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Ranibizumab for Treating Submacular Vascularized Pigment Epithelial Detachments

Primary Purpose

Retinal Pigment Epithelial Detachment

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ranibizumab
Ranibizumab
Ranibizumab
Ranibizumab
Sponsored by
Clement K. Chan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Retinal Pigment Epithelial Detachment focused on measuring choroidal neovascularization, vascularized

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient is 50 years or older
  • Patient is willing to participate in this study and to follow the criteria and protocol of this study.
  • Patient is not involved with another clinical trial.
  • Ability to understand the informed consent and willingness to sign the consent.
  • Presence of a submacular vascularized or fibrovascular PED. Central foveal involvement by the PED or the CNV due to age related macular degeneration.
  • PED less than or equal to 12 disc area in size
  • BCVA with ETDRS of greater than or equal to 19 letters and less than or equal to 69 letters (20/400 to 20/40)
  • Central 1-mm foveal thickness of greater than or equal to 250 microns on OCT.
  • Greatest linear diameter of the submacular hemorrhage needs to be less than 50% of the entire PED.
  • Submacular fibrosis needs to be less than 50% of the entire PED.
  • Sufficiently clear media (cornea, anterior chamber, lens, vitreous) for OCT, FA, and FP.
  • Intraocular pressure of 25 mm or less in the study eye, with or without use of ocular hypotensive agents.

Exclusion Criteria:

  • Pregnancy or lactation
  • Premenopausal women not using adequate contraception
  • Known serious allergies to ranibizumab, fluorescein dye, drug for pupillary dilation, topical anesthetic, sterilizing solution
  • Contraindication to pupillary dilation in study eye
  • Any condition (including inability to read visual acuity charts or language barrier) that may preclude patient's ability to comply with the study protocol requirements
  • Presence of any advanced systemic condition or endstage disease, advanced Alzheimer syndrome, endstage cancer, etc., which will likely prevent patient from completing study.
  • Previous therapeutic radiation in the region of the study eye.
  • Prior anti-vascular endothelial factor therapy within 30 days.
  • More than 3 sessions of prior anti-VEGF therapy.
  • More than 1 prior photodynamic therapy (PDT)
  • Prior triamcinolone in the past 6 months or dexamethasone in the past 1 month.
  • Prior retinal pigment epithelial (RPE) tear in study eye.
  • Prior ocular surgery (except YAG laser capsulotomy) for study eye within past 90 days.
  • Anticipated ocular surgery (except YAG laser capsulotomy) for the next 12 months.
  • Prior therapy for AMD (except minerals and vitamins), including laser, within the past 30 days.
  • Prior intraocular or periocular corticosteroid therapy within the past 120 days
  • Prior vitrectomy
  • Presence of any causes of CNV and PED other than due to AMD.
  • Presence of any substantial ocular disease (other than CNV and PED) that may compromise vision in the study eye and/or confound interpretation of the date; e.g. substantial cataracts, concomitant diabetic retinopathy affecting the macula, advanced glaucoma, optic neuritis, optic neuropathy or atrophy, marked macular atrophy, ocular vascular occlusion, history of retinal detachment, uveitis, viral or other forms of chorioretinitis, etc.
  • Presence of ocular disease other than AMD affecting study eye, i.e. presumed ocular histoplasmosis syndrome, angioid streaks, pathologic myopia (spherical equivalent of greater than or equal to -8 diopters of myopia or axial length of greater than or equal to 25 mm), choroidal rupture, multifocal choroiditis, etc.
  • Active ocular infection (i.e., bacterial, viral, parasitic, or fungal) in either eye at screening or Day 0.

Sites / Locations

  • Jules Stein Eye Institute
  • Southern California Desert Retina Consultants
  • Black Hills Regional Eye Institute

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

Regimen 1

Regimen 2

Regimen 3

Regimen 4

Arm Description

Intravitreal injection of Ranibizumab monthly for 12 months.

Intravitreal injection of ranibizumab for 4 months (at Day 0, Month 1, Month 2, and Month 3) followed by by treatments on predefined re-treatment criteria.

Intravitreal injection of Ranibizumab 2.0mg monthly for 12 months

Intravitreal injection 2.0mg ranibizumab for 4 months (at Day 0, Month 1 and Month 2, and Month 3) followed by PRN treatments on pre-defined re-treatment criteria

Outcomes

Primary Outcome Measures

Mean change in Best Corrected Visual Acuity from baseline measured at 4 meters on the ETDRS chart at 12 months.

