Clinical Trials Logo

Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT03128463
Other study ID # 2016YFC0904800
Secondary ID
Status Recruiting
Phase N/A
First received March 9, 2017
Last updated April 20, 2017
Start date February 28, 2017
Est. completion date December 31, 2018

Study information

Verified date April 2017
Source Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Contact Xun Xu, MS,MD.
Phone +86-13386259538
Email drxuxun@sjtu.edu.cn
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Macular neovascular diseases including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), pathological myopia (PM) and etc. can cause severe vision loss. It has become the focus of World Health Organization's blindness- prevention cause. A new anti—VEGF drug conbercept has been approved and showed good efficacy and safety in clinical trials. But the exact therapeutic regimen and the efficacy in the real world still needs to be further studied, the reasons are as follows:

1. The efficacy and safety data of conbercept are collected from rigorous random controlled trials (RCT) , it can not fully reflect the clinical application of conbercept in the real world . Therefore, the knowledge of the therapeutic regimen, safety and efficacy of conbercept is still limited.

2. Conbercept has been approved for wet-AMD only, but in clinical practice, some doctors applied other "off-label use" of conbercept. These "off-label use" has become a common phenomenon all over the world for the instruction book of drugs usually lag behind scientific researches. There is no specific law or regulatory document of drug off-label use in China until now.

3. Anti-VEGF drugs are expensive and often require multiple treatments, and some patients have poor or even no response to the drugs. This resulted enormous waste of medical resources. So, how to accurately find out those patients who have good response, how to develop individualized therapeutic regimen, and the response of patients in the real world need to be urgently investigated in the aspect of pharmacogenomics, and pharmacometabolomics.

Therefore, the investigators plan to carry out real-world researches of conbercept on treating macular neovascular diseases has significance and urgency.

The investigators intended to conduct a nationwide, non-intrusive, prospective, observational, and multicenter registration study to investigate the efficacy of conbercept in the real-world. And this study will explore the pharmacogenomics and pharmacometabolomics of conbercept, relationships of phenotype and the effectiveness of the drug, optimize the therapeutic regimen, then reduce the financial burden of patients and save the limited medical resources to achieve the purpose of accurate treatment.

For three unanswered questions raised in the background, the researchers carried out the following purposes:

1. Investigate the safety and efficacy of conbercept in treating neovascular macular disease in the real world.

2. Find out whether the "off-label use" of conbercept on PCV and PM have good efficacy.

3. Explore the pharmacogenomics and pharmacometabolomics of conbercept through large-sample registration study.


Description:

Research Background

Macular neovascular disease, is a group of diseases with subfoveal choroidal neovascularization, including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), pathological myopia (PM) and etc. Due to the high permeability of immature blood vessel wall, consequent bleeding, and scarring,macular neovascularization often leads to severe vision loss. It has become the focus of World Health Organization's blindness- prevention cause [1]. Currently, the vascular endothelial growth factor (VEGF) has been widely recognized as an important promoter for neovascularization. And a series of large-scale clinical studies revealed that anti- VEGF drug is the only effective way for macular neovascular disease [2], Anti-VEGF drug has been awarded as one of the top ten scientific and technological progress by Nature magazine.

Conbercept is an anti-VEGF drug developed independently by Chinese researchers in recent years, it competitively prevents the binding of VEGF to its receptor and inhibits the downstream pathway activation, and has a higher binding affinity to VEGFA than other widely used anti-VEGF drugs. Many multicenter double blind random controlled study showed that conbercept has good efficacy and safety in treating macular neovascular diseases. In 2013, conbercept has been approved by the State Food and Drug Regulatory Administration of China and now has been widely used and recognized.

Clinical trial results showed that the conbercept has good efficacy and safety in treating macular neovascular diseases [3], but the exact therapeutic regimen and the efficacy in the real world still needs to be further studied, the reasons are as follows:

1. The efficacy and safety data of conbercept are collected from rigorous random controlled trials (RCT), it cannot fully reflect the clinical application of conbercept in the real world. Therefore, the knowledge of the therapeutic regimen, safety and efficacy of conbercept is still limited.

