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. 2020 Jul 7;2020(7):CD008946. doi: 10.1002/14651858.CD008946.pub3

Whittaker 2012.

Study characteristics
Methods This was a randomised, open‐label, multicentre study which lasted 16 weeks.
Participants This study recruited 93 patients with mycosis fungoides stage IB to IIA, who were randomised to receive bexarotene in combination with PUVA vs. PUVA alone. A histologically‐confirmed mycosis fungoides stage IB or IIA, confirmed by current or prior diagnostic lesion biopsy, was required to enrol in this study.
Demographics of the included participants
  • Sex:majority male, absolute numbers not reported, according to authors "evenly distributed"

  • Age: Mean age (range) not reported

  • Stages of disease: IB‐IIA (distribution not reported)

  • 1 of 45 participants (2%) was lost to follow‐up in the PUVA; intention to treat analysis carried out


Exclusion criteria of the trial
  • Any topical therapy within 4 weeks prior to the study

Interventions
  • Arm I: participants receive PUVA comprising oral methoxsalen given 2 hours before whole body ultraviolet A therapy. PUVA is given 3 times per week.

  • Arm II: participants receive oral bexarotene once daily and PUVA as in arm I. In both arms, treatment repeats for up to 16 weeks in the absence of complete clinical response, disease progression, or unacceptable toxicity.

Outcomes Primary outcomes of the trial
  • Overall response rate (complete clinical response (CCR) and partial response (PR))


Secondary outcomes of the trial
  • Cumulative dose of UVA required to achieve CCR

  • Number of PUVA sessions necessary to achieve a CCR

  • Duration of CCR as measured by Logrank every 4 weeks during treatment and then every 8 weeks until progression

  • Time‐to‐relapse

  • Safety as assessed by CTC v2.0 every 4 weeks during treatment, then every 8 weeks

  • Percentage of dropouts as measured by the percentage of cases not completing treatment due to toxicity at the completion of treatment

Notes This study was funded by educational grants from Ligand Pharmaceuticals Inc./Eisai Co., Ltd. and by a donation from Cancer Research
U.K. through the EORTC Charitable Trust.
The authors stated no conflicts of interest.
This study was conducted in tertiary care hospitals in 11 participating countries.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk The authors used a minimisation method for randomising patients into treatment arms.
Allocation concealment (selection bias) Unclear risk The study did not provide information about this. We sought information but got no response. We judged this to be of unclear risk.
Blinding of participants and personnel (performance bias)
All outcomes High risk Study personnel were not blinded to study groups.
Blinding of outcome assessment (detection bias)
All outcomes Unclear risk This was unknown. We contacted the corresponding author for additional outcome data, but we received no reply within 4 weeks.
Incomplete outcome data (attrition bias)
All outcomes Low risk ITT analysis was carried out. 6 of 93 patients did not start treatment after randomisation. For 5 of those 6, reasons for not starting therapy were not stated. The other patient was ineligible because of prior treatment. Additionally 1 patient lost to follow‐up and 1 drop out for "other" reasons.
Selective reporting (reporting bias) Low risk Although the primary outcome measure was changed during the conduct of the trial, the authors clearly stated the reason for this change (low accrual and overestimation of CR). The primary end point was changed from cumulative dose of UVA necessary to achieve a CR to cumulative dose of UVA to achieve an ORR.
Other bias High risk The primary end point was changed after realising that the a priori expected rate of complete responses was overestimated in trial design.