Intravitreal Aflibercept Injection for Polypoidal Choroidal Vasculopathy With Hemorrhage or Exudation (EPIC)

• ClinicalTrials.gov Identifier: NCT01871376
• Recruitment Status: Completed
• First Posted: June 6, 2013
• Last Update Posted: November 23, 2016
• Sponsor: Gregg T. Kokame, MD
• Collaborator: Regeneron Pharmaceuticals
• Information provided by (Responsible Party): Gregg T. Kokame, MD, Hawaii Pacific Health

Study Description

Brief Summary:

To evaluate the efficacy and safety of intravitreal aflibercept injection in the treatment of PCV

Condition or disease	Intervention/treatment	Phase
Polypoidal Choroidal Vasculopathy	Drug: Intravitreal aflibercept injection 2.0mg	Phase 4

Detailed Description:

This is an open-label, randomized, one-year, multiple-dose study of 2mg aflibercept in patients with PCV.

The study consists of the baseline visit on day 0 and a mandatory clinic visit every 30 days to assess efficacy and safety. All patients will receive three monthly injections of 2mg intravitreal aflibercept injection followed by treatment every 60 days through 720 days (24 months). Patients can be treated every 30 days if needed.

The fellow eye may be treated with intravitreal aflibercept injection per the investigator's discretion at any point during the study if evidence of disease activity are met: exudation or hemorrhage secondary to polypoidal choroidal vasculopathy or exudative AMD. The fellow eye will not be considered the study eye. If treatment with aflibercept is to be given in the fellow eye, the injections are to be administered according to the Food and Drug Administration (FDA) approved label for EYLEA®.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 25 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Intravitreal Aflibercept Injection for Polypoidal Choroidal Vasculopathy With Hemorrhage or Exudation
• Study Start Date: May 2013
• Actual Primary Completion Date: September 2016
• Actual Study Completion Date: September 2016

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Previously Treated; Patients that have previously received treatment for polypoidal choroidal vasculopathy. Intervention: Monthly 2.0mg intravitreal aflibercept injection, followed by Q8W dosing with 2.0mg intravitreal aflibercept injection or as often as monthly if needed for 1 year for previously treated arm.	Drug: Intravitreal aflibercept injection 2.0mg; Monthly 2.0mg intravitreal aflibercept injection, followed by Q8W dosing with 2.0mg intravitreal aflibercept injection or as often as monthly if needed for 1 year for both treatment naive and prior treatment arms.; Other Name: Eylea
Active Comparator: Treatment-Naive; Patients that have not received treatment for polypoidal choroidal vasculopathy. Intervention: Monthly 2.0mg intravitreal aflibercept injection, followed by Q8W dosing with 2.0mg intravitreal aflibercept injection or as often as monthly if needed for 1 year for treatment-naive arm.	Drug: Intravitreal aflibercept injection 2.0mg; Monthly 2.0mg intravitreal aflibercept injection, followed by Q8W dosing with 2.0mg intravitreal aflibercept injection or as often as monthly if needed for 1 year for both treatment naive and prior treatment arms.; Other Name: Eylea

Outcome Measures

Primary Outcome Measures :

1. efficacy of intravitreal aflibercept injection of 2.0mg aflibercept [ Time Frame: 2 Years ]

   This study will evaluate the efficacy of intravitreal aflibercept injection of 2.0mg aflibercept administered Q8W following an initial loading dose of 3 monthly injections in patients with polypoidal choroidal vasculopathy with active exudation or bleeding as measured by:

   • Mean change in BCVA between Day 0 (Baseline) and Day 720 (M24)

Secondary Outcome Measures :

