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Comparing the Effectiveness and Costs of Bevacizumab to Ranibizumab in Patients With Diabetic Macular Edema (BRDME) (BRDME)

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ClinicalTrials.gov Identifier: NCT01635790
Recruitment Status : Unknown
Verified June 2015 by Prof. dr. R.O. Schlingemann, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA).
Recruitment status was:  Recruiting
First Posted : July 10, 2012
Last Update Posted : July 1, 2015
Sponsor:
Collaborators:
University Medical Center Groningen
Free University Medical Center
Erasmus Medical Center
Radboud University
Leiden University Medical Center
UMC Utrecht
Information provided by (Responsible Party):
Prof. dr. R.O. Schlingemann, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Brief Summary:
The primary objective is to demonstrate the non-inferiority of bevacizumab to ranibizumab in the treatment of patients with DME (OCT central area thickness > 275 μm) as determined by the change in best-corrected visual acuity (BCVA) in the study eye from baseline to month 6.

Condition or disease Intervention/treatment Phase
Diabetic Macular Edema Drug: Ranibizumab Drug: Bevacizumab Phase 2 Phase 3

Detailed Description:

Objective: To compare the effectiveness and costs of 1.25 mg of bevacizumab to 0.5 mg ranibizumab, given as monthly intravitreal injections during 6 months. It is hypothesized that bevacizumab is non-inferior to ranibizumab regarding its effectiveness.

Study design: This will be a randomized, controlled, double masked, clinical trial in 246 patients in seven academic trial centres in The Netherlands.

Study population: patients 18 years of age or higher with diabetic macular and a best corrected visual acuity BCVA score between 78 and 20 letters in the study eye.

Outcomes: The primary outcome measure will be the change in best-corrected visual acuity (BCVA) in the study eye from Baseline to Month 6.

Secondary outcomes will be amongst others the proportion of patients with a gain of 15 letters or more and/or a BCVA of 20/40 or more at 6 months, and the costs and costs per quality adjusted life-year of the two treatments.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 246 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Comparing the Effectiveness and Costs of Bevacizumab to Ranibizumab in Patients With Diabetic Macular Edema (The BRDME Study)
Study Start Date : June 2012
Estimated Primary Completion Date : June 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Edema

Arm Intervention/treatment
Active Comparator: Ranibizumab
0.5 mg ranibizumab. Given as monthly intravitreal injections during 6 months
Drug: Ranibizumab
0.5 mg ranibizumab. Given as monthly intravitreal injections during 6 months
Other Name: Lucentis

Drug: Bevacizumab
1.25 mg of bevacizumab; Given as monthly intravitreal injections during 6 months
Other Name: Avastin

Active Comparator: Bevacizumab
1.25 mg of bevacizumab; Given as monthly intravitreal injections during 6 months
Drug: Ranibizumab
0.5 mg ranibizumab. Given as monthly intravitreal injections during 6 months
Other Name: Lucentis

Drug: Bevacizumab
1.25 mg of bevacizumab; Given as monthly intravitreal injections during 6 months
Other Name: Avastin




Primary Outcome Measures :
  1. Best Corrected Visual Acuity [ Time Frame: 6 months ]
    Primary outcome measure will be the change in best-corrected visual acuity (BCVA) in the study eye from baseline to month 6.


Secondary Outcome Measures :
  1. The proportion of patients with a gain or loss of 15 letters or more [ Time Frame: 6 months ]
    The proportion of patients with a gain or loss of 15 letters or more at 6 months compared to baseline BCVA

  2. Change in leakage on fluorescein angiography [ Time Frame: 6 months ]
    Change in leakage on fluorescein angiography, baseline compared to 6 month exit visit

  3. Change in foveal thickness by optical coherence tomography [ Time Frame: 6 months ]
    The change in foveal thickness (central retinal area) by optical coherence tomography, 6 month exit visit compared to baseline

  4. Number of adverse events [ Time Frame: 6 months ]
    The total number of adverse events that occured during the 6 month study timeframe, with secondary a classification of the types of adverse events

  5. Costs per quality adjusted life-year of the two treatments [ Time Frame: 6 months ]
    The costs per quality adjusted life year of the two treatments, results will be based on the use of standardized health questionnaires (EQ5D or HUI3)

  6. The proportion of patients with a BCVA of 20/40 or more [ Time Frame: 6 months ]
    The proportion of patients with a BCVA of 20/40 or more at 6 months compared to baseline BCVA



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male or female patients > 18 years of age who have signed an informed consent;
  2. Patients with Type 1 or Type 2 diabetes mellitus (according to American Diabetes Association or World Health Organization (WHO) guidelines) with glycosylated haemoglobin (HbA1c) less than 12.0% at screening (Visit 1). Patients should be on a dietary, exercise and/or pharmacological program for diabetes. Treatment for diabetes must have been stable for at least 2 months;
  3. Patients with visual impairment due to DME (within the EDTRS criteria of clinically significant macular edema) in at least one eye, with a central area thickness >275 ìm, who are eligible for anti-VEGF treatment according to the investigator. If both eyes are eligible, the one with the worse visual acuity, as assessed at visit 1, will be selected by the investigator as the study eye;
  4. BCVA equal or more than 24 and less or equal to 78 letters in the study eye at screening using ETDRS- like visual acuity testing charts at a testing distance of 4 meter (approximate Snellen equivalent of 20/32 to 20/320).

