Trial record 2 of 19 for:    diabetes and eye and open and active | Open Studies

A Safety and Efficacy Trial of a Treat and Extend Protocol Using Ranibizumab With and Without Laser Photocoagulation for Diabetic Macular Edema (TREX-DME)

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2014 by Palmetto Retina Center, LLC
Sponsor:
Information provided by (Responsible Party):
Palmetto Retina Center, LLC
ClinicalTrials.gov Identifier:
NCT01934556
First received: August 28, 2013
Last updated: April 14, 2014
Last verified: April 2014
  Purpose

The purpose of this research study is to determine if a "Treat and Extend" regimen (increasing the time between visits when the disease is stable and not getting worse) of Ranibizumab 0.3 mg injections inside the eye is safe and effective at treating patients with swelling of the retina from diabetes.


Condition Intervention Phase
Diabetic Macular Edema
Drug: Ranibizumab 0.3 mg intravitreal injection
Device: Guided Laser Photocoagulation
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Factorial Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II, Open Label, Multicenter, Randomized, Controlled Study of the Safety, Tolerability and Efficacy of Intravitreal Injections of 0.3 mg Ranibizumab Given Monthly Compared to a TReat and EXtend Protocol in Patients With Diabetic Macular Edema

Resource links provided by NLM:


Further study details as provided by Palmetto Retina Center, LLC:

Primary Outcome Measures:
  • Mean change in vision at 24 months [ Time Frame: 2 Years ] [ Designated as safety issue: No ]
    Mean change in ETDRS (Early Treatment in Diabetic Retinopathy Study) visual acuity at 24 months (week 92-week 107) from Day 0.


Secondary Outcome Measures:
  • Incidence and severity of adverse events (ocular and non-ocular). [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    The incidence and severity of adverse events, both ocular and non-ocular, will be monitored throughout the study period

  • Number of intravitreal injections [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Total number of intravitreal injections required during the first 12 months (week 46 - week 57) and the entire 24-month (week 92 - week 107) study period. In a separate proof of concept analysis, the number of intravitreal injections in the GILA Cohort over the 24-month study period will be compared with that of the other two cohorts (p = 0.20).

  • Number of office visits [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Total number of office visits and imaging studies performed during the first 12 months (week 46 - week 57) and the entire 24-month (week 92 - week 107) study period.

  • Change in retinal thickness [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Mean change in central foveal thickness per SDOCT (Spectral Domain Optical Coherence Tomography) from randomization to 12 months (week46 - week 57) and randomization to 24 months (week 92 - week 107) study period.

  • Percentage of eyes gaining or losing vision [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Percentage of eyes gaining or losing 3 lines of vision or more and 1 line of vision or more at 6 months (week 22 - week 29),12 months (week 46 - week 57),18 months (week 70 - week 85) and 24 months (week 92 - week 107) from Day 0.

  • Percentage of eyes which progress to proliferative diabetic retinopathy [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    The percentage of eyes which show progression of proliferative diabetic retinopathy requiring panretinal photocoagulation and/or pars plana vitrectomy over the 24-month study period.

  • Percentage of patients able to begin extension after 4 treatment visits [ Time Frame: 3 months ] [ Designated as safety issue: No ]
    The percentage of eyes in the TREX (Treat and Extend) and GILA (Guided Laser) cohorts who are eligible to begin the extension phase after 4 treatment visits.

  • Percentage of eyes with a secondary or tertiary baseline retinal thickness [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    For TREX and GILA Cohorts, the time to achieve a "Secondary or Tertiary Baseline" retinal thickness.

  • Noninferiority Comparison [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Noninferiority comparison (margin of 9 letters) of the mean change in ETDRS vision from Day 0 to 24 months (week 92 - week 107) between the three study groups.


