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Efficacy and Safety Study of iSONEP With & Without Lucentis/Avastin/Eylea to Treat Wet AMD (Nexus)

Primary Purpose

Exudative Age-related Macular Degeneration

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
4.0 mg iSONEP
0.5 mg iSONEP
0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea
sham injection
Sponsored by
Lpath, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Exudative Age-related Macular Degeneration focused on measuring choroidal neovascularization, age-related macular degeneration, iSONEP, sonepcizumab, Lucentis, ranibizumab, Avastin, bevacizumab, Eylea, aflibercept

Eligibility Criteria

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

Inclusion Criteria:

  • ≥50 years of age with a diagnosis of wet AMD
  • Subjects who have received 3 injections of Lucentis or Avastin or Eylea within 12 months prior to screening
  • Active subfoveal CNV secondary to AMD (leakage on FA)
  • Presence of residual subretinal or intraretinal fluid on Cirrus or Spectralis SDOCT
  • SDOCT in the 1 mm central macular subfield on the retinal map analysis of ≥250 μm at screening
  • ETDRS BCVA of ≥25 and ≤73 letters (approximately 20/320 and 20/40 on the Snellen scale) at screening and on Day 0
  • In the fellow eye, ETDRS BCVA of 20/400 or better
  • Subject with serous pigment epithelial detachment (PED) (any part of which may be subfoveal) with intraretinal and/or subretinal fluid may be included

Exclusion Criteria:

  • Most recent IVT injection of Lucentis or Avastin fewer than 28 days and more than 65 days prior to screening
  • Most recent IVT injection of Eylea fewer than 42 days and more than 79 days prior to screening
  • Previous photodynamic therapy (PDT) or Macugen® at any time point
  • Focal thermal laser or grid laser within 3 months prior to Day 0
  • Use of IVT, subtenon or subconjunctival steroids within 3 months prior to Day 0
  • Use of topical ophthalmic corticosteroids 2 weeks prior to Day 0
  • Intraocular surgery, including cataract surgery, and / or laser of any type within 3 months prior to Day 0 or anticipated need for ocular surgery or ophthalmic laser treatment during the study period
  • Subjects previously treated with, or are currently receiving treatment with another investigational agent or device for neovascular AMD in the study eye
  • Retinal total lesion size >12 disc areas (30.5 mm2), including blood, scars and neovascularization as assessed by FA in the study eye
  • Presence of a fibrovascular PED extending underneath the center of the fovea
  • Presence of retinal angiomatous proliferation (RAP) lesions
  • Presence of polypoidal choroidal vasculopathy (PCV) (if suspected, Indocyanine Green Angiography (ICG) should be performed at the discretion of the Investigator)
  • Subretinal hemorrhage in the study eye if any of the following is true: (i) the subretinal hemorrhage represents 50% or more of the total lesion area; (ii) subfoveal blood is 1 or more disc areas in size (iii) subfoveal blood where the fovea is surrounded by less than 270 degrees of visible CNV on FA
  • Scar or fibrosis making up >50% of total lesion area in the study eye
  • Anatomic damage to the center of the fovea including fibrosis, scarring or atrophy
  • History of a retinal pigment epithelial tear
  • History of vitreous hemorrhage within 4 weeks prior to screening in the study eye
  • Clinical evidence of diabetic retinopathy, diabetic macular edema or any other vascular disease affecting the retina, other than AMD, in either eye
  • Uncontrolled glaucoma defined as: (i) as intraocular pressure ≥25 mmHg despite treatment with anti glaucoma medication in the study eye or (ii) by the Investigator
  • Prior trabeculectomy or other filtration surgery in the study eye (prior laser trabeculoplasty is allowed)