Exclusion Criteria:

  1. Women of child-bearing potential.
  2. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive serum pregnancy test (human chorionic gonadotropin > 5 mIU/ml);
  3. Inability to comply with study procedures;
  4. Active intraocular inflammation (grade + or above) in either eye at enrolment;
  5. Any active infection (e.g., conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) in either eye at the time of enrolment;
  6. History of uveitis in either eye at any time;
  7. Structural damage within 600 m of the centre of the macula in the study eye likely to preclude improvement in visual acuity following in the resolution of macular edema, including atrophy of the retinal pigment epithelium, subretinal fibrosis, laser scar(s), epiretinal membrane involving fovea or organized hard exudate plaques;
  8. Uncontrolled glaucoma in the study eye at screening (IOP > 24 mmHg on medication or according to investigator's judgment);
  9. Neovascularization of the iris in the study eye;
  10. Evidence of vitreomacular traction in the study eye;
  11. Active untreated proliferative diabetic retinopathy in the study eye;
  12. Any intraocular surgery in the study eye within 3 months prior to randomization;
  13. History of vitrectomy in study eye regardless of time prior to randomization;
  14. Planned medical or surgical intervention during the 6 months study period;
  15. Panretinal laser photocoagulation in the study eye within 3 months prior to or during the study;
  16. Focal/grid laser photocoagulation in the study eye 3 months prior to study entry;
  17. Treatment with anti-angiogenic drugs in the study eye (pegaptanib sodium, anecortave acetate, bevacizumab, ranibizumab, VEGF-Trap, etc.) within 3 months prior to randomization;
  18. Use of other investigational drugs at the time of enrolment, or within 3 month or 5 half-lives from enrolment, whichever is longer;
  19. History of intravitreal corticosteroids in phakic eye within 18 months prior to randomization or in post-cataract surgery study eye (aphakic or pseudophakic, without damaged posterior capsule) within 4 months prior to randomization;
  20. Ocular conditions in the study eye that require chronic concomitant therapy with topical ocular or systemically administered corticosteroids;
  21. History of stroke or transient ischemic attack (TIA) within 6 months prior to enrolment;
  22. Renal failure requiring dialysis or renal transplant or renal insufficiency with creatinine levels > 2.0 mg/dl at screening;
  23. Blood pressure systolic > 165 mm Hg or diastolic > 105 mmHg at screening and randomization;
  24. Hypertension or change in antihypertensive treatment within 1 month preceding randomization;
  25. Current use of or likely need for systemic medications known to be toxic to the lens, retina or optic nerve, including deferoxamine, chloroquine/hydroxychloroquine (Plaquenil), tamoxifen, phenothiazines and ethambutol;
  26. Known hypersensitivity to fluorescein, ranibizumab or bevacizumab or any component thereof or drugs of similar chemical classes;
  27. Any type of advanced, severe or unstable disease or its treatment, that may interfere with primary and/or secondary variable evaluations including any medical condition that could be expected to progress, recur, or change to such an extend that it may bias the assessment of the clinical status of the patient to a significant degree or put the patient at special risk;
  28. Concomitant conditions in the study eye which would, in the opinion of the investigator, prevent the improvement of visual acuity on study treatment;
  29. Ocular disorders in the study eye that may confound interpretation of study results, compromise visual acuity or require medical or surgical intervention during the 6-month study period, including cataract, retinal vascular occlusion, retinal detachment, macular hole, or choroidal neovascularization of any cause (e.g., AMD, ocular histoplasmosis, or pathologic myopia).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01635790


Contacts
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Contact: Reinier O Schlingemann, MD, PhD +31 20 5663682 r.schlingemann@amc.uva.nl
Contact: Monique Wezel +31 20 5663616 m.wezel@amc.uva.nl

Locations
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Netherlands
Academic Medical Center, Dept. Ophthalmology, Recruiting
Amsterdam, Netherlands, 1105 AZ
Sponsors and Collaborators
Prof. dr. R.O. Schlingemann
University Medical Center Groningen
Free University Medical Center
Erasmus Medical Center
Radboud University
Leiden University Medical Center
UMC Utrecht
Investigators
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Principal Investigator: Reinier O Schlingemann, MD, PhD Academic Medical Center, Dept. Ophthalmology, Room A2-122, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Prof. dr. R.O. Schlingemann, Clinical Professor, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
ClinicalTrials.gov Identifier: NCT01635790     History of Changes
Other Study ID Numbers: NL35860.018.11
First Posted: July 10, 2012    Key Record Dates
Last Update Posted: July 1, 2015
Last Verified: June 2015

Keywords provided by Prof. dr. R.O. Schlingemann, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA):
bevacizumab
ranibizumab
diabetic macular edema
randomized clinical trial

Additional relevant MeSH terms:
Layout table for MeSH terms
Edema
Macular Edema
Signs and Symptoms
Macular Degeneration
Retinal Degeneration
Retinal Diseases
Eye Diseases
Bevacizumab
Ranibizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors