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Use of Intravitreal Ranibizumab in the Treatment of Vitreous Hemorrhage

Primary Purpose

Diabetic Retinopathy, Vitreous Hemorrhage

Status
Unknown status
Phase
Phase 4
Locations
Brazil
Study Type
Interventional
Intervention
intravitreal ranibizumab injections
Sponsored by
Hospital Regional de São José - Dr. Homero de Miranda Gomes
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Retinopathy focused on measuring diabetic retinopathy, vitreous hemorrhage, intravitreal ranibizumab

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female patients >18 years of age who have signed an informed consent
  • Patients with Type 1 or Type 2 diabetes mellitus (according to ADA or WHO guidelines).
  • Patients with visual impairment due to vitreous hemorrhage.
  • Medication for the management of diabetes must have been stable within 3 months prior to randomization and is expected to remain stable during the course of the study.

Exclusion criteria:

Ocular concomitant conditions/ diseases

  • Concomitant conditions in the study eye which could, in the opinion of the investigator, prevent the improvement of visual acuity on study treatment
  • Active intraocular inflammation (grade trace or above) in either eye
  • Any active infection (e.g. conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) in either eye
  • History of uveitis in either eye
  • Ocular disorders in the study eye that may confound interpretation of study results, compromise visual acuity or require medical or surgical intervention during the 12-month study period, including retinal vascular occlusion, retinal detachment, macular hole, or choroidal neovascularization of any cause (e.g., age-related macular degeneration, ocular histoplasmosis, or pathologic myopia)
  • Uncontrolled glaucoma in the study eye (according to investigator's judgment)
  • Neovascularization of the iris in study eye
  • Evidence of vitreomacular traction in study eye

Ocular treatments

  • Panretinal laser photocoagulation in the study eye within 6 months or focal/grid laser photocoagulation in the study eye within 3 months prior to study entry
  • Treatment with anti-angiogenic drugs (pegaptanib sodium, anecortave acetate, bevacizumab, ranibizumab, etc.) or intravitreal corticosteroids in either eye within 4 months prior to randomization
  • Any intraocular surgery in the study eye within 3 months prior to randomization
  • History of vitrectomy in study eye
  • Phakic study eye with a history of intravitreal corticosteroid treatment
  • Ocular conditions in the study eye that require chronic concomitant therapy with topical ocular or systemically administered corticosteroids

Systemic conditions or treatments

  • History of disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug, might affect the interpretation of the results of the study, or renders the patient at high risk from treatment complications
  • Renal failure requiring dialysis or renal transplant OR renal insufficiency with creatinine levels >2.0 mg/dl
  • Untreated diabetes mellitus
  • Severe (blood pressure systolic > 160 mmHg OR diastolic > 100 mmHg) AND untreated hypertension
  • 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
  • Known hypersensitivity to ranibizumab or any component of the ranibizumab formulation or to fluorescein contrast.

Compliance/ Administrative

  • Previous participation in any clinical studies of investigational drugs (excluding vitamins and minerals) within 1 month (or a period corresponding to 5 half-lives of the investigational drug, whatever is longer) prior to randomization
  • Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, including women whose career, lifestyle, or sexual orientation precludes intercourse with a male partner and women whose partners have been sterilized by vasectomy or other means, UNLESS they are using two birth control methods. The two methods can be a double barrier method or a barrier method plus a hormonal method. Adequate barrier methods of contraception include: diaphragm, condom (by the partner), intrauterine device (copper or hormonal), sponge or spermicide. Hormonal contraceptives include any marketed contraceptive agent that includes an estrogen and/or a progestational agent.
  • Pregnant or nursing (lactating) women.
  • Inability to comply with study or follow-up procedures.

Sites / Locations

  • Marcelo NovelloRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

vitreous hemorrhage group

Arm Description

Patients will be treated monthly: intravitreal ranibizumab (0.5 mg) will be administered in an open-label fashion, using 3 monthly injections (at day 0, day 30 and day 60) followed by an additional post treatment visit, a month after the last injection, for posterior reports

Outcomes

Primary Outcome Measures

Gain in visual acuity and transparence of vitreous in treated eyes.