Sites / Locations

  • Retina Consultants of Arizona
  • Retina Consultants of Arizona
  • Associated Retina Consultants
  • Retina Centers, P.C.
  • Retina-Vitreous Associates Medical Group
  • Retinal Diagnostic Center
  • Specialty Eye Care Medical Center
  • Retina Associates of Orange County
  • Northern California Retina Vitreous Associates
  • Sagar Kenyon American Eye Institute
  • Retinal Consultants Medical Group, Inc.
  • Orange County Retina Medical Group
  • Miramar Eye Specialists
  • Florida Eye Microsurgical Institute
  • Retina Health Center
  • Retina Specialty Institute
  • Fort Lauderdale Eye Institute
  • East Florida Eye Institute
  • Center for Retina & Macular Disease
  • Retina Consultants of Hawaii
  • Midwest Eye Institute
  • Central Plains Eye MDs
  • Bennett & Bloom Eye Centers
  • Retina Group of Washington
  • Retina Specialists
  • Ophthalmic Consultants of Boston
  • Henry Ford Health System
  • TLC Eye Care and Laser Center
  • Retina Consultants of Michigan
  • Island Retina
  • Charlotte Eye Ear Nose & Throat Associates
  • Retina & Vitreous Center SO
  • Associates in Ophthalmology
  • Palmetto Retina Center
  • Retina Research Institute of Texas
  • Austin Retina Associates
  • Retina Research Center
  • Texas Retina Associates
  • Valley Retina Institute
  • Medical Center Ophthalmology Associates
  • Retina Associates of South Texas
  • Rocky Mountain Retina Consultants
  • Retina Group of Washington
  • Spokane Eye Clinical Research

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Active Comparator

Arm Label

Monotherapy

0.5 mg iSONEP & Lucentis/Avastin/Eylea

4.0 mg iSONEP & Lucentis/Avastin/Eylea

Lucentis or Avastin or Eylea

Arm Description

4.0 mg iSONEP followed by sham injection; given monthly intravitreously for 4 months

0.5 mg iSONEP and 0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea; given monthly intravitreously for 4 months

4.0 mg iSONEP followed by 0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea; given monthly intravitreously for 4 months

0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea followed by a sham injection; given monthly intravitreously for 4 months

Outcomes

Primary Outcome Measures

Mean Change in Best Corrected Visual Acuity (BCVA) by Early Treatment Diabetic Retinopathy Study (ETDRS)
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly.

Secondary Outcome Measures

Mean Change in Central Subfield Retinal Thickness
Mean Change in CNV Lesion Area as Determined by Fluorescein Angiography (FA).
Proportion of Subjects Gaining Greater Than or Equal to 0, 5, 10 and 15 Letters on the ETDRS Chart.
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly.
Proportion of Subjects Losing 3 Lines or More in ETDRS BCVA.
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly. One line is equivalent to 5 letters, so a loss of 3 lines is a loss of 15 letters.
Proportion of Subjects With ETDRS BCVA of 20/40 or Better.
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly. 20/40 Snellen corresponds to a range of 69-73 letters by ETDRS.
Proportion of Subjects With Adverse Events.

Full Information

First Posted
August 9, 2011
Last Updated
August 22, 2016
Sponsor
Lpath, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01414153
Brief Title
Efficacy and Safety Study of iSONEP With & Without Lucentis/Avastin/Eylea to Treat Wet AMD
Acronym
Nexus
Official Title
Phase 2a, Multicenter, Masked, Randomized, Comparator Controlled Study Evaluating iSONEP™ as Monotherapy or Adjunctive Therapy to Lucentis/Avastin/Eylea Versus Lucentis/Avastin/Eylea Alone for Treatment of Subjects With Choroidal Neovascularization (CNV) Secondary to Age-related Macular Degeneration (AMD)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2016
Overall Recruitment Status
Completed
Study Start Date
August 2012 (undefined)
Primary Completion Date
May 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Lpath, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of the study is to determine the safety and efficacy of 4 monthly injections of iSONEP given alone or in combination with Lucentis, Avastin or Eylea in subjects with wet Age-related Macular Degeneration (AMD). iSONEP not only has an anti-permeability effect, but also has anti-angiogenic, anti-inflammatory, and anti-fibrotic properties. The drug may therefore have the ability to achieve better visual outcomes than Lucentis, Avastin or Eylea, particularly in those subjects who do not demonstrate a robust response to Lucentis, Avastin or Eylea after several monthly injections. Further, the combination of Lucentis, Avastin or Eylea and iSONEP may be additive or synergistic. By inhibiting the multiple mechanisms that contribute to exudative-AMD-related vision loss, better visual outcomes may be possible than with Lucentis, Avastin or Eylea alone.
Detailed Description
The study will be conducted in subjects who qualify as "sub-responders" to Lucentis, Avastin or Eylea meaning that each subject has (i) residual subretinal or intra-retinal fluid observed on Cirrus or Spectralis Spectral Domain Optical Coherence Tomography (SD-OCT), (ii) leakage on fluorescein angiogram (FA), and (iii) an average central subfield thickness of ≥250 μm. Additionally, each subject will have previously received a minimum of 3 intravitreous (IVT) injections of Lucentis, Avastin or Eylea within the 12-month period prior to screening. Screening must occur between 28 and 65 days from the subject's last Lucentis or Avastin treatment or between 42 and 79 days from the subject's last Eylea treatment. Subjects must be dosed within 14 days of screening, and as of the day of initial study treatment (Day 0), meet the following criteria: (i) Early Treatment Diabetic Retinopathy Study (ETDRS) Best-corrected visual acuity (BCVA) of ≥25 and ≤73 letters (approximately 20/320 and 20/40 on the Snellen scale), (ii) residual subretinal or intra-retinal fluid observed on Cirrus or Spectralis SDOCT, and (iii) leakage on FA.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Exudative Age-related Macular Degeneration
Keywords
choroidal neovascularization, age-related macular degeneration, iSONEP, sonepcizumab, Lucentis, ranibizumab, Avastin, bevacizumab, Eylea, aflibercept

