Study protocol for a multicentre, open-label, single-arm phase I/II trial to evaluate the safety and efficacy of ripasudil 0.4% eye drops for retinopathy of prematurity

Glaucoma in retinopathy of prematurity: A review

Glaucoma in retinopathy of prematurity (ROP) is a challenge. It is typically secondary, though it may be associated with primary congenital glaucoma. Secondary causes are multifactorial, with mechanisms and severity potentially linked to the stage of ROP, time of presentation, or interventions for its treatment. Anecdotal reports of glaucoma following anti-vascular endothelial growth factor injection exist, but conclusive evidence is lacking. The most important cause of glaucoma in ROP is secondary angle closure in patients with stage 5 ROP. Clinical features such as corneal clouding and increased corneal diameters are clues to diagnosing glaucoma; however, glaucoma may present much later in life as well, therefore, life-long follow-up of these patients is essential. Appropriate control of intraocular pressure (IOP) becomes imperative in infants with ROP as these eyes tend to enlarge quickly with raised IOP. Management strategies consist of medical therapy, angle-based surgery, filtration surgery, glaucoma drainage devices and cyclo-ablation. The choice of therapy is individualized according to the age, presentation of glaucoma, and visual potential. We review the epidemiology, etiology, natural history, risk factors, clinical features, investigations, differential diagnosis, management and outcomes of glaucoma in ROP.

Endothelial cytoskeleton in mechanotransduction and vascular diseases

The cytoskeleton is an important structural component that regulates various aspects of cell morphology, movement, and intracellular signaling. It plays a pivotal role in the cellular response to biomechanical stimuli, particularly in endothelial cells, which are critical for vascular homeostasis and the pathogenesis of cardiovascular diseases. Mechanical forces, such as shear and tension, activate intracellular signaling cascades that regulate transcription, translation, and cellular behaviors. Despite extensive research into cytoskeletal functions, the precise mechanisms by which the cytoskeleton transduces mechanical signals remain incompletely understood. This review focuses on the role of cytoskeletal components in membrane, cytoplasm, and nucleus in mechanotransduction, with an emphasis on their structure, mechanical and biological behaviors, dynamic interactions, and response to mechanical forces. The collaboration between membrane cytoskeleton, cytoplasmic cytoskeleton, and nucleoskeleton is indispensable for endothelial cells to respond to mechanical stimuli. Understanding their mechanoresponsive mechanisms is essential for advancing therapeutic strategies for cardiovascular diseases.

Safety and efficacy of ripasudil eye drops in preterm infants with retinopathy of prematurity: phase 1/2, open label, single-arm trial

PURPOSE

To assess the safety and efficacy of ripasudil for retinopathy of prematurity (ROP).

STUDY DESIGN

Phase 1/2, multicenter, open-label, single-arm, 12-week clinical trial.

METHODS

Infants born with gestational age (GA) of ≤ 32 weeks or weight of ≤ 1500 g with zone I or II, ≥ stage 1, ROP in both eyes were enrolled. Ripasudil eye drops were administered to patients in both eyes. Phase 1 was a dose-escalation study (once daily for 1 week, then twice daily for 2 weeks); an additional dosing up to 9 weeks was allowed if no safety issues occurred. In phase 2, ripasudil was administered twice daily for up to 12 weeks. Adverse events were assessed. The proportion of patients with type 1 ROP progression, number of days for type 1 ROP progression, and progression to the most advanced ROP stage were estimated.

RESULTS

Twenty-four infants were enrolled (phase 1, n = 3; phase 2, n = 21). Nineteen and four patients experienced systemic and ocular adverse events, respectively. Efficacy endpoints were not different between the ripasudil and historical control groups. However, in the GA ≤ 27 weeks subgroup, fewer patients progressed to type 1 ROP in the ripasudil than in the historical control group (P = 0.09). In the GA ≤ 27 weeks subgroups, the 25th percentile for the number of days for type 1 ROP progression was 22 days in the historical control group and 44 days in the ripasudil group.

CONCLUSION

Ripasudil was safe and inhibited/delayed type 1 ROP progression, especially in infants with short GA.

The neonatal adverse event severity scale: current status, a stakeholders' assessment, and future perspectives

To support informed decisions on drug registration and prescription, clinical trials need tools to assess the efficacy and safety signals related to a given therapeutic intervention. Standardized assessment facilitates reproducibility of results. Furthermore, it enables weighted comparison between different interventions, instrumental to facilitate shared decisions. When focused on adverse events in clinical trials, tools are needed to assess seriousness, causality and severity. As part of such a toolbox, the international Neonatal Consortium (INC) developed a first version of the neonatal adverse event severity scale (NAESS). This version underwent subsequent validation in retro-and prospective trials to assess its applicability and impact on the inter-observer variability. Regulators, sponsors and academic researchers also reported on the use of the NAESS in regulatory documents, trial protocols and study reports. In this paper, we aim to report on the trajectory, current status and impact of the NAESS score, on how stakeholders within INC assess its relevance, and on perspectives to further develop this tool.