Secondary Outcome Measures

Proportion of eyes reaching BCVA greater than or equal to 20/200
Proportion of eyes gaining greater than or equal to 0, 5, 10, and 15 letters on the ETDRS chart
Reduction in central macular thickness from baseline (central 1-mm subfield) as measured by an OCT
Changes in choroidal neovascular lesion (CNV)size on fluorescein angiography and fundus photography from baseline
Changes in retinal pigment epithelial detachment size on fluorescein angiography and fundus photography, including height of the PED and associated submacular fluid on OCT in comparison to baseline
Status of fluorescein staining or leakage (increased or decreased) from baseline
Ocular safety outcome including ocular complication, i.e. RPE tears, uveitis, endophthalmitis
Systemic safety outcome including cardiovascular event, cerebral vascular events
Proportion of patients with an improvement from baseline in Contrast Sensitivity at 24 and 48 weeks
Proportion of patients with an improvement from baseline in the VFQ overall composite score and near and distance activities subscales at 24 and 48 weeks

Full Information

First Posted
September 8, 2008
Last Updated
October 3, 2012
Sponsor
Clement K. Chan
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1. Study Identification

Unique Protocol Identification Number
NCT00749021
Brief Title
Ranibizumab for Treating Submacular Vascularized Pigment Epithelial Detachments
Official Title
A Phase I Study to Evaluate the Efficacy and Safety of Treating Subfoveal Pigment Epithelial Detachment Associated With Choroidal Neovascularization With Anti-vascular Endothelial Growth Factor Fragment, Ranibizumab.
Study Type
Interventional

2. Study Status

Record Verification Date
October 2012
Overall Recruitment Status
Completed
Study Start Date
September 2008 (undefined)
Primary Completion Date
August 2012 (Actual)
Study Completion Date
August 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Clement K. Chan

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a multicenter, randomized, open-label study. 40 patients will be followed for a period of 12 months. All consented and enrolled patients will receive either 0.5mg or 2.0mg of intravitreal ranibizumab injection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Retinal Pigment Epithelial Detachment
Keywords
choroidal neovascularization, vascularized

