Center-involved Diabetic Macular Edema Clinical Trial
Official title:
A Multicenter, Open-label, Prospective, Interventional Study to Assess the Efficacy and Safety of Aflibercept as Mono-therapy in Treat and Extend Regimen for DME Patients in Taiwan
| Verified date | February 2020 |
| Source | Taipei Veterans General Hospital, Taiwan |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | |
| Study type | Interventional |
Phase IIIb, multicenter, open-label, prospective, interventional study to assess the potential benefit of Aflibercept treatment administered IVT at a dosage of 2 mg with five monthly loading doses and then treat and extend over 48 weeks, with the primary endpoint as BCVA assessed at Week 52.
| Status | Completed |
| Enrollment | 45 |
| Est. completion date | November 16, 2017 |
| Est. primary completion date | November 16, 2017 |
| Accepts healthy volunteers | No |
| Gender | All |
| Age group | 20 Years and older |
| Eligibility |
Inclusion Criteria: - Adults = 20 years old with type 1 or 2 diabetes mellitus - Subjects with DME secondary to diabetes mellitus involving the center of the macula (defined as the area of the center subfield of optical coherence tomography [OCT]) in the study eye - Retinal thickness as assessed by OCT above (>) 300 um in the study eye - BCVA ETDRS letter score of 73 to 24 (20/40 to 20/320) in the study eye - Would be able to comply with clinic visits and study-related procedures - Would be able to provide a signed informed consent form (ICF) Exclusion Criteria: 1. Ocular conditions with a poorer prognosis in the fellow eye than in the study eye 2. History of vitreoretinal surgery and/or including scleral buckling in the study eye 3. Laser photocoagulation (pan-retinal or macular) in the study eye within 90 days of Day 1 4. Against the background of a relevant number of previous macular laser treatments the investigator's point of view was that the subjects had no potential to benefit from laser treatments (e.g., if too many laser treatments were applied in the past) 5. Previous use of intraocular or periocular corticosteroids in the study eye within 120 days of Day 1 6. Previous treatment with anti-angiogenic drugs in either eye (pegaptanib sodium, bevacizumab, ranibizumab etc.) within 90 days of Day 1 7. High risk proliferative diabetic retinopathy (PDR) in the study eye upon physician's discretion High risk = the presence of any of the following: - Vitreous hemorrhage - New vessels on the disk >1/3 disk diameter - New vessels elsewhere >1/2 disk diameter 8. History of idiopathic or autoimmune uveitis in the study eye 9. Cataract surgery within 90 days before Day 1 in the study eye 10. Aphakia in the study eye 11. Yttrium-aluminium-garnet (YAG) capsulotomy in the study eye within 30 days before Day 1 12. Any other intraocular surgery within 90 days of Day 1 in the study eye 13. Vitreomacular traction or epiretinal membrane in the study eye evident biomicroscopically or on OCT that is thought to affect central vision 14. Current iris neovascularization, vitreous hemorrhage, or tractional retinal detachment in the study eye 15. Pre-retinal fibrosis involving the macula in the study eye 16. Structural damage to the center of the macula in the study eye that was likely to preclude improvement in BCVA following the resolution of macular edema including atrophy of the retinal pigment epithelium, subretinal fibrosis or scar, significant macular ischemia or organized hard exudates 17. Ocular inflammation including trace or above in the study eye 18. Evidence of infectious blepharitis, keratitis, scleritis, or conjunctivitis in either eye 19. Filtration surgery for glaucoma in the past or likely to be needed in the future on the study eye 20. Intraocular pressure (IOP) = 25 mmHg in the study eye 21. High