title: Evaluation of oral beclomethasone dipropionate for prevention of acute graft-versus-host disease.
abstract: Results from two randomized trials have shown that oral beclomethasone dipropionate (BDP) is effective for treatment of acute gastrointestinal graft-versus-host disease. Here, we report results of a double-blind, randomized placebo-controlled phase II study designed to test the hypothesis that acute graft-versus-host disease could be prevented by administration of oral BDP, beginning before hematopoietic cell transplantation and continuing until day 75 after hematopoietic cell transplantation after myeloablative conditioning. Study drug (BDP or placebo) was administered as 1-mg immediate-release formulation plus 1-mg delayed-release formulation orally four times daily. According to the primary endpoint, systemic glucocorticoid treatment for graft-versus-host disease was given to 60 of the 92 participants (65%) in the BDP arm, versus 31 of 46 participants (67%) in the placebo arm. The secondary efficacy endpoints showed no statistically significant differences between the two arms. The proportion of participants who took at least 90% of the prescribed study drug during the first 4 weeks after hematopoietic cell transplantation was 54% overall. Lower severity of mucositis strongly correlated with higher adherence to the schedule of study drug administration. Inconsistent adherence related to mucositis during recovery after myeloablative conditioning may have obscured a beneficial therapeutic effect in the current study.
authors.affiliation: Divisions of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. pmartin@fhcrc.org
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.forename: Terry
authors.initials: T
authors.lastname: Furlong
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rowley
authors.forename: Steven A
authors.initials: SA
authors.lastname: Pergam
authors.forename: Michele
authors.initials: M
authors.lastname: Lloid
authors.forename: Mark M
authors.initials: MM
authors.lastname: Schubert
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Horgan
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001507:Beclomethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000276:immunology / Q000628:therapy*; D010349:Patient Compliance; D010919:Placebos; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents; D005938:Glucocorticoids; D010919:Placebos; D001507:Beclomethasone
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