Estimated Enrollment: 150
Study Start Date: November 2013
Estimated Study Completion Date: November 2016
Estimated Primary Completion Date: November 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Monthly
Monthly Cohort (30 eyes) - Study eyes will receive intravitreal injections of 0.3 mg ranibizumab every 4 weeks for 24 months.
Drug: Ranibizumab 0.3 mg intravitreal injection
Other Names:
  • Ranibizumab
  • Lucentis
Active Comparator: TREX
(60 eyes) - Monthly intravitreal injections of 0.3 mg ranibizumab for four visits. At the fourth visit (Week 12), if the central foveal thickness is ≤ 325 μm then the eye will receive 0.3 mg ranibizumab and begin the extension phase of the study. For all subsequent visits in the extension phase, appropriate changes to the treatment interval with 0.3 mg ranibizumab (i.e. extend, maintain, reduce) will be made based on pre-specified SD (Spectral Domain)-OCT criteria. Treatment is rendered at every visit. The time between visits is individualized based on each subject's response to treatment. If the central foveal thickness is > 325 μm at week 12, then the patient will continue to receive monthly intravitreal injections of 0.3 mg ranibizumab until the central foveal thickness is ≤ 325 μm. Once the central foveal thickness is ≤ 325 μm, then the study eye will begin the extension phase of the study.
Drug: Ranibizumab 0.3 mg intravitreal injection
Other Names:
  • Ranibizumab
  • Lucentis
Active Comparator: GILA
(60 eyes) - Monthly intravitreal injections of 0.3 mg ranibizumab for four visits combined with guided laser photocoagulation to all microaneurysms in the area of DME at visit 2 (Week 4) and then again every 3 months, if leakage is present on fluorescein angiography. If the central foveal thickness is ≤ 325 μm at visit 4 (Week 12), eyes will receive 0.3 mg ranibizumab and the extension phase will begin. For all subsequent visits in the extension phase, appropriate changes to the treatment interval with 0.3 mg ranibizumab (i.e. extend, maintain, reduce) will be made based on pre-specified SD-Optical coherence tomography criteria. If the central foveal thickness is > 325 μm at week 12, then the patient will continue to receive monthly intravitreal injections of 0.3 mg ranibizumab and possible guided laser every 3 months until the central foveal thickness is ≤ 325 μm. Once the central foveal thickness is ≤ 325 μm, then the study eye will begin the extension phase of the study.
Drug: Ranibizumab 0.3 mg intravitreal injection
Other Names:
  • Ranibizumab
  • Lucentis
Device: Guided Laser Photocoagulation
Other Name: NAVILAS Guided Laser System

Detailed Description:

This research study will compare the visual outcomes between a group of patients who are treated with monthly injections of Ranibizumab 0.3 mg and two groups of patients who are treated with the "Treat and Extend" regimen. One of the "Treat and Extend" groups will also receive laser therapy to determine if this has any additional beneficial effects.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Ability to provide written informed consent and comply with study assessments for the full duration of the study
  • Age > 18 years of age Patient related considerations
  • For sexually active women of childbearing potential, agreement to the use of an appropriate form of contraception (or abstinence) for the duration of the study
  • Although no birth control method is 100% effective, the following are considered effective means of contraception: surgical sterilization, use of oral contraceptives, barrier contraception using either a condom or diaphragm with spermicidal gel, an intrauterine device, or contraceptive hormone implant or patch. A patient's primary care physician, obstetrician, or gynecologist should be consulted regarding an appropriate form of birth control.
  • Ability and willingness to return for all scheduled visits and assessments

Disease related considerations

  • The presence of center-involving diabetic macular edema on clinical exam and SDOCT
  • Best corrected visual acuity in the study eye, using ETDRS testing, between 20/25 and 20/320 (Snellen equivalent), inclusive.
  • Clear ocular media and adequate pupillary dilation to permit good quality fundus imaging.

Exclusion Criteria:

  • General Exclusion Criteria

    • Pregnancy (positive urine pregnancy test) or lactation.
    • Premenopausal women not using adequate contraception. The following are considered effective means of contraception: surgical sterilization or use of oral contraceptives, barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel, an IUD (Intrauterine Device) , or contraceptive hormone implant or patch.
    • Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated
    • Participation in another simultaneous medical investigation or trial

Ocular Exclusion Criteria Prior Ocular Treatment

  • History of active proliferative diabetic retinopathy in the study eye on clinical exam
  • History of vitrectomy surgery, submacular surgery, or other intraocular surgical intervention for diabetic macular edema in the study eye
  • Any previous intravitreal drug delivery (e.g., intravitreal corticosteroid injection, anti-VEGF drugs including ranibizumab, or device implantation) in the study eye within 90 days of the screening visit.
  • History of prior laser macular photocoagulation more than 90 days prior to screening will be eligible for study inclusion. However, if the investigator does not feel that additional laser photocoagulation can be safely performed or would benefit the patient, then the eye in consideration will be excluded.
  • Evidence of vitreomacular interface abnormality or epiretinal membranes which may be responsible for macular edema

Concurrent Ocular Conditions

• Any concurrent intraocular condition in the study eye (e.g., cataract or macular degeneration) that, in the opinion of the investigator, could either: Require medical or surgical intervention during the 24-month study period to prevent or treat visual loss that might result from that condition; or if allowed to progress untreated, could likely contribute to loss of at least 2 Snellen equivalent lines of BCVA (Best Corrected Visual Acuity) over the 24-month study period.

