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Intravitreal Aflibercept Injection for Radiation Retinopathy

Primary Purpose

Radiation Retinopathy, Macular Edema

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Aflibercept every 2 months
Aflibercept monthly
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Radiation Retinopathy focused on measuring radiation, retinopathy, macular edema, anti-VEGF, VEGF-Trap, aflibercept

Eligibility Criteria

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

Inclusion Criteria:

  • Retinopathy associated with previous I-125 brachytherapy for uveal melanoma (85 Gy over 96 hours) at least 6 months prior to enrollment
  • Ability to provide written informed consent and comply with study assessments for the full duration of the study
  • Age > 18 years
  • Center involved macular edema > 300µm in thickness on SD-OCT
  • Best corrected visual acuity of 20/40- 20/400
  • Birth control therapy for females of child-bearing age

Exclusion Criteria:

  • Pre-existing retinopathy due to other disorders
  • Vision decrease is considered to be due to ischemic radiation retinopathy without macular edema or optic neuropathy
  • Presence of metastasis
  • Pregnancy (positive 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, or contraceptive hormone implant or patch.
  • Prior enrollment in any study with intravitreal aflibercept injection
  • Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated
  • Uncontrolled glaucoma in the study eye (defined as IOP ≥ 30 mmHg despite treatment with anti-glaucoma medication)
  • History of cerebral vascular accident, myocardial infarction, transient ischemic attacks within 4 months of study enrollment.
  • Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye
  • Any concurrent intraocular condition in the study eye (e.g., cataract or diabetic retinopathy) that, in the opinion of the investigator, could either require medical or surgical intervention during the 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 over the 6-month study period
  • Presence of significant subfoveal fibrosis or atrophy
  • Intraocular surgery (including cataract surgery) in the study eye within 2 months of enrollment
  • Active intraocular inflammation (grade trace or above) in the study eye
  • History of allergy to fluorescein, ICG or iodine, not amenable to treatment
  • Prior/Concomitant Treatment:
  • Panretinal photocoagulation treatment
  • Previous intraocular steroids or PDT within 3 months
  • Previous participation in any studies of investigational drugs within 30 days preceding Day 0 (excluding vitamins and minerals)
  • Previous treatment with intravitreally (in either eye) or intravenously administered Avastin (bevacizumab) within 60 days or concomitant use in either eye outside the scope of this study
  • Previous use of Eylea, Macugen or Lucentis in study eye within 60 days or concomitant use in either eye outside the scope of this study
  • Prior submacular or vitreous surgery

Sites / Locations

  • Washington University School of Medicine
  • Retina Consultants of Houston

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

aflibercept every 2 months

aflibercept monthly

Arm Description

Outcomes

Primary Outcome Measures

Incidence of adverse events
Severity of adverse events

Secondary Outcome Measures

Mean change in best corrected visual acuity from baseline
Mean change in central foveal thickness by optical coherence tomography (OCT) from baseline
Mean visual acuity
Mean central foveal thickness
Proportion of patients gaining 3 lines of vision
Mean change in lesion characteristics (lesion size, leakage)
Proportion of patients with no fluid on OCT
Mean change in macular volume

Full Information

First Posted
April 10, 2012
Last Updated
April 24, 2019
Sponsor
Washington University School of Medicine
Collaborators
Regeneron Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01579760
Brief Title
Intravitreal Aflibercept Injection for Radiation Retinopathy
Official Title
Treatment of Radiation Retinopathy With Intravitreal Aflibercept Injection 2.0mg
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
November 2012 (undefined)
Primary Completion Date
January 2019 (Actual)
Study Completion Date
March 27, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
Regeneron Pharmaceuticals

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to assess the safety of intravitreal aflibercept injection - in the treatment of macular edema associated with retinopathy secondary to previous radiation therapy.
Detailed Description
Radiation retinopathy can cause decreased vision in patients who have received either external beam radiation or local plaque therapy to the eye. An early manifestation of radiation retinopathy is macular edema, which represents fluid within the retina that affects central vision. There is currently no approved treatment for this disease, although there have been anecdotal reports of benefit with laser photocoagulation, intravitreal anti-VEGF agents, or intravitreal steroid use. This is a phase 1 study to evaluate aflibercept for the treatment of macular edema associated with retinopathy secondary to previous radiation treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Radiation Retinopathy, Macular Edema
Keywords
radiation, retinopathy, macular edema, anti-VEGF, VEGF-Trap, aflibercept

