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Rivas AB, Lopez-Picado A, Calamia V, Carreño E, Cocho L, Cordero-Coma M, Fonollosa A, Francisco Hernandez FM, Garcia-Aparicio A, Garcia-Gonzalez J, Mondejar JJ, Lojo-Oliveira L, Martínez-Costa L, Munoz S, Peiteado D, Pinto JA, Rodriguez-Lozano B, Pato E, Diaz-Valle D, Molina E, Tebar LA, Rodriguez-Rodriguez L. Efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis: a protocol for a multicentre, randomised, parallel three arms, active-controlled, phase III open label with blinded outcome assessment study. BMJ Open 2022; 12:e051378. [PMID: 35318229 PMCID: PMC8943738 DOI: 10.1136/bmjopen-2021-051378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Non-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than and as safe as their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet. METHODS AND ANALYSIS The Combination THerapy with mEthotrexate and adalImumAb for uveitis (CoTHEIA) study is a phase III, multicentre, prospective, randomised, single-blinded with masked outcome assessment, parallel three arms with 1:1:1 allocation, active-controlled, superiority study design, comparing the efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis. We aim to recruit 192 subjects. The duration of the treatment and follow-up will last up to 52 weeks, plus 70 days follow-up with no treatment. The complete and maintained resolution of the ocular inflammation will be assessed by masked evaluators (primary outcome). In addition to other secondary measurements of efficacy (quality of life, visual acuity and costs) and safety, we will identify subjects' subgroups with different treatment responses by developing prediction models based on machine learning techniques using genetic and proteomic biomarkers. ETHICS AND DISSEMINATION The protocol, annexes and informed consent forms were approved by the Reference Clinical Research Ethic Committee at the Hospital Clínico San Carlos (Madrid, Spain) and the Spanish Agency for Medicines and Health Products. We will elaborate a dissemination plan including production of materials adapted to several formats to communicate the clinical trial progress and findings to a broad group of stakeholders. The promoter will be the only access to the participant-level data, although it can be shared within the legal situation. TRIAL REGISTRATION NUMBER 2020-000130-18; NCT04798755.
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Affiliation(s)
- Ana Belen Rivas
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Departamento de Enfermería. Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Amanda Lopez-Picado
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Valentina Calamia
- Unidad de Proteómica. Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, and Universidade da Coruña, A Coruna, Galicia, Spain
| | - Ester Carreño
- Department of Ophthalmology, University Hospital Fundacion Jimenez Diaz, and University Hospital Rey Juan Carlos, Madrid, Madrid, Spain
| | - Lidia Cocho
- Department of Ophthalmology, IOBA (Institute of Applied OphthalmoBiology), University of Valladolid, and Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Miguel Cordero-Coma
- Uveitis Unit, University Hospital of León, IBIOMED, and University of León, Leon, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, País Vasco, Spain
| | - Felix M Francisco Hernandez
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Javier Garcia-Gonzalez
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Jose Juan Mondejar
- Department of Ophthalmology, Hospital General Universitario de Alicante, Alicante, Comunidad Valenciana, Spain
| | | | - Llucí Martínez-Costa
- Department of Ophthalmology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Munoz
- Department of Rheumatology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Diana Peiteado
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Antonio Pinto
- Department of Rheumatology, Complexo Hospitalario Universitario de A Coruña, A Coruna, Galicia, Spain
| | - Beatriz Rodriguez-Lozano
- Department of Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain
| | - Esperanza Pato
- Department of Rheumatology, Hospital Clínico San Carlos, IdISSC, Madrid, Madrid, Spain
| | - David Diaz-Valle
- Department of Ophthalmology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Elena Molina
- Department of Pathology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Alberto Tebar
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Musculoskeletal Pathology Group, Fundacion para la Investigacion Biomedica del Hospital Clinico San Carlos, IdISSC, Madrid, Spain
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Valls Pascual E, Vicens Bernabeu E, Alegre Sancho J, Martínez Ibáñez I, Acevedo Leόn D, Guixeres Esteve M, Martínez-Costa L, Román Ivorra J, Vergara Dangond C, Ybáñez García D, Martínez Ferrer M, Aguilar Zamora M. AB0899 Serum Levels of Calprotectin in Active Non Infectious Endogenous Uveitis. Comparison with Healthy Controls. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beltrán-Catalán E, Calvo-Río V, Rodríguez-Cundin P, Blanco-Alonso R, Sánchez-Bursόn J, Mesquida M, Adán A, Hernandez M, Hernandez Garfella M, Martínez-Costa L, Sellas A, Cordero Coma M, Díaz-Llopis M, García Serrano J, Ortego N, Herreras J, Fonollosa A, García-Aparicio Ά, Maíz O, Blanco A, Torre I, Fernández-Espartero C, Jovaní V, Peiteado D, Pato-Cour E, Cruz J, Aurrecoechea E, García M, Caracuel M, Montilla C, Atanes A, Francisco F, González S, González-Gay M. FRI0470 Comparative Study of Infliximab versus Adalimumab in Patients with Refractory Uveitis Due to BehÇEt's Disease. Multicenter Study of 125 Cases. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Benavent X, Martínez-Costa L, Ayala G, Domingo J, Marco P. Semi-automated evaluation tool for retinal vasculopathy. Comput Methods Programs Biomed 2009; 95:288-299. [PMID: 19541385 DOI: 10.1016/j.cmpb.2009.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 05/11/2009] [Accepted: 05/21/2009] [Indexed: 05/27/2023]