  • Active intraocular inflammation (grade trace or above) in the study eye
  • Current vitreous hemorrhage in the study eye
  • History of rhegmatogenous retinal detachment or macular hole (Stage 3 or 4) in the study eye
  • Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye
  • Aphakia or absence of the posterior capsule in the study eye
  • Intraocular surgery (including cataract surgery) in the study eye within 3 months preceding Day 0
  • Uncontrolled glaucoma in the study eye (defined as IOP (Intraocular Pressure) ≥ 30 mmHg despite treatment with anti-glaucoma medication)
  • History of glaucoma-filtering surgery in the study eye
  • History of corneal transplant in the study eye
  • History of pars plana vitrectomy

Concurrent Systemic Conditions

  • Any history of use of systemic anti-VEGF (Vascular Endothelial Growth Factor) agents
  • Uncontrolled blood pressure (defined as systolic > 180 mmHg and/or diastolic > 110 mmHg while patient is sitting) If a patient's initial reading exceeds these values, a second reading may be taken 30 or more minutes later. If the patient's blood pressure needs to be controlled by antihypertensive medication, the patient can become eligible if medication is taken continuously for at least 30 days prior to Day 0.
  • Atrial fibrillation not managed by patient's primary care physician or cardiologist within 3 months of screening visit
  • Women of childbearing potential not using adequate contraception (as defined in the inclusion criteria).

A woman is considered not to be of childbearing potential if she is postmenopausal, defined by amenorrhea for at least 1 year in a woman > 45 years old; or has undergone hysterectomy and/or bilateral oophorectomy.

  • History of stroke within the last 3 months of screening visit
  • 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 an investigational drug or that might affect interpretation of the results of the study or renders the patient at high risk for treatment complications
  • Current treatment for active systemic infection
  • Active malignancy
  • History of allergy to fluorescein, not amenable to treatment
  • Inability to obtain fundus photographs or fluorescein angiograms of sufficient quality to be analyzed and graded by the reading center
  • Inability to comply with study or follow-up procedures
  • Previous participation in any studies of investigational drugs within 1 month preceding Day 0 (excluding vitamins and minerals)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01934556

Contacts
Contact: John F Payne, MD (803) 931-0077 jpayne@palmettoretina.com
Contact: Cassie Cahill (803) 931-0077 ccahill@palmettoretina.com

Locations
United States, California
Retina-Vitreous Associates Medical Group Recruiting
Beverly Hills, California, United States, 90211
Contact: David Boyer, MD    310-854-6201    vitdoc@aol.com   
Principal Investigator: David S. Boyer, MD         
Sub-Investigator: Richard H. Rowe, M.D.         
Sub-Investigator: Roger L. Novack, M.D.         
Sub-Investigator: Thomas G. Chu, M.D.         
Sub-Investigator: Pouya N. Dayani, M.D.         
Sub-Investigator: Firas M. Rahhal, M.D.         
Sub-Investigator: David S. Liao, M.D.         
Sub-Investigator: Homayoun Tabandeh, M.D.         
United States, South Carolina
Palmetto Retina Center Recruiting
West Columbia, South Carolina, United States, 29169
Principal Investigator: John F Payne, MD         
Sub-Investigator: William L Clark, MD         
Sub-Investigator: John A Wells, III, MD         
Sub-Investigator: David L. Johnson, MD         
United States, Texas
Retina Consultants of Houston Recruiting
Houston, Texas, United States, 77030
Contact: David M Brown, MD    713-524-3434    dmb@4milecreek.com   
Principal Investigator: David M Brown, MD         
Sub-Investigator: Charles C Wykoff, MD         
Sub-Investigator: Tien P. Wong, M.D.         
Sub-Investigator: Richard H. Fish, M.D.         
Sub-Investigator: Rosa Y. Kim, M.D.         
Sub-Investigator: Amy C. Schefler, M.D.         
Sub-Investigator: Matthew S. Benz, M.D.         
Sponsors and Collaborators
Palmetto Retina Center, LLC
  More Information

No publications provided

Responsible Party: Palmetto Retina Center, LLC
ClinicalTrials.gov Identifier: NCT01934556     History of Changes
Other Study ID Numbers: ML28724
Study First Received: August 28, 2013
Last Updated: April 14, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Edema
Macular Edema
Signs and Symptoms
Macular Degeneration
Retinal Degeneration
Retinal Diseases
Eye Diseases

ClinicalTrials.gov processed this record on July 23, 2014