2. Conbercept has been approved for wet-AMD only, but in clinical practice, some doctors applied other "off-label use" of conbercept. These "off-label use" has become a common phenomenon all over the world for the instruction book of drugs usually lag behind scientific researches. There is no specific law or regulatory document of drug off-label use in China until now.

3. Anti-VEGF drugs are expensive and often require multiple treatments, besides, some patients have poor or even no response to the drugs. This resulted enormous waste of medical resources. So, how to accurately find out those patients who have good response, how to develop individualized therapeutic regimen, and the response of patients in the real world need to be urgently investigated in the aspect of pharmacogenomics, and pharmacometabolomics.

Therefore, the investigators plan to carry out real-world researches of conbercept on treating macular neovascular diseases has significance and urgency.

Scientific assumptions

The investigators intended to conduct a nationwide, non-intrusive, prospective, observational, and multicenter registration study to investigate the efficacy of conbercept in the real-world. And this study will explore the pharmacogenomics and pharmacometabolomics of conbercept, relationships of phenotype and the effectiveness of the drug, optimize the therapeutic regimen, then reduce the financial burden of patients and save the limited medical resources to achieve the purpose of accurate treatment.

For three unanswered questions raised in the background, the researchers carried out the following purposes:

1. Investigate the safety and efficacy of conbercept in treating neovascular macular disease in the real world.

2. Find out whether the "off-label use" of conbercept on PCV and PM have good efficacy.

3. Explore the pharmacogenomics and pharmacometabolomics of conbercept through large-sample registration study.

Research Plan

Program schedule: Total 2 years (1 year on enrollment, 1-year on observation) Start time: February of 2017 (FPFV, First Time Patient First Visit) End time: December of 2018 (LPLV, the last time Last Patient Last Visit) Clinical study report (CSR): December of 2018; Publish: June of 2019

This is an observational study, the investigators aim to observe and collect 5000 patients from forty nationwide ophthalmic centers that receive ocular injections of conbercept to treat macular neovascular diseases during December 2016- November 2017. And the follow-up observation last for one year. The investigators do not interfere patients' treatment plan during the entire research.

Registration time:

V1: baseline (enrollment period), V2: 1month after treatment, V3: 3 months, V4: 6 months, V5: 12 months.

Data collection and transfer:

In each visit, patients' demographic information, vital sign, history of systematic diseases, concomitant medication, eye disease history, eye examinations record, safety information and blood samples are collected. Clinical data and fundus imaging data collected by forty clinical centers will be uploaded to Shanghai Jiaotong University Ophthalmic Reading Center database then be analyzed and evaluated together.

Statistics Program: Statistical general principles:

All data will undergo descriptive statistics and statistical tests,analysis will be based on baseline and follow-up data.

Sample size:

Plan to enroll 5,000 patients by 40 hospitals. The amount will depend on the registration capacity and follow-up rate.

Safety: observe the number of cases and the percentage of adverse events and severe adverse events of conbercept in real world.

Possible bias and solutions:

Patients lost to follow (such as patients from other places, can not undergo regular local follow up): Solution 1, enroll in local patients or patients who plan to have regular and long-term follow-up in our hospital; 2, Follow up and register by telephone.

Poor patient compliance: offer some compensation for patients' transport costs.

Patients who cannot afford the drugs due to economic conditions: pharmaceutical has policies on drug donation for this population.

Quality control and Management:

Object Data Management: Ensure that all enrolled patients have signed informed consent. Each visit information should be timely, accurately and completely recorded and entered into the electronic case report form (CRF). The electronic CRF should be consistent with the original medical records. All adverse events, concomitant medications should be documented, serious adverse events should be reported to the relevant authorities within 24 hours.