myopia (= -6.0 diopters or axial length of =26.5 mm) prior to any possible refractive or cataract surgery 22. Concurrent disease in the study eye, other than DME, that could compromise VA, require medical or surgical intervention during the study period, or could confound interpretation of the results (including retinal vascular occlusion, retinal detachment, macular hole, or choroidal neovascularization of any cause) 23. Only 1 functional eye even if that eye was otherwise eligible for the study 24. Ocular media of insufficient quality to obtain fundus and OCT images 25. Current treatment for a serious systemic infection 26. Administration of systemic anti-angiogenic agents within 180 days before Day 1 27. Uncontrolled diabetes mellitus, as defined by Hemoglobin A1c; (glycosylated hemoglobin) (HbA1c)>10%. 28. Uncontrolled blood pressure (defined as systolic >160 mmHg or diastolic >95 mmHg while subject was sitting) 29. History of either cerebral vascular accident and/or myocardial infarction within 180 days prior to Day 1 30. Renal failure requiring dialysis or renal transplant 31. History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug, might affect interpretation of the results of the study, or rendered the subject at high risk for treatment complications 32. Pregnant or breast-feeding women 33. Sexually active men or women of childbearing potential who were unwilling to practice adequate contraception during the study were excluded (adequate contraceptive measures include stable use of oral contraceptives or other prescription pharmaceutical contraceptives for 2 or more menstrual cycles prior to screening; intrauterine device [IUD]; bilateral tubal ligation; vasectomy; condom plus contraceptive sponge, foam, or jelly or diaphragm plus contraceptive sponge, foam, or jelly). 34. Allergy to fluorescein 35. Participation in an investigational study within 30 days prior to screening visit that involved treatment with any drug (excluding vitamins and minerals) or device |
| Country | Name | City | State |
|---|---|---|---|
| n/a | |||
| Lead Sponsor | Collaborator |
|---|---|
| Taipei Veterans General Hospital, Taiwan | Chang Gung Memorial Hospital, Kaohsiung Veterans General Hospital., National Taiwan University Hospital |
Angelousi A, Larger E. Anaemia, a common but often unrecognized risk in diabetic patients: a review. Diabetes Metab. 2015 Feb;41(1):18-27. doi: 10.1016/j.diabet.2014.06.001. Epub 2014 Jul 17. Review. — View Citation
Arevalo JF, Sanchez JG, Wu L, Maia M, Alezzandrini AA, Brito M, Bonafonte S, Lujan S, Diaz-Llopis M, Restrepo N, Rodríguez FJ, Udaondo-Mirete P; Pan-American Collaborative Retina Study Group. Primary intravitreal bevacizumab for diffuse diabetic macular e — View Citation
Bhagat N, Grigorian RA, Tutela A, Zarbin MA. Diabetic macular edema: pathogenesis and treatment. Surv Ophthalmol. 2009 Jan-Feb;54(1):1-32. doi: 10.1016/j.survophthal.2008.10.001. Review. — View Citation
Buyukkaya E, Karakas MF, Karakas E, Akçay AB, Tanboga IH, Kurt M, Sen N. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost. 2014 Mar;20(2):159-63. doi: 10.1177/1076029612459675. Epub 2012 Sep 18. — View Citation
Diabetic Retinopathy Clinical Research Network, Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, Ferris FL 3rd, Friedman SM, Glassman AR, Miller KM, Scott IU, Stockdale CR, Sun JK. Randomized trial evaluating ranibizumab plus prompt or — View Citation
Do DV, Nguyen QD, Boyer D, Schmidt-Erfurth U, Brown DM, Vitti R, Berliner AJ, Gao B, Zeitz O, Ruckert R, Schmelter T, Sandbrink R, Heier JS; da Vinci Study Group. One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema — View Citation
El Sanharawi M, Kowalczuk L, Touchard E, Omri S, de Kozak Y, Behar-Cohen F. Protein delivery for retinal diseases: from basic considerations to clinical applications. Prog Retin Eye Res. 2010 Nov;29(6):443-65. doi: 10.1016/j.preteyeres.2010.04.001. Epub 2010 Apr 14. Review. — View Citation