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
aflibercept every 2 months
Arm Type
Experimental
Arm Title
aflibercept monthly
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Aflibercept every 2 months
Other Intervention Name(s)
EYLEA, VEGF Trap-Eye
Intervention Description
2.0 mg aflibercept intravitreal injections once per month for the first 3 months (M0, M1, M2), then every 2 months (M4, M6, M8, M10)
Intervention Type
Drug
Intervention Name(s)
Aflibercept monthly
Other Intervention Name(s)
EYLEA, VEGF Trap-Eye
Intervention Description
2.0mg aflibercept intravitreal injections every month (M0-11)
Primary Outcome Measure Information:
Title
Incidence of adverse events
Time Frame
12 months
Title
Severity of adverse events
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Mean change in best corrected visual acuity from baseline
Time Frame
12 months
Title
Mean change in central foveal thickness by optical coherence tomography (OCT) from baseline
Time Frame
12 months
Title
Mean visual acuity
Time Frame
12 months
Title
Mean central foveal thickness
Time Frame
12 months
Title
Proportion of patients gaining 3 lines of vision
Time Frame
12 months
Title
Mean change in lesion characteristics (lesion size, leakage)
Time Frame
12 months
Title
Proportion of patients with no fluid on OCT
Time Frame
12 months
Title
Mean change in macular volume
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Retinopathy associated with previous I-125 brachytherapy for uveal melanoma (85 Gy over 96 hours) at least 6 months prior to enrollment Ability to provide written informed consent and comply with study assessments for the full duration of the study Age > 18 years Center involved macular edema > 300µm in thickness on SD-OCT Best corrected visual acuity of 20/40- 20/400 Birth control therapy for females of child-bearing age Exclusion Criteria: Pre-existing retinopathy due to other disorders Vision decrease is considered to be due to ischemic radiation retinopathy without macular edema or optic neuropathy Presence of metastasis Pregnancy (positive 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, or contraceptive hormone implant or patch. Prior enrollment in any study with intravitreal aflibercept injection Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated Uncontrolled glaucoma in the study eye (defined as IOP ≥ 30 mmHg despite treatment with anti-glaucoma medication) History of cerebral vascular accident, myocardial infarction, transient ischemic attacks within 4 months of study enrollment. Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye Any concurrent intraocular condition in the study eye (e.g., cataract or diabetic retinopathy) that, in the opinion of the investigator, could either require medical or surgical intervention during the 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 over the 6-month study period Presence of significant subfoveal fibrosis or atrophy Intraocular surgery (including cataract surgery) in the study eye within 2 months of enrollment Active intraocular inflammation (grade trace or above) in the study eye History of allergy to fluorescein, ICG or iodine, not amenable to treatment Prior/Concomitant Treatment: Panretinal photocoagulation treatment Previous intraocular steroids or PDT within 3 months Previous participation in any studies of investigational drugs within 30 days preceding Day 0 (excluding vitamins and minerals) Previous treatment with intravitreally (in either eye) or intravenously administered Avastin (bevacizumab) within 60 days or concomitant use in either eye outside the scope of this study Previous use of Eylea, Macugen or Lucentis in study eye within 60 days or concomitant use in either eye outside the scope of this study Prior submacular or vitreous surgery
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Prabakar K Rao, MD
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Retina Consultants of Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
18301032
Citation
Horgan N, Shields CL, Mashayekhi A, Teixeira LF, Materin MA, Shields JA. Early macular morphological changes following plaque radiotherapy for uveal melanoma. Retina. 2008 Feb;28(2):263-73. doi: 10.1097/IAE.0b013e31814b1b75.
Results Reference
background
PubMed Identifier
17562985
Citation
Finger PT, Chin K. Anti-vascular endothelial growth factor bevacizumab (avastin) for radiation retinopathy. Arch Ophthalmol. 2007 Jun;125(6):751-6. doi: 10.1001/archopht.125.6.751.
Results Reference
background
PubMed Identifier
19349865
Citation
Wen JC, McCannel TA. Treatment of radiation retinopathy following plaque brachytherapy for choroidal melanoma. Curr Opin Ophthalmol. 2009 May;20(3):200-4. doi: 10.1097/ICU.0b013e328329b62d.
Results Reference
background

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Intravitreal Aflibercept Injection for Radiation Retinopathy

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