Secondary Outcome Measures

Full Information

First Posted
March 18, 2013
Last Updated
April 1, 2013
Sponsor
Hospital Regional de São José - Dr. Homero de Miranda Gomes
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1. Study Identification

Unique Protocol Identification Number
NCT01824043
Brief Title
Use of Intravitreal Ranibizumab in the Treatment of Vitreous Hemorrhage
Official Title
Pilot Study Investigating the Use of Intravitreal Ranibizumab in the Treatment of Vitreous Hemorrhage in Proliferative Diabetic Retinopathy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Unknown status
Study Start Date
March 2013 (undefined)
Primary Completion Date
September 2013 (Anticipated)
Study Completion Date
December 2013 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hospital Regional de São José - Dr. Homero de Miranda Gomes

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Primary Objective: To investigate the effectiveness of intravitreal applications of 0.5 mg Lucentis (ranibizumab) in patients with vitreous hemorrhage due to proliferative diabetic retinopathy. The primary endpoint for the study will be the mean change in best-corrected visual acuity (BCVA) from baseline to the mean level at Month 3. Secondary Objectives: To assess any differences in mean change in BCVA over time; To assess differences in vitreous transparency (amount of hemorrhage) with fundus angiography exam; To assess any differences in retinopathy severity level according to the Early Treatment Diabetic Retinopathy Study; To correlate the visual outcomes with serum glucose levels.
Detailed Description
Written informed consent must be obtained before any study assessment is performed. This study will have only one group of patients, with a total of twenty subjects stratified based on decreased visual acuity due to vitreous hemorrhage in proliferative diabetic retinopathy: Stratus 1 (ten subjects): patients with low to moderate diabetic vitreous hemorrhage; Stratus 2 (ten subjects): patients with severe diabetic vitreous hemorrhage. Patients will be treated monthly: intravitreal ranibizumab (0.5 mg) will be administered in an open-label fashion, using 3 monthly injections (at day 0, day 30 and day 60) followed by an additional post treatment visit, a month after the last injection, for posterior reports. During regular, monthly visits, a detailed ophthalmologic evaluation will be performed, including a BCVA assessment. Vitreous hemorrhage density will also be assessed, according to the fundus visualization in retinal angiography: low to moderate vitreous hemorrhage: posterior pole detail slightly hazy or very hazy; severe vitreous hemorrhage: fundus details not visible. All patients with severe vitreous hemorrhage will have A/B ultrasound scan performed in the day of the injection. The intravitreal injection will always be the last procedure performed in a given day. Blood samples will also be collected in each study visit, in order to assess serum glucose levels. Laser treatment may be administered at investigator's discretion if vitreous hemorrhage reduce or disappear after the intravitreal treatment with ranibizumab to such a retinal fundus visibility level that permits photocoagulation. All the patients of the study will be monitored about adverse events and will remain in their usual clinical and ophthalmological care after the end of the study. Visit Schedule Day0 Day30 Day 60 Day 90 Informed Consent X Ophthalmologic Examination X X X X Best Corrected Visual Acuity X X X X Fluorescein Angiography X X X X Serum Glucose Level X X X X A/B Ultrasound Scan X* X* X* Ranibizumab Injection X X X Laser Treatment ** ** ** Adverse Events Monitoring X X X X * Only for patients that present severe vitreous hemorrhages. At investigator's discretion. Check the Methodology section for details. Population: Patients with proliferative diabetic retinopathy with vitreous hemorrhage.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Retinopathy, Vitreous Hemorrhage
Keywords
diabetic retinopathy, vitreous hemorrhage, intravitreal ranibizumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
vitreous hemorrhage group
Arm Type
Experimental
Arm Description
Patients will be treated monthly: intravitreal ranibizumab (0.5 mg) will be administered in an open-label fashion, using 3 monthly injections (at day 0, day 30 and day 60) followed by an additional post treatment visit, a month after the last injection, for posterior reports
Intervention Type
Drug
Intervention Name(s)
intravitreal ranibizumab injections
Intervention Description
Patients will be treated monthly: intravitreal ranibizumab (0.5 mg) will be administered in an open-label fashion, using 3 monthly injections (at day 0, day 30 and day 60) followed by an additional post treatment visit, a month after the last injection, for posterior reports