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Regimen 1
Arm Type
Active Comparator
Arm Description
Intravitreal injection of Ranibizumab monthly for 12 months.
Arm Title
Regimen 2
Arm Type
Active Comparator
Arm Description
Intravitreal injection of ranibizumab for 4 months (at Day 0, Month 1, Month 2, and Month 3) followed by by treatments on predefined re-treatment criteria.
Arm Title
Regimen 3
Arm Type
Active Comparator
Arm Description
Intravitreal injection of Ranibizumab 2.0mg monthly for 12 months
Arm Title
Regimen 4
Arm Type
Active Comparator
Arm Description
Intravitreal injection 2.0mg ranibizumab for 4 months (at Day 0, Month 1 and Month 2, and Month 3) followed by PRN treatments on pre-defined re-treatment criteria
Intervention Type
Drug
Intervention Name(s)
Ranibizumab
Other Intervention Name(s)
Lucentis
Intervention Description
0.5 mg of intravitreal ranibizumab monthly for 12 months
Intervention Type
Drug
Intervention Name(s)
Ranibizumab
Other Intervention Name(s)
Lucentis
Intervention Description
0.5 mg intravitreal injection of ranibizumab for 4 months followed by PRN dosing
Intervention Type
Drug
Intervention Name(s)
Ranibizumab
Other Intervention Name(s)
Lucentis
Intervention Description
2.0mg of intravitreal ranibizumab monthly for 12 months
Intervention Type
Drug
Intervention Name(s)
Ranibizumab
Other Intervention Name(s)
Lucentis
Intervention Description
2.0mg of intravitreal injection of Ranibizumab for 4 months followed by PRN dosing
Primary Outcome Measure Information:
Title
Mean change in Best Corrected Visual Acuity from baseline measured at 4 meters on the ETDRS chart at 12 months.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Proportion of eyes reaching BCVA greater than or equal to 20/200
Time Frame
12 months
Title
Proportion of eyes gaining greater than or equal to 0, 5, 10, and 15 letters on the ETDRS chart
Time Frame
12 months
Title
Reduction in central macular thickness from baseline (central 1-mm subfield) as measured by an OCT
Time Frame
12 months
Title
Changes in choroidal neovascular lesion (CNV)size on fluorescein angiography and fundus photography from baseline
Time Frame
12 months
Title
Changes in retinal pigment epithelial detachment size on fluorescein angiography and fundus photography, including height of the PED and associated submacular fluid on OCT in comparison to baseline
Time Frame
12 months
Title
Status of fluorescein staining or leakage (increased or decreased) from baseline
Time Frame
12 months
Title
Ocular safety outcome including ocular complication, i.e. RPE tears, uveitis, endophthalmitis
Time Frame
12 months
Title
Systemic safety outcome including cardiovascular event, cerebral vascular events
Time Frame
12 months
Title
Proportion of patients with an improvement from baseline in Contrast Sensitivity at 24 and 48 weeks
Time Frame
24 and 48 weeks
Title
Proportion of patients with an improvement from baseline in the VFQ overall composite score and near and distance activities subscales at 24 and 48 weeks
Time Frame
24 and 48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is 50 years or older Patient is willing to participate in this study and to follow the criteria and protocol of this study. Patient is not involved with another clinical trial. Ability to understand the informed consent and willingness to sign the consent. Presence of a submacular vascularized or fibrovascular PED. Central foveal involvement by the PED or the CNV due to age related macular degeneration. PED less than or equal to 12 disc area in size BCVA with ETDRS of greater than or equal to 19 letters and less than or equal to 69 letters (20/400 to 20/40) Central 1-mm foveal thickness of greater than or equal to 250 microns on OCT. Greatest linear diameter of the submacular hemorrhage needs to be less than 50% of the entire PED. Submacular fibrosis needs to be less than 50% of the entire PED. Sufficiently clear media (cornea, anterior chamber, lens, vitreous) for OCT, FA, and FP. Intraocular pressure of 25 mm or less in the study eye, with or without use of ocular hypotensive agents. Exclusion Criteria: Pregnancy or lactation Premenopausal women not using adequate contraception Known serious allergies to ranibizumab, fluorescein dye, drug for pupillary dilation, topical anesthetic, sterilizing solution Contraindication to pupillary dilation in study eye Any condition (including inability to read visual acuity charts or language barrier) that may preclude patient's ability to comply with the study protocol requirements Presence of any advanced systemic condition or endstage disease, advanced Alzheimer syndrome, endstage cancer, etc., which will likely prevent patient from completing study. Previous therapeutic radiation in the region of the study eye. Prior anti-vascular endothelial factor therapy within 30 days. More than 3 sessions of prior anti-VEGF therapy. More than 1 prior photodynamic therapy (PDT) Prior triamcinolone in the past 6 months or dexamethasone in the past 1 month. Prior retinal pigment epithelial (RPE) tear in study eye. Prior ocular surgery (except YAG laser capsulotomy) for study eye within past 90 days. Anticipated ocular surgery (except YAG laser capsulotomy) for the next 12 months. Prior therapy for AMD (except minerals and vitamins), including laser, within the past 30 days. Prior intraocular or periocular corticosteroid therapy within the past 120 days Prior vitrectomy Presence of any causes of CNV and PED other than due to AMD. Presence of any substantial ocular disease (other than CNV and PED) that may compromise vision in the study eye and/or confound interpretation of the date; e.g. substantial cataracts, concomitant diabetic retinopathy affecting the macula, advanced glaucoma, optic neuritis, optic neuropathy or atrophy, marked macular atrophy, ocular vascular occlusion, history of retinal detachment, uveitis, viral or other forms of chorioretinitis, etc. Presence of ocular disease other than AMD affecting study eye, i.e. presumed ocular histoplasmosis syndrome, angioid streaks, pathologic myopia (spherical equivalent of greater than or equal to -8 diopters of myopia or axial length of greater than or equal to 25 mm), choroidal rupture, multifocal choroiditis, etc. Active ocular infection (i.e., bacterial, viral, parasitic, or fungal) in either eye at screening or Day 0.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clement K Chan, M.D.
Organizational Affiliation
Southern California Desert Retina Consultants
Official's Role
Principal Investigator
Facility Information:
Facility Name
Jules Stein Eye Institute
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
Southern California Desert Retina Consultants
City
Palm Desert
State/Province
California
ZIP/Postal Code
92211
Country
United States
Facility Name
Black Hills Regional Eye Institute
City
Rapid City
State/Province
South Dakota
ZIP/Postal Code
57701
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
25277305
Citation
Chan CK, Abraham P, Sarraf D, Nuthi AS, Lin SG, McCannel CA. Earlier therapeutic effects associated with high dose (2.0 mg) Ranibizumab for treatment of vascularized pigment epithelial detachments in age-related macular degeneration. Eye (Lond). 2015 Jan;29(1):80-7. doi: 10.1038/eye.2014.233. Epub 2014 Oct 3.
Results Reference
derived

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Ranibizumab for Treating Submacular Vascularized Pigment Epithelial Detachments

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