Abstract
The ocular fundus is the only area of human body where vascular system is visible using relatively simple instrumentation. Furthermore, there is medical suggestive evidence of a direct relationship between certain measures of vascular characteristics in the ocular fundus (arteriolar and venular calibers and focal arteriolar narrowing) and cardiovascular diseases. In order to establish such relationship on sound statistical basis a method must be provided to measure the needed values in an easy, yet precise and repeatable way. This paper presents a system to assist physicians in signaling and storing the data associated to signs of vascular deterioration and vascular calibers in non-mydriatic ocular fundus images. The system is built around a graphical user interface that, even not fully automatic, guides the practitioner to mark certain anatomic visible features in an easy and precise way. The data are exported in common database formats for further processing and a statistical summary is also presented.
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Affiliation(s)
- X Benavent
- Institute of Robotics, University of Valencia, Polígono de la Coma, s/n, Aptdo 2085, 46023 Valencia, Spain
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Díaz ME, Ayala G, Sebastian R, Martínez-Costa L. Granulometric analysis of corneal endothelium specular images by using a germ-grain model. Comput Biol Med 2006; 37:364-75. [PMID: 16793033 DOI: 10.1016/j.compbiomed.2006.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 12/05/2005] [Accepted: 04/20/2006] [Indexed: 11/27/2022]
Abstract
Specular microscopy is widely used to study the human corneal endothelium status in vivo. In this paper, the corneal endothelium is represented as a binary image composed of the cell inscribed circles. The granulometric distribution function of the complement of this image is used as a functional descriptor, which provides information about the shape, size and spatial arrangement of cells. Experimental evaluation using bootstrap techniques shows its ability to discriminate between controls and pathological cases. It represents a reliable and graphical alternative to the classical indices (cell density, hexagonality and coefficient of variation of cell areas), which behave poorly when detecting subtle abnormalities.
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Affiliation(s)
- M E Díaz
- Departamento de Informática, Universidad de Valencia, Avda. Vicente Andrés Estellés, s/n, 46100 Burjasot, Spain.
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Díaz ME, Ayala G, Quesada S, Martínez-Costa L. Testing abnormality in the spatial arrangement of cells in the corneal endothelium using spatial point processes. Stat Med 2001; 20:3429-39. [PMID: 11746327 DOI: 10.1002/sim.931] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study of central corneal endothelium morphology is important in Ophthalmology. Some of the pathologies that could compromise endothelial cell morphology are trauma, cataract, surgery, use of contact lenses, corneal dystrophies or degenerations. The quantitative analysis of cell shape and cellular pattern is more sensitive in detecting subtle changes in endothelial morphology than cell density measurement or cell area analysis. In this paper, the morphology of the central cornea, the most important area from the point of view of vision, is studied through an associated bivariate spatial point pattern: the centroids of the cells and the triple points, that is, the points where three different cells converge. Nine different summary descriptors (widely used in the statistical analysis of spatial point patterns) have been used: the empty space distribution function; the nearest neighbour distribution function and Ripley's K-function for each type of point separately (centroids and triple points), plus the corresponding three versions of these functions in the bivariate case. A control sample with similar age and cell density and no known abnormality is associated to each patient. The above descriptors are calculated for the patient and the controls. Each descriptive of the patient is compared with the corresponding descriptors from the controls by means of a graphical analysis and a formal test. Some patients presenting different pathologies are analysed in detail. Endothelia considered morphologically abnormal by visual inspection, which were not detected by hexagonality or density analysis, could be distinguished from control endothelia by these new descriptors.
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Affiliation(s)
- M E Díaz
- Departamento de Informática, Universidad de Valencia, Dr. Moliner 50, 46100-Burjasot, Spain.
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