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
158 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Monotherapy
Arm Type
Experimental
Arm Description
4.0 mg iSONEP followed by sham injection; given monthly intravitreously for 4 months
Arm Title
0.5 mg iSONEP & Lucentis/Avastin/Eylea
Arm Type
Experimental
Arm Description
0.5 mg iSONEP and 0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea; given monthly intravitreously for 4 months
Arm Title
4.0 mg iSONEP & Lucentis/Avastin/Eylea
Arm Type
Experimental
Arm Description
4.0 mg iSONEP followed by 0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea; given monthly intravitreously for 4 months
Arm Title
Lucentis or Avastin or Eylea
Arm Type
Active Comparator
Arm Description
0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea followed by a sham injection; given monthly intravitreously for 4 months
Intervention Type
Drug
Intervention Name(s)
4.0 mg iSONEP
Other Intervention Name(s)
sonepcizumab
Intervention Description
4.0 mg iSONEP given monthly intravitreously for 4 months
Intervention Type
Drug
Intervention Name(s)
0.5 mg iSONEP
Other Intervention Name(s)
sonepcizumab
Intervention Description
0.5 mg iSONEP given monthly intravitreously for 4 months
Intervention Type
Drug
Intervention Name(s)
0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea
Other Intervention Name(s)
ranibizumab, bevacizumab, aflibercept
Intervention Description
0.5 mg Lucentis or 1.25 mg Avastin or 2 mg Eylea given monthly intravitreously for 4 months
Intervention Type
Drug
Intervention Name(s)
sham injection
Other Intervention Name(s)
placebo
Intervention Description
administered monthly for 4 months
Primary Outcome Measure Information:
Title
Mean Change in Best Corrected Visual Acuity (BCVA) by Early Treatment Diabetic Retinopathy Study (ETDRS)
Description
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly.
Time Frame
Baseline to Day 120
Secondary Outcome Measure Information:
Title
Mean Change in Central Subfield Retinal Thickness
Time Frame
Baseline to Day 120
Title
Mean Change in CNV Lesion Area as Determined by Fluorescein Angiography (FA).
Time Frame
Baseline to Day 120
Title
Proportion of Subjects Gaining Greater Than or Equal to 0, 5, 10 and 15 Letters on the ETDRS Chart.
Description
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly.
Time Frame
Baseline to Day 120
Title
Proportion of Subjects Losing 3 Lines or More in ETDRS BCVA.
Description
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly. One line is equivalent to 5 letters, so a loss of 3 lines is a loss of 15 letters.
Time Frame
Baseline to Day 120
Title
Proportion of Subjects With ETDRS BCVA of 20/40 or Better.
Description
Visual function was assessed using the ETDRS protocol, for which numerical scores range from 0 to 100 (roughly equivalent to 20/10 vision as measured by Snellen). A higher score represents better functioning. A positive number represents an increase in number of letters read correctly. 20/40 Snellen corresponds to a range of 69-73 letters by ETDRS.
Time Frame
Baseline to Day 120
Title
Proportion of Subjects With Adverse Events.
Time Frame
Baseline to Day 120