Ferrara N, Davis-Smyth T. The biology of vascular endothelial growth factor. Endocr Rev. 1997 Feb;18(1):4-25. Review. — View Citation
Ferrara N. VEGF: an update on biological and therapeutic aspects. Curr Opin Biotechnol. 2000 Dec;11(6):617-24. Review. — View Citation
Grover D, Li TJ, Chong CC. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005656. doi: 10.1002/14651858.CD005656.pub2. Review. — View Citation
Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984 Apr;102(4):527-32. — View Citation
Korobelnik JF, Do DV, Schmidt-Erfurth U, Boyer DS, Holz FG, Heier JS, Midena E, Kaiser PK, Terasaki H, Marcus DM, Nguyen QD, Jaffe GJ, Slakter JS, Simader C, Soo Y, Schmelter T, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Zeitz O, Metzig C, Brown DM. I — View Citation
Moss SE, Klein R, Klein BE. Ten-year incidence of visual loss in a diabetic population. Ophthalmology. 1994 Jun;101(6):1061-70. — View Citation
Moss SE, Klein R, Klein BE. The 14-year incidence of visual loss in a diabetic population. Ophthalmology. 1998 Jun;105(6):998-1003. — View Citation
Nguyen QD, Tatlipinar S, Shah SM, Haller JA, Quinlan E, Sung J, Zimmer-Galler I, Do DV, Campochiaro PA. Vascular endothelial growth factor is a critical stimulus for diabetic macular edema. Am J Ophthalmol. 2006 Dec;142(6):961-9. Epub 2006 Aug 2. — View Citation
Sefil F, Ulutas KT, Dokuyucu R, Sumbul AT, Yengil E, Yagiz AE, Yula E, Ustun I, Gokce C. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res. 2014 Apr;42(2):581-8. doi: 10.1177/0300060513516944. Epub 2014 Feb 24. — View Citation
Terasaki H, Shiraki K, Ohji M, Metzig C, Schmelter T, Zeitz O, Sowade O, Kobayashi M, Vitti R, Berliner A, Shiraga F. EFFICACY AND SAFETY OUTCOMES OF INTRAVITREAL AFLIBERCEPT FOCUSING ON PATIENTS WITH DIABETIC MACULAR EDEMA FROM JAPAN. Retina. 2019 May;39 — View Citation
Wang FH, Liang YB, Zhang F, Wang JJ, Wei WB, Tao QS, Sun LP, Friedman DS, Wang NL, Wong TY. Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Ophthalmology. 2009 Mar;116(3):461-7. doi: 10.1016/j.ophtha.2008.10.003. Epub 2009 Jan 24. — View Citation
Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J; China National Diabetes and Metabolic Disorders Study Group. Prevalence of diabetes among men and women in China. N Engl J Med. 2010 Mar 25;362(12):1090-101. doi: 10.1056/NEJMoa0908292. — View Citation
Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, Gregg EW, Albright AL, Klein BE, Klein R. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010 Aug 11;304(6):649-56. doi: 10.1001/jama.2010.1111. — View Citation
* Note: There are 20 references in all — Click here to view all references
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Mean change of best corrected visual acuity (BCVA) from baseline to week 52 | BCVA is measured by ETDRS chart | baseline to week 52 | |
| Secondary | Mean change in central subfoveal thickness (CST) from baseline to week 52. | Central subfoveal thickness (CST) as assessed by OCT | baseline to week 52 | |
| Secondary | Mean/medium number of injection from baseline to week 52 | Mean/medium number of intravitreal aflibercept injection from baseline to week 52 | baseline to week 52 | |
| Secondary | Proportion of subjects who gained > 15 ETDRS letters from baseline to week 52 | BCVA is measured by ETDRS chart | baseline to week 52 | |
| Secondary | Proportion of subjects with > 2-step improvement in DRSS from baseline to week 52 | DR level as assessed by diabetic retinopathy severity score (DRSS) | baseline to week 52 | |
| Secondary | Proportion of subjects demonstrating retina dry at week 20 and week 52 | Retina dry as assessed by OCT | week 20 and week 52 |