1. Proportion of Patients with Stable, Improved, Significant Improved, Decreased, Significant Decreased Vision [ Time Frame: 6 Months, 12 Months, 18 Months, 24 Months ]
   To evaluate the proportion of patients at Day 180 (M6), Day 360 (M12), Day 540 (M18) and Day 720 (M24) with "Stable" vision <5 letters gained or lost, "Improved" vision >5 letters gained, "Significant Improved" vision ≥15 letters gained, "Decreased" vision >5 letters lost, "Significant Decreased" vision ≥15 letters lost
2. Proportion of Patients with decrease in Subretinal Hemorrhage and/or Exudates [ Time Frame: Month 6, Month 12, Month 18, Month 24 ]
   To evaluate the proportion of patients at Day 180 (M6), Day 360 (M12), Day 540 (M18), Day 720 (M24) in decreasing subretinal hemorrhage and/or subretinal exudates via fundus photos and fundus exams
3. Proportion of patients with decreased / complete resolution of Polypoidal Polyp. [ Time Frame: Month 3, Month 6, Month 12, Month 18, Month 24 ]
   To evaluate the proportion of subjects with a decrease and/or complete resolution of polypoidal polyps from PCV at Day 90 (M3), Day 180 (M6), Day 360 (M12), Day 540 (M18) and Day 720 (M24) as assessed by fluorescein and indocyanine green angiography
4. Proportion of subject with a decrease or complete resolution of branching vascular network from PCV [ Time Frame: Month 3, Month 6, Month 12, Month 18, Month 24 ]
   To identify the proportion of subjects with a decrease and/or complete resolution of branching vascular network (BVN) from PCV at Day 90 (M3), Day 180 (M6), Day 360 (M12), Day 540 (M18) and 720 (M24) months as assessed by fluorescein and indocyanine green angiography
5. Determine mean change in Central Foveal Thickness and/or peripapillary edema as measured by SD-OCT [ Time Frame: Baseline, Month 6, Month 12, Month 18, Month 24 ]
   To determine mean change in central foveal thickness (CFT) and/or peripapillary edema as measured by spectral domain optical coherence tomography (SD-OCT) in central and/or paracentral fields from Day 0 (Baseline), Day 180 (M6), Day 360 (M12), Day 540 (M18) and 720 (M24)
6. Mean Change in Choroidal Thickness [ Time Frame: Baseline, Month 6, Month 12, Month 18, Month 24 ]
   To determine mean change in choroidal thickness (at fovea) as imaged via EDI-OCT between Day 0 (Baseline), Day 180 (M6), Day 360 (M12), Day 540 (M18), and Day 720 (M24)
7. Proportion of previously treated and treatment naive patients that require additional dosing outside of the protocol determined dosing schedule [ Time Frame: Month 24 ]
   To identify proportion of patients between previously treated and treatment naïve patients that require additional dosing outside of the protocol determined dosing schedule: 3- initial monthly dosing followed by dosing every other month for 720 days (M24)
8. Assess changes on Autofluorescence [ Time Frame: Baseline, Month 6, Month 12, Month 18, Month 24 ]
   To assess changes on autofluorescence (AF) as seen on images from Day 1 (Baseline), Day 180 (M6), Day 360 (M12), Day 540 (M18) and Day 720 (M24)
9. Incidence and Severity of Ocular and Non-Ocular Adverse Events [ Time Frame: Baseline through Month 24 ]
   To determine the incidence and severity of ocular and non-ocular adverse events from Day 1(Baseline) through the end of the study (Day 720)

Eligibility Criteria

• Ages Eligible for Study: 25 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• Age > 25 years of age.
• In the opinion of the principal investigator, the study eye has PCV with active exudation and/or bleeding that may benefit from treatment with study medication.
• Diagnosis of PCV via ICG Angiography with evidence of active leakage, active bleeding or recent decreased in vision.
• Baseline visual acuity better than or equal to 20/200 using ETDRS
• Willing and able to comply with clinic visits and study-related procedures
• Provide signed informed consent

Exclusion Criteria:

• Any history of previous vitrectomy
• Previous cataract surgery within the preceding 2 months of Day 0
• Active infections conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye
• Presence of any condition that would jeopardize the patient's participation in this study
• Participation in an investigational trial within 30 days of randomization that involved treatment with any drug that has not received regulatory approval at the time of study entry
• For the Treatment-Naïve cohort: no prior anti-VEGF (Macugen, Avastin, Lucentis, Eylea) in the study eye
• For the Previous-Treated cohort: no prior anti-VEGF (Macugen, Avastin, Lucentis) in the study eye within 30 days or enrollment in this study
• For the Previous-Treated cohort: no prior Eylea in the study eye
• Known allergy to any component of the study drug
• Blood pressure >180/119 (systolic above 180 or diastolic above 110). If blood pressure is brought below 180/110 by anti-hypertensive treatment, the patient can be eligible.
• Major surgery within 28 days prior to randomization or major surgery planned within the next 12 months. Major surgery is defined as a surgical procedure that is more extensive than needle biopsy/aspiration placement of a central venous access device, removal/biopsy of a skin lesion, or placement of a peripheral venous catheter
• Myocardial infarction, other cardiac event requiring hospitalization, stroke, transient ischemic attack, or treatment for acute congestive heart failure within 6 months prior to randomization
• Systemic anti-VEGF or pro-VEGF treatment within 3 months prior to randomization
• Pregnant or breast-feeding women
• Simultaneous participation in another medical investigational trial
• Sexually active men* or women of childbearing potential** who are unwilling to practice adequate contraception during the study (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)

Contacts and Locations

Locations

United States, Hawaii

Retina Consultants of Hawaii

Aiea, Hawaii, United States, 96701

Sponsors and Collaborators

Gregg T. Kokame, MD

Regeneron Pharmaceuticals

Investigators

• Principal Investigator: Gregg T. Kokame, MD, MMS; Hawaii Pacific Health

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Kokame GT, Lai JC, Wee R, Yanagihara R, Shantha JG, Ayabe J, Hirai K. Prospective clinical trial of Intravitreal aflibercept treatment for PolypoIdal choroidal vasculopathy with hemorrhage or exudation (EPIC study): 6 month results. BMC Ophthalmol. 2016 Jul 27;16:127. doi: 10.1186/s12886-016-0305-2.

• Responsible Party: Gregg T. Kokame, MD, Primary Investigator, Hawaii Pacific Health
• ClinicalTrials.gov Identifier: NCT01871376
• Other Study ID Numbers: EPIC
• First Posted: June 6, 2013
• Last Update Posted: November 23, 2016
• Last Verified: November 2016

Keywords provided by Gregg T. Kokame, MD, Hawaii Pacific Health:

PCV

Additional relevant MeSH terms:

Vascular Diseases; Aflibercept; Hemorrhage; Pathologic Processes; Cardiovascular Diseases; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Physiological Effects of Drugs; Growth Inhibitors; Antineoplastic Agents