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Efficacy and safety of a diffusion-based extended-release fluticasone propionate intra-articular injection (EP-104IAR) in knee osteoarthritis (SPRINGBOARD): a 24-week, multicentre, randomised, double-blind, vehicle-controlled, phase 2 trial. 扩散型缓释丙酸氟替卡松关节内注射液(EP-104IAR)治疗膝关节骨性关节炎的疗效和安全性(SPRINGBOARD):一项为期 24 周的多中心、随机、双盲、载体对照 2 期试验。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-11 DOI: 10.1016/S2665-9913(24)00223-6
Amanda Malone, Mark M Kowalski, James Helliwell, Sidsel Lynggaard Boll, Helene Rovsing, Kathrine Moriat, Alejandro Castillo Mondragón, Yanqi Li, Claire Prener Miller, Asger Reinstrup Bihlet, Christine Dobek, Vik Peck, Mike Wilmink, Lee S Simon, Philip G Conaghan
<p><strong>Background: </strong>Corticosteroids are among the few effective treatments for knee osteoarthritis, but short duration of action limits their utility. EP-104IAR, a long-acting formulation of fluticasone propionate for intra-articular injection, optimises the action of fluticasone propionate through novel diffusion-based extended-release technology. The SPRINGBOARD trial assessed the efficacy, safety, and pharmacokinetics of EP-104IAR in people with knee osteoarthritis.</p><p><strong>Methods: </strong>SPRINGBOARD was a randomised, vehicle-controlled, double-blind, phase 2 trial done at 12 research sites in Denmark, Poland, and Czech Republic. We recruited adults aged 40 years or older with primary knee osteoarthritis (Kellgren-Lawrence grade 2-3) who reported Western Ontario and McMaster Universities Osteoarthritis Arthritis Index (WOMAC) pain scores of at least 4 and no more than 9 out of 10. Participants were randomly assigned (1:1) to receive one intra-articular dose of 25 mg EP-104IAR or vehicle control. Randomisation was done via interactive web-based access to a central predefined computer-generated list with block size of six (allocated by clinical site). Participants and assessors were masked to treatment allocation. Participants were followed up for 24 weeks. The primary outcome was the difference between groups in change in WOMAC pain score from baseline to week 12, analysed in all participants who were randomly assigned and received treatment. Safety, including laboratory analyses, and pharmacokinetics from quantification of fluticasone propionate in peripheral blood were assessed in all participants who received a dose of randomly assigned treatment. A person with lived experience of knee osteoarthritis was involved in study interpretation and writing of the report. This trial is registered with ClinicalTrials.gov, NCT04120402, and the EU Clinical Trials Register, EudraCT 2021-000859-39, and is complete.</p><p><strong>Findings: </strong>Between Sept 10, 2021, and Nov 16, 2022, 1294 people were screened for eligibility, and 319 were randomly assigned to EP-104IAR (n=164) or vehicle control (n=155). One participant in the EP-104IAR group was excluded from all analyses because treatment was not administered due to an adverse event. 