Follow-up management: follow-up should be conducted according to required time point and rules. Researchers should try to find out the reasons of losing visit and avoid them. If patients failed to come to clinic, then the researchers should make a phone call follow up. If patients refused to continue participating in the study for some concerns, they should be interpreted by reasonable encourages to continue cooperation.


Recruitment information / eligibility

Status Recruiting
Enrollment 5000
Est. completion date December 31, 2018
Est. primary completion date December 31, 2018
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria:

1. Signed informed consent

2. Patients were diagnosed with macular neovascular disease (wet age- related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV)and choroidal neovascularization secondary to pathological myopia (PM) ), no gender requirement, age = 18years

3. Patients plan to receive intravitreal injection of conbercept;

4. Patients should be resident in this region or who plans a long-term follow- up in the clinical center.

Exclusion Criteria:

1. Participate in other intervention therapy at the same time

2. Received anti- VEGF treatment (including intravitreal injection or systematic application) within three months prior to enrollment .

Study Design


Intervention

Drug:
Intravitreal injection of conbercept
We observe and collect patients with macular neovascular diseases who had intravitreal injections of conbercept. We do not interfere patients' treatment plan.

Locations

Country Name City State
China Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine Shanghai Shi Shanghai

Sponsors (5)

Lead Sponsor Collaborator
Xun Xu Fourth Military Medical University, Peking University, Tianjin Medical University, Zhongshan Ophthalmic Center, Sun Yet-san University

Country where clinical trial is conducted

China, 

References & Publications (4)

Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond). 2015 Jun;29(6):721-31. doi: 10.1038/eye.2015.48. Epub 2015 Apr 17. Review. Erratum in: Eye (Lond). 2015 Oct;29(10):1397-8. Kelly, S [corrected to Kelly, S P]. — View Citation

CATT Research Group., Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011 May 19;364(20):1897-908. doi: 10.1056/NEJMoa1102673. Epub 2011 Apr 28. — View Citation

Li X, Xu G, Wang Y, Xu X, Liu X, Tang S, Zhang F, Zhang J, Tang L, Wu Q, Luo D, Ke X; AURORA Study Group.. Safety and efficacy of conbercept in neovascular age-related macular degeneration: results from a 12-month randomized phase 2 study: AURORA study. Ophthalmology. 2014 Sep;121(9):1740-7. doi: 10.1016/j.ophtha.2014.03.026. Epub 2014 May 1. — View Citation

Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CM. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res. 2016 Jul;53:107-39. doi: 10.1016/j.preteyeres.2016.04.002. Epub 2016 Apr 14. Review. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary visual improvement after intravitreal injection of conbercept The efficacy was graded as significantly effective (visual improvement =15 letters in EDTRS ),effective (visual improvement =5 letters and <15 letters in EDTRS),invalid(visual improvement <5 letters and visual reduction<5 letters in EDTRS, deterioration (visual reduction=5 letters in EDTRS. The number and ratio of the above-mentioned grade are to be analyzed. Feb. 2017—Dec.2018
Secondary The off-label use of conbercept in real world. Calculate the number of cases and percentage of off-label use(%)in real world. Feb. 2017—Dec.2018
Secondary The application of off-label use on targeted diseases Record the name of diseases when off-label use is applied. Feb. 2017—Dec.2018
Secondary The number and percentage(%)of each target diseases in off-label use. Calculate the the number and percentage(%)of each target diseases in off-label use respectively. Feb. 2017—Dec.2018
Secondary The improvement of retinal edema after using conbercept The improvement of retinal edema after using conbercept and compare the difference between central foveal retinal thickness (CRT in µm) and the baseline after 1 month, 3 months, 6 months, and 12 months. Feb. 2017—Dec.2018
Secondary The different therapeutic regimens The different therapeutic regimens when conbercept is applied on different diseases in real world, including number of treatments, frequency of injection(times per year), interval time(months). Feb. 2017—Dec.2018
Secondary Dropout rate of the study. Calculate the dropout rate(%) of each follow-up time and during the whole follow-up. Feb. 2017—Dec.2018
Secondary Predict patients' response to conbercept on treating macular neovascular diseases by analyzing macular leakage area After 3 months treatment, compare the macular leakage area (mm2) to baseline in Fluorescein Fundus Angiography (FFA) on patients who response to conbercept treatment and patients with no response, to further analyze the potential relationship with the response / non-response. Feb. 2017—Dec.2018
Secondary Predict patients' response to conbercept on treating macular neovascular diseases by analyzing CNV area After 3 months treatment, compare the CNV area (mm2) to baseline in FFA on patients who response to conbercept treatment and patients with no response, to further analyze the potential relationship with the response / non-response. Feb. 2017—Dec.2018
See also
  Status Clinical Trial Phase
Recruiting NCT05984927 - NG101 AAV Gene Therapy in Subjects With Wet Age-Related Macular Degeneration Phase 1/Phase 2
Active, not recruiting NCT05536297 - Avacincaptad Pegol Open-Label Extension for Patients With Geographic Atrophy Phase 3
Recruiting NCT04101604 - Biomarkers of Common Eye Diseases
Completed NCT04005352 - Study to Assess the Efficacy and Safety of Brolucizumab 6mg Compared to Aflibercept 2 mg in a Treat-to-control Regimen (TALON) Phase 3
Withdrawn NCT02873351 - A Safety and Efficacy Study of Carbidopa-levodopa in Patients With Macular Degeneration Phase 2
Active, not recruiting NCT02802657 - Efficacy and Safety of "Treat-and-Extend" Regimen Versus "Pro Re Nata" of Conbercept in Age-related Macular Degeneration Phase 4
Not yet recruiting NCT02864472 - Comparison of PDT Combination With Ranibizumab vs. Ranibizumab Monotherapy in Persistent PCV With Initial Loading Dose Phase 4
Recruiting NCT01521065 - An Open-label Study to Evaluate the Clinical and Economic Benefits of I-Ray in Patients With Choroidal Neovascularization Secondary to Age-related Macular Degeneration Phase 2
Completed NCT01445548 - Sirolimus for Advanced Age-Related Macular Degeneration Phase 1/Phase 2
Completed NCT02035722 - Intravitreal Injections-related Anxiety Phase 2/Phase 3
Completed NCT01175395 - 20089 TA+Lucentis Combo Intravitreal Injections for Treatment of Neovascular Age-related Macular Degeneration (AMD) Phase 1/Phase 2
Recruiting NCT01048476 - Effects of Lutein and Zeaxanthin Supplementation on Age-related Macular Degeneration Phase 1/Phase 2
Active, not recruiting NCT01174407 - Implication of CD35, CD21 and CD55 in Exudative Age-related Macular Degeneration N/A
Terminated NCT00712491 - Phase 1/2 Study of an Ocular Sirolimus (Rapamycin) Formulation in Patients With Age-Related Macular Degeneration Phase 1/Phase 2
Completed NCT00345176 - Age-Related Eye Disease Study 2 (AREDS2) Phase 3
Completed NCT02140151 - Prophylactic Ranibizumab for Exudative Age-related Macular Degeneration Phase 1/Phase 2
Completed NCT02555306 - A Phase I/II Safety, Tolerability, Immunogenicity, and Bioactivity Study of DE-122 Injectable Solution for Refractory Exudative Age-related Macular Degeneration Phase 1/Phase 2
Recruiting NCT04796545 - Post-market Clinical Investigation of the SING IMT System, Model NG SI IMT 3X in Patients With End-stage Age-related Macular Degeneration N/A
Completed NCT03166202 - Age-Related Macular Degeneration, Scotopic Dysfunction, and Driving Performance in a Simulator
Completed NCT01397409 - Evaluation of AGN-150998 in Exudative Age-related Macular Degeneration (AMD) Phase 2