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: ≥50 years of age with a diagnosis of wet AMD Subjects who have received 3 injections of Lucentis or Avastin or Eylea within 12 months prior to screening Active subfoveal CNV secondary to AMD (leakage on FA) Presence of residual subretinal or intraretinal fluid on Cirrus or Spectralis SDOCT SDOCT in the 1 mm central macular subfield on the retinal map analysis of ≥250 μm at screening ETDRS BCVA of ≥25 and ≤73 letters (approximately 20/320 and 20/40 on the Snellen scale) at screening and on Day 0 In the fellow eye, ETDRS BCVA of 20/400 or better Subject with serous pigment epithelial detachment (PED) (any part of which may be subfoveal) with intraretinal and/or subretinal fluid may be included Exclusion Criteria: Most recent IVT injection of Lucentis or Avastin fewer than 28 days and more than 65 days prior to screening Most recent IVT injection of Eylea fewer than 42 days and more than 79 days prior to screening Previous photodynamic therapy (PDT) or Macugen® at any time point Focal thermal laser or grid laser within 3 months prior to Day 0 Use of IVT, subtenon or subconjunctival steroids within 3 months prior to Day 0 Use of topical ophthalmic corticosteroids 2 weeks prior to Day 0 Intraocular surgery, including cataract surgery, and / or laser of any type within 3 months prior to Day 0 or anticipated need for ocular surgery or ophthalmic laser treatment during the study period Subjects previously treated with, or are currently receiving treatment with another investigational agent or device for neovascular AMD in the study eye Retinal total lesion size >12 disc areas (30.5 mm2), including blood, scars and neovascularization as assessed by FA in the study eye Presence of a fibrovascular PED extending underneath the center of the fovea Presence of retinal angiomatous proliferation (RAP) lesions Presence of polypoidal choroidal vasculopathy (PCV) (if suspected, Indocyanine Green Angiography (ICG) should be performed at the discretion of the Investigator) Subretinal hemorrhage in the study eye if any of the following is true: (i) the subretinal hemorrhage represents 50% or more of the total lesion area; (ii) subfoveal blood is 1 or more disc areas in size (iii) subfoveal blood where the fovea is surrounded by less than 270 degrees of visible CNV on FA Scar or fibrosis making up >50% of total lesion area in the study eye Anatomic damage to the center of the fovea including fibrosis, scarring or atrophy History of a retinal pigment epithelial tear History of vitreous hemorrhage within 4 weeks prior to screening in the study eye Clinical evidence of diabetic retinopathy, diabetic macular edema or any other vascular disease affecting the retina, other than AMD, in either eye Uncontrolled glaucoma defined as: (i) as intraocular pressure ≥25 mmHg despite treatment with anti glaucoma medication in the study eye or (ii) by the Investigator Prior trabeculectomy or other filtration surgery in the study eye (prior laser trabeculoplasty is allowed)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dario A Paggiarino, MD
Organizational Affiliation
Lpath, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Retina Consultants of Arizona
City
Peoria
State/Province
Arizona
ZIP/Postal Code
85381
Country
United States
Facility Name
Retina Consultants of Arizona
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85014
Country
United States
Facility Name
Associated Retina Consultants
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85020
Country
United States
Facility Name
Retina Centers, P.C.
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85704
Country
United States
Facility Name
Retina-Vitreous Associates Medical Group
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90211
Country
United States
Facility Name
Retinal Diagnostic Center
City
Campbell
State/Province
California
ZIP/Postal Code
95008
Country
United States
Facility Name
Specialty Eye Care Medical Center
City
Glendale
State/Province
California
ZIP/Postal Code
91203
Country
United States
Facility Name
Retina Associates of Orange County
City
Laguna Hills
State/Province
California
ZIP/Postal Code
92653
Country
United States
Facility Name
Northern California Retina Vitreous Associates
City
Mountain View
State/Province
California
ZIP/Postal Code
94040
Country
United States
Facility Name
Sagar Kenyon American Eye Institute
City
New Albany
State/Province
California
ZIP/Postal Code
47150
Country
United States
Facility Name
Retinal Consultants Medical Group, Inc.
City
Sacramento
State/Province
California
ZIP/Postal Code
95819
Country
United States
Facility Name
Orange County Retina Medical Group
City
Santa Ana,
State/Province
California
ZIP/Postal Code
92705
Country
United States
Facility Name
Miramar Eye Specialists
City
Ventura
State/Province
California
ZIP/Postal Code
93003
Country
United States
Facility Name
Florida Eye Microsurgical Institute
City
Boynton Beach
State/Province
Florida
ZIP/Postal Code
33426
Country
United States
Facility Name
Retina Health Center
City
Ft. Myers
State/Province
Florida
ZIP/Postal Code
33907
Country
United States
Facility Name
Retina Specialty Institute
City
Pensacola
State/Province
Florida
ZIP/Postal Code
32503
Country
United States
Facility Name
Fort Lauderdale Eye Institute
City
Plantation
State/Province
Florida
ZIP/Postal Code
33324
Country
United States
Facility Name
East Florida Eye Institute
City
Stuart
State/Province
Florida
ZIP/Postal Code
34994
Country
United States
Facility Name
Center for Retina & Macular Disease
City
Winter Haven
State/Province
Florida
ZIP/Postal Code
33880
Country
United States
Facility Name
Retina Consultants of Hawaii
City
Aiea
State/Province
Hawaii
ZIP/Postal Code
96701
Country
United States
Facility Name
Midwest Eye Institute
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46290
Country
United States
Facility Name
Central Plains Eye MDs
City
Wichita
State/Province
Kansas
ZIP/Postal Code
67226
Country
United States
Facility Name
Bennett & Bloom Eye Centers
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40207
Country
United States
Facility Name
Retina Group of Washington
City
Chevy Chase
State/Province
Maryland
ZIP/Postal Code
20815
Country
United States
Facility Name
Retina Specialists
City
Towson
State/Province
Maryland
ZIP/Postal Code
21204
Country
United States
Facility Name
Ophthalmic Consultants of Boston
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Henry Ford Health System
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Facility Name
TLC Eye Care and Laser Center
City
Jackson
State/Province
Michigan
ZIP/Postal Code
49202
Country
United States
Facility Name
Retina Consultants of Michigan
City
Southfield
State/Province
Michigan
ZIP/Postal Code
48034
Country
United States
Facility Name
Island Retina
City
Shirley
State/Province
New York
ZIP/Postal Code
11967
Country
United States
Facility Name
Charlotte Eye Ear Nose & Throat Associates
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28210
Country
United States
Facility Name
Retina & Vitreous Center SO
City
Ashland
State/Province
Oregon
ZIP/Postal Code
97520
Country
United States
Facility Name
Associates in Ophthalmology
City
West Mifflin
State/Province
Pennsylvania
ZIP/Postal Code
15122
Country
United States
Facility Name
Palmetto Retina Center
City
West Columbia
State/Province
South Carolina
ZIP/Postal Code
29169
Country
United States
Facility Name
Retina Research Institute of Texas
City
Abilene
State/Province
Texas
ZIP/Postal Code
79606
Country
United States
Facility Name
Austin Retina Associates
City
Austin
State/Province
Texas
ZIP/Postal Code
78705
Country
United States
Facility Name
Retina Research Center
City
Austin
State/Province
Texas
ZIP/Postal Code
78705
Country
United States
Facility Name
Texas Retina Associates
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
Valley Retina Institute
City
Harlingen
State/Province
Texas
ZIP/Postal Code
78550
Country
United States
Facility Name
Medical Center Ophthalmology Associates
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78240
Country
United States
Facility Name
Retina Associates of South Texas
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78240
Country
United States
Facility Name
Rocky Mountain Retina Consultants
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84107
Country
United States
Facility Name
Retina Group of Washington
City
Fairfax
State/Province
Virginia
ZIP/Postal Code
22031
Country
United States
Facility Name
Spokane Eye Clinical Research
City
Spokane
State/Province
Washington
ZIP/Postal Code
99204
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Efficacy and Safety Study of iSONEP With & Without Lucentis/Avastin/Eylea to Treat Wet AMD

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