. 2020;143(5):425-431. doi: 10.1159/000502405. Epub 2019 Sep 10.
- Jung JW, Lee YJ, Yoon SC, Kim TI, Kim EK, Seo KY. Long-term result of maintenance treatment with tacrolimus ointment in chronic ocular graft-versus-host disease. Am J Ophthalmol. 2015 Mar;159(3):519-27.e1. doi: 10.1016/j.ajo.2014.11.035. Epub 2014 Dec 9.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Immune System Diseases
- Graft vs Host Disease
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Dermatologic Agents
- Antifungal Agents
- Pharmaceutical Solutions
- Calcineurin Inhibitors
- Ophthalmic Solutions
- Tacrolimus
- Cyclosporine
- Cyclosporins
Other Study ID Numbers
- PI23-00201
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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