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TP23. TP023 LUNG TRANSPLANT: OUTCOME PREDICTORS AND THERAPEUTIC OPTIONS最新文献

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Study Design of Two Phase III, Prospective, Multicenter, Randomized, Controlled Clinical Trials Evaluating the Efficacy and Safety of Liposomal Cyclosporin A for Inhalation(L-CsA-i) in Patients with Bronchiolitis Obliterans Syndrome Post Single- (BOSTON-1) or Double- (BOSTON-2) Lung Transplantation 两项III期、前瞻性、多中心、随机对照临床试验的研究设计,评估单(BOSTON-1)或双(BOSTON-2)肺移植后吸入环孢素A脂质体(l - csa -1)治疗闭塞性细支气管炎综合征患者的疗效和安全性
Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1790
S. Prante Fernandes, V. Monforte Torres, D. Cuomo, R. Hachem, G. Boerner, J. Mcgrain
RATIONALE: Bronchiolitis obliterans syndrome (BOS) is the most common form of chronic lung allograft dysfunction, and the major limitation of long-term survival post lung transplantation (LTx). BOS affects up to 50% of LTx recipients within 5 years post-transplant. Currently there are no therapies indicated specifically for BOS. The most common treatment is augmentation of systemic immunosuppression, which has limited efficacy and is associated with deleterious long-term side effects. To address the goal of optimizing immunosuppression as a treatment for BOS, a novel liposomal formulation of cyclosporine A (L-CsA) delivered with an investigational eFlow® Technology nebulizer system (PARI Pharma GmbH) is being investigated. The objective of these two trials is to assess the efficacy and safety of inhaled L-CsA added to standard of Care (SoC) immunosuppression, in adult patients with single (SLT) and double lung transplantation (DLT). METHODS: Adult patients who received a SLT or DLT at least 12 months prior to screening, diagnosed with clinically defined BOS by FEV1 between 85-60% of personal best after transplant are eligible for inclusion. Patients are randomized 1:1 to L-CsA-i (5mg dose for SLT;10mg dose for DLT) twice daily plus SoC or SoC alone. After informed consent has been obtained, a Screening Visit is carried out to check general eligibility for participation. At the Randomization Visit, inclusion and exclusion criteria will be reevaluated and spirometry performed. Safety and tolerability will be assessed by physical examination, vital signs, adverse event reporting, and clinical laboratory parameters at every visit. A total of 11 visits throughout the 48-week treatment period will be performed. At completion of trial period, patients from both treatment groups could be eligible to continue in an open-label extension trial (BOSTON-3). The primary endpoint for both trials is the mean absolute change in FEV1 (mL) from baseline to Week 48 between the treatment groups. Secondary endpoints for both trials include mean change in FEV1/FVC from baseline to Week 48 and time to progression of BOS. The latter endpoint will be assessed in a pooled analysis of both trials. CONCLUSIONS: These phase III trials will help characterize the safety and efficacy of L-CsA-i as add-on therapy to SoC in BOS patients. Despite the COVID-19 pandemic, BOSTON-1 and BOSTON-2 are ongoing, ensuring the integrity of data collection and safety of enrolled patients. .
理由:闭塞性细支气管炎综合征(BOS)是慢性同种异体肺移植功能障碍最常见的形式,也是肺移植后长期生存的主要限制因素。移植后5年内,多达50%的LTx受者发生BOS。目前还没有专门针对BOS的治疗方法。最常见的治疗方法是增强全身免疫抑制,但效果有限,并伴有有害的长期副作用。为了优化免疫抑制作为BOS治疗的目标,一种新的环孢素a (L-CsA)脂体制剂正在研究中,该制剂由一种研究性的eFlow®Technology雾化器系统(PARI Pharma GmbH)提供。这两项试验的目的是评估单肺(SLT)和双肺移植(DLT)成人患者在标准护理(SoC)免疫抑制中加入吸入L-CsA的疗效和安全性。方法:筛查前至少12个月接受SLT或DLT的成年患者,移植后FEV1在个人最佳值的85-60%之间诊断为临床定义的BOS,符合纳入条件。患者以1:1的比例随机分配至l - csa - 1 (SLT 5mg剂量;DLT 10mg剂量),每日两次加SoC或单独SoC。在获得知情同意后,进行筛选访问以检查参与的一般资格。在随机访问时,将重新评估纳入和排除标准,并进行肺活量测定。安全性和耐受性将通过每次就诊时的体格检查、生命体征、不良事件报告和临床实验室参数来评估。在48周的治疗期间共进行11次访问。在试验结束时,两个治疗组的患者都有资格继续进行开放标签扩展试验(BOSTON-3)。两项试验的主要终点是治疗组之间从基线到第48周FEV1 (mL)的平均绝对变化。两项试验的次要终点包括FEV1/FVC从基线到第48周的平均变化以及BOS进展的时间。后一个终点将在两个试验的汇总分析中进行评估。结论:这些III期试验将有助于表征l - csa - 1作为BOS患者SoC附加治疗的安全性和有效性。尽管2019冠状病毒病大流行,但波士顿-1和波士顿-2仍在进行中,以确保数据收集的完整性和入组患者的安全。
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引用次数: 0
Transbronchial Biopsy Yields After the First Year Post-Lung Transplantation 肺移植后第一年经支气管活检率
Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1778
J. Magin, L. Snyder, H. Ali
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引用次数: 0
Intraoperative Red Blood Cell Transfusion Is Associated with Primary Graft Dysfunction After Lung Transplantation 术中红细胞输注与肺移植术后原发性移植物功能障碍有关
Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1785
K. Subramaniam, L. Gabriel, B. Bottiger, G. Warneckie, H. Mathew, D. Daoud, W. Qi, M. Villavicencio-Theoduloz, S. Chandrasekharan, T. Machuca, V. Raemdonck, A. Neyrinck, Y. Toyoda, M. Kashem, S. Huddleston, N. Ryssel, F. Ius, A. Osho, M. Myers, P. Sanchez
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引用次数: 2
期刊
TP23. TP023 LUNG TRANSPLANT: OUTCOME PREDICTORS AND THERAPEUTIC OPTIONS
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