Primary Outcome Measure Information:
Title
Gain in visual acuity and transparence of vitreous in treated eyes.
Time Frame
90 days
Other Pre-specified Outcome Measures:
Title
Visual acuity improvement measured by Snellen chart
Time Frame
90 days
Title
Reduction in the ETDRS diabetic retinopathy severity level
Time Frame
90 days
Title
Serum glucose levels will be compared with the visual outcomes
Description
It is expected that low glucose levels helps in better visual outcomes.
Time Frame
90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients >18 years of age who have signed an informed consent Patients with Type 1 or Type 2 diabetes mellitus (according to ADA or WHO guidelines). Patients with visual impairment due to vitreous hemorrhage. Medication for the management of diabetes must have been stable within 3 months prior to randomization and is expected to remain stable during the course of the study. Exclusion criteria: Ocular concomitant conditions/ diseases Concomitant conditions in the study eye which could, in the opinion of the investigator, prevent the improvement of visual acuity on study treatment Active intraocular inflammation (grade trace or above) in either eye Any active infection (e.g. conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) in either eye History of uveitis in either eye Ocular disorders in the study eye that may confound interpretation of study results, compromise visual acuity or require medical or surgical intervention during the 12-month study period, including retinal vascular occlusion, retinal detachment, macular hole, or choroidal neovascularization of any cause (e.g., age-related macular degeneration, ocular histoplasmosis, or pathologic myopia) Uncontrolled glaucoma in the study eye (according to investigator's judgment) Neovascularization of the iris in study eye Evidence of vitreomacular traction in study eye Ocular treatments Panretinal laser photocoagulation in the study eye within 6 months or focal/grid laser photocoagulation in the study eye within 3 months prior to study entry Treatment with anti-angiogenic drugs (pegaptanib sodium, anecortave acetate, bevacizumab, ranibizumab, etc.) or intravitreal corticosteroids in either eye within 4 months prior to randomization Any intraocular surgery in the study eye within 3 months prior to randomization History of vitrectomy in study eye Phakic study eye with a history of intravitreal corticosteroid treatment Ocular conditions in the study eye that require chronic concomitant therapy with topical ocular or systemically administered corticosteroids Systemic conditions or treatments History of disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug, might affect the interpretation of the results of the study, or renders the patient at high risk from treatment complications Renal failure requiring dialysis or renal transplant OR renal insufficiency with creatinine levels >2.0 mg/dl Untreated diabetes mellitus Severe (blood pressure systolic > 160 mmHg OR diastolic > 100 mmHg) AND untreated hypertension 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 Known hypersensitivity to ranibizumab or any component of the ranibizumab formulation or to fluorescein contrast. Compliance/ Administrative Previous participation in any clinical studies of investigational drugs (excluding vitamins and minerals) within 1 month (or a period corresponding to 5 half-lives of the investigational drug, whatever is longer) prior to randomization Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, including women whose career, lifestyle, or sexual orientation precludes intercourse with a male partner and women whose partners have been sterilized by vasectomy or other means, UNLESS they are using two birth control methods. The two methods can be a double barrier method or a barrier method plus a hormonal method. Adequate barrier methods of contraception include: diaphragm, condom (by the partner), intrauterine device (copper or hormonal), sponge or spermicide. Hormonal contraceptives include any marketed contraceptive agent that includes an estrogen and/or a progestational agent. Pregnant or nursing (lactating) women. Inability to comply with study or follow-up procedures.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Dr Marcelo Novello, Chief
Phone
551832719094
Email
mbnovell@yahoo.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marcelo Novello
Organizational Affiliation
Hospital Regional Sao Jose
Official's Role
Principal Investigator
Facility Information:
Facility Name
Marcelo Novello
City
Sao Jose
State/Province
SC
ZIP/Postal Code
88103-901
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
MARCELO NOVELLO
Email
mbnovell@yahoo.com

12. IPD Sharing Statement

Learn more about this trial

Use of Intravitreal Ranibizumab in the Treatment of Vitreous Hemorrhage

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