Prophylactic Ranibizumab for Exudative Age-related Macular Degeneration

Overview

This study will determine whether quarterly injections of Ranibizumab may prevent eyes with dry age-related macular degeneration from progressing to wet age-related macular degeneration (AMD).

Full Title of Study: “Prophylactic Ranibizumab for Exudative Age-related Macular Degeneration (AMD) in Vulnerable Eyes With Nonexudative AMD Trial: A Multicenter, Prospectively Randomized, Masked and Controlled, Interventional Investigator Sponsored Phase I/II Study”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: December 2018

Detailed Description

This is a multicenter, prospectively randomized, masked and controlled, interventional investigator sponsored phase I/II study of subjects with high-risk nonexudative age-related macular degeneration (AMD) treated with intravitreal ranibizumab quarterly for prophylaxis of conversion to exudative age-related macular degeneration.

The objective of this study is to investigate the safety and efficacy of prophylactic anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab to prevent the development of exudative AMD in eyes with high-risk nonexudative AMD. In addition, baseline characteristics of high-risk eyes (fundus features, optical coherence tomography (OCT) parameters and genetic profile) will be evaluated to determine their predictive value in conversion to exudative AMD. The effect of ranibizumab on the atrophic component of AMD will also be monitored.

Interventions

  • Drug: Ranibizumab 0.5mg

Arms, Groups and Cohorts

  • No Intervention: Sham
    • Sham Injection
  • Active Comparator: Quarterly Ranibizumab 0.5mg
    • Quarterly intravitreal injection of 0.5mg ranibizumab

Clinical Trial Outcome Measures

Primary Measures

  • Development of exudative AMD
    • Time Frame: 2 years
    • Development of choroidal neovascularization (conversion) defined by the presence of leakage on fluorescein angiography (FA) and fluid within or below the retina or below the retinal pigment epithelium seen on spectral-domain optical coherence tomography (SD-OCT)

Secondary Measures

  • Vision change
    • Time Frame: 2 years
    • Change in best-corrected visual acuity (BCVA) from baseline at 12 and 24 months
  • Vision loss
    • Time Frame: 2 years
    • Proportion of eyes losing < 5, 10, and 15 letters on EDTRS chart at 12 and 24 months
  • Number of injections
    • Time Frame: 2 years
    • Number of injections required in eyes that convert from dry to wet AMD during the study period
  • Baseline predictive factors
    • Time Frame: 2 years
    • Baseline demographic, genetic and ocular characteristics predictive of development of wet AMD
  • Development of geographic atrophy (GA)
    • Time Frame: 2 years
    • Development of geographic atrophy (GA) as detected by fundus photography (FP) and/or fundus autofluorescence (AF).
  • Ocular adverse events
    • Time Frame: 2 years
    • Incidence and severity of ocular adverse events, as identified by eye examination and imaging
  • Systemic adverse events
    • Time Frame: 2 years
    • Incidence and severity of other adverse events, as identified by physical examination or subject reporting.

Participating in This Clinical Trial

Inclusion Criteria

  • Adult over 50 years old
  • Able to sign informed consent and comply with the study protocol for the duration of two years
  • Nonexudative age-related macular degeneration (AMD) in one eye (study eye)
  • History of exudative AMD in one eye only (fellow eye) diagnosed within 5 years of study enrollment

Exclusion Criteria

  • Participation in another simultaneous medical investigation or clinical trial
  • Patient is pregnant, lactating, or premenopausal and not using adequate contraception
  • Known serious allergies to ranibizumab, fluorescein dye, drugs for pupillary dilation, topical anesthetic, sterilizing solution (e.g. Betadine solution)
  • Presence of ocular conditions with increased risk of choroidal neovascularization (CNVM) or pigment epithelial detachment (PED), including presumed ocular histoplasmosis syndrome (POHS), traumatic choroidal rupture, angioid streaks, pathologic myopia (spherical equivalent of ≥ -8 diopters or axial length of ≥ 25 mm), multifocal choroiditis, macular choroidal nevus, polypoidal choroidal vasculopathy (PCV), idiopathic central serous chorioretinopathy (ICSC), etc.
  • History of vitrectomy in the study eye
  • History of cataract surgery within 3 months of enrollment
  • History of yttrium aluminum garnet (YAG) capsulotomy within 1 month of enrollment
  • History of intraocular or periocular corticosteroid therapy within the past 90 days
  • History of therapeutic radiation in the region of the study eye.
  • Presence of media opacity that would preclude adequate examination and/or imaging
  • Concurrent macular conditions that would affect the study parameters (epiretinal membrane, macular hole, macular edema) or require treatment within the duration of the study
  • Any progressive ocular condition (uncontrolled glaucoma, diabetic retinopathy, uveitis) that may affect the visual acuity for the duration of the study
  • Active ocular infection (i.e., bacterial, viral, parasitic, or fungal) in either eye at enrollment
  • Presence of any advanced systemic condition that may hinder the patients participation and completion of the study
  • Concurrent use of systemic anti-VEGF therapy

Gender Eligibility: All

Minimum Age: 50 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Southern California Desert Retina Consultants, MC
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Maziar Lalezary, MD, Principal Investigator, Southern California Desert Retina Consultants
  • Overall Contact(s)
    • Maziar Lalezary, MD, 760-340-2394, mlalezary@desertretina.com

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