318 participants (135 [42%] male and 183 [58%] female, 315 [99%] White) received randomly assigned treatment and were included in the primary analysis and safety analysis (EP-104IAR, n=163; vehicle control, n=155). At week 12, least squares mean change in WOMAC pain score from baseline was -2·89 (95% CI -3·22 to -2·56) in the EP-104IAR group and -2·23 (-2·56 to -1·89) in the vehicle control group, with a between-group difference of -0·66 (-1·11 to -0·21; p=0·0044); a significant between-group difference persisted to week 14. 106 (65%) of 163 participants in the EP-104IAR group had one or more treatment-emergent adverse event compared with 89 (57%) of 155 participants in the vehicle control group. Ef
背景:皮质类固醇是治疗膝骨关节炎的少数几种有效药物之一,但作用时间短限制了其效用。EP-104IAR是一种用于关节内注射的丙酸氟替卡松长效制剂,它通过基于扩散的新型缓释技术优化了丙酸氟替卡松的作用。SPRINGBOARD试验评估了EP-104IAR对膝骨关节炎患者的疗效、安全性和药代动力学:SPRINGBOARD是一项随机、药物对照、双盲、2期试验,在丹麦、波兰和捷克共和国的12个研究机构进行。我们招募了年龄在 40 岁或以上、患有原发性膝关节骨关节炎(凯尔格伦-劳伦斯 2-3 级)的成年人,他们的西安大略和麦克马斯特大学骨关节炎关节炎指数(WOMAC)疼痛评分至少为 4 分,在满分 10 分中不超过 9 分。参与者被随机分配(1:1)接受一次25毫克EP-104IAR关节内剂量或药物对照。随机分配是通过交互式网络访问计算机生成的中央预定义列表进行的,每组 6 人(按临床地点分配)。参试者和评估人员对治疗分配进行了蒙蔽。对参与者进行了为期 24 周的随访。主要研究结果是各组间从基线到第12周WOMAC疼痛评分变化的差异,分析对象是所有随机分配并接受治疗的参与者。对所有接受了一定剂量随机分配治疗的参与者的安全性(包括实验室分析)和外周血丙酸氟替卡松的药代动力学进行了评估。一位有膝关节骨关节炎生活经验的人士参与了研究解释和报告撰写。该试验已在ClinicalTrials.gov(NCT04120402)和欧盟临床试验注册中心(EudraCT 2021-000859-39)注册,并已完成:2021年9月10日至2022年11月16日,1294人通过资格筛选,319人被随机分配到EP-104IAR(n=164)或药物对照组(n=155)。EP-104IAR组中有一名参与者因不良事件未接受治疗而被排除在所有分析之外。318名参与者(男性135人[42%],女性183人[58%],白人315人[99%])接受了随机分配的治疗,并被纳入主要分析和安全性分析(EP-104IAR,n=163;药物对照组,n=155)。第12周时,EP-104IAR组WOMAC疼痛评分与基线相比的最小平方平均变化为-2-89(95% CI -3-22至-2-56),药物对照组为-2-23(-2-56至-1-89),组间差异为-0-66(-1-11至-0-21;P=0-0044);显著的组间差异持续到第14周。EP-104IAR组的163名参与者中有106人(65%)出现了一种或多种治疗突发不良事件,而药物对照组的155名参与者中有89人(57%)出现了这种不良事件。EP-104IAR对血清葡萄糖和皮质醇浓度的影响很小,而且是短暂的。没有出现治疗引起的死亡或与治疗相关的严重不良事件。丙酸氟替卡松的血浆浓度显示出钝化的初始峰值,最终半衰期约为18-20周:这些2期研究结果表明,EP-104IAR有可能为膝关节骨关节炎患者提供长达14周的有临床意义的疼痛缓解,比目前市场上销售的皮质类固醇的公开数据更长。EP-104AR对血糖和皮质醇的影响极小,血浆中丙酸氟替卡松的浓度稳定。EP-104IAR的安全性和有效性将在3期试验中进一步评估,包括EP-104IAR双侧用药和重复用药的可能性:资金来源:Eupraxia Pharmaceuticals:摘要的丹麦语译文见 "补充材料 "部分。
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引用次数: 0
Inclusion of pregnant populations in clinical trials in China: the ethical considerations 在中国将妊娠人群纳入临床试验:伦理方面的考虑。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-03 DOI: 10.1016/S2665-9913(24)00276-5
Xiaoyan Chen , Huifeng Shi , Barbara Wilkinson , Yuanfang Zhu
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引用次数: 0
Inclusive study design to better serve the needs of children and young people with rheumatological conditions 包容性研究设计,更好地满足患有风湿病的儿童和青少年的需求。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/S2665-9913(24)00271-6
Ameenat Lola Solebo , Salomey Kellett
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引用次数: 0
Constitutional symptoms of severe childhood-onset polyarteritis nodosa. 儿童期严重多发性结节性动脉炎的体征。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-27 DOI: 10.1016/S2665-9913(24)00269-8
Pavneet Kaur, Srinivasavaradan Govindarajan, Manisha Jana, Aditi Sinha, Narendra Kumar Bagri
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引用次数: 0
Correction to Lancet Rheumatol 2024; 6: e507–17 柳叶刀风湿病学》2024;6:e507-17 更正。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-27 DOI: 10.1016/S2665-9913(24)00303-5
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引用次数: 0
The emerging risk of overdiagnosis in rheumatoid arthritis and polymyalgia rheumatica. 类风湿性关节炎和多发性风湿性关节炎新出现的过度诊断风险。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-25 DOI: 10.1016/S2665-9913(24)00227-3
Elizabeth Nettleton, Kylie Carlson, Michael Putman

Overdiagnosis occurs when patients are diagnosed with a disease that would otherwise never have affected the quality or duration of their lives. This often happens unintentionally through well-meaning screening programmes that aim to detect diseases during so-called subclinical stages. Recently, it has been suggested that patients with polymyalgia rheumatica should be screened for giant cell arteritis to identify those at higher risk of relapse or vascular complications. Screening for interstitial lung disease for patients with rheumatoid arthritis has also been recommended to identify patients who could benefit from pulmonary interventions. These potential benefits must be weighed against foreseeable harms. Such harms include the uncovering of incidental findings that necessitate additional medical follow-up, the financial costs associated with screening initiatives, the risk of overtreatment through increased immunosuppression in patients who might not have otherwise required it, and the psychosocial burden of a new diagnosis. Randomised clinical trials and prospective cohort studies of screening interventions should be conducted to establish the risks and benefits and identify patients most likely to benefit from them. This Viewpoint covers risks that overdiagnosis presents to the field of rheumatology, with focus on rheumatoid arthritis and polymyalgia rheumatica.

过度诊断是指患者被诊断出患有一种本来不会影响其生活质量或寿命的疾病。这种情况往往是通过旨在发现所谓亚临床阶段疾病的善意筛查计划无意中发生的。最近,有人建议对多发性风湿痛患者进行巨细胞动脉炎筛查,以识别复发或血管并发症风险较高的患者。还有人建议对类风湿性关节炎患者进行间质性肺病筛查,以确定哪些患者可以从肺部干预中获益。这些潜在的益处必须与可预见的危害进行权衡。这些危害包括发现需要额外医疗随访的偶然发现、与筛查措施相关的经济成本、通过增加免疫抑制对原本不需要治疗的患者进行过度治疗的风险,以及新诊断带来的社会心理负担。应该对筛查干预措施进行随机临床试验和前瞻性队列研究,以确定其风险和益处,并确定最有可能从中受益的患者。本观点涵盖了过度诊断给风湿病学领域带来的风险,重点关注类风湿性关节炎和多发性风湿痛。
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引用次数: 0
Challenges and solutions for cellular therapy development in autoimmune diseases 自身免疫性疾病细胞疗法开发的挑战与解决方案。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-24 DOI: 10.1016/S2665-9913(24)00274-1
Elizabeth R Volkmann , John Varga , Bruce R Blazar , Steven Z Pavletic
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引用次数: 0
Research in Brief 研究简介
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-23 DOI: 10.1016/S2665-9913(24)00278-9
Jennifer Thorley
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引用次数: 0
Trials and tribulations for children with rheumatic diseases 风湿病患儿的考验和磨难
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-23 DOI: 10.1016/S2665-9913(24)00279-0
The Lancet Rheumatology
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引用次数: 0
Treating antineutrophil cytoplasmic antibody-associated vasculitis in frail older adults 治疗体弱老年人的抗中性粒细胞胞浆抗体相关性血管炎。
IF 15 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-18 DOI: 10.1016/S2665-9913(24)00272-8
Alexandra Legge
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Lancet Rheumatology
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