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NEWTON: Aflibercept Injection for Previously Treated Macular Edema Associated With Central Retinal Vein Occlusions (NEWTON)

Primary Purpose

Macular Edema With Central Retinal Vein Occlusions

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Aflibercept (2.0 mg)
Sponsored by
Northern California Retina Vitreous Associates
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Macular Edema With Central Retinal Vein Occlusions focused on measuring Macular Edema, Central Retinal Vein Occlusion, CRVO, Aflibercept, VEGF Trap-Eye, Eylea, Ranibizumab, Bevacizumab

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients aged 18 and above with documented history of center-involved macular edema secondary to CRVO.
  • Patients must have received treatment for at least 6 months before baseline, with 3 initial loading doses, and evidence of recurrence of edema when extended beyond 4 weeks.
  • Protocol refracted ETDRS BCVA of 20/25 to 20/320 (73-24 letters).
  • Willing and able to comply with clinic visits and study-related procedures.
  • Provide signed informed consent.

Exclusion Criteria:

  • Prior panretinal or macular laser photocoagulation
  • Previous use of intraocular corticosteroids or use of periocular corticosteroids within the 3 months prior to day 1
  • Prior treatment with systemic anti-VEGF agents
  • Presence of iris neovascularization
  • Vitreous hemorrhage in the Study Eye
  • Traction retinal detachment, or preretinal fibrosis involving the macula
  • Diabetic macular edema or diabetic retinopathy, defined as eyes of diabetic patients with more than 1 microaneurysm outside the area of the vein occlusion.
  • Infectious blepharitis, keratitis, scleritis, or conjunctivitis.
  • Active intraocular inflammation (grade trace or above) in the study eye, or history of idiopathic or autoimmune-associated uveitis in either eye.
  • Uncontrolled glaucoma in the study eye (defined as intraocular pressure equal or greater than 30mmHg despite treatment with anti-glaucoma medication)
  • Concurrent eye disease in the study eye that could compromise visual acuity (e.g. advanced glaucoma, age-related macular degeneration, etc)
  • Any concurrent intraocular condition in the study eye (e.g. glaucoma) that, in the opinion of the investigator, could either require medical or surgical intervention during the 52 weeks study period to prevent or treat visual loss that might result from that condition.
  • Pregnant or breast-feeding women
  • Sexually active men* or women of childbearing potential** who are unwilling to practice adequate contraception during the study (adequate contraceptive measures include stable use of oral contraceptives or other prescription pharmaceutical contraceptives for 2 or more menstrual cycles prior to screening; intrauterine device [IUD]; bilateral tubal ligation; vasectomy; condom plus, contraceptive sponge, foam or jelly, or diaphragm) *Contraception is not required for men with documented vasectomy. **Postmenopausal women must be amenorrheic for at least 12 months in order not to be considered of child bearing potential. Pregnancy testing and contraception are not required for women with documented hysterectomy or tubal ligation.

Sites / Locations

  • Northern California Retina Vitreous Associates

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Aflibercept (2.0 mg)

Arm Description

Intravitreal Aflibercept (2.0 mg)

Outcomes

Primary Outcome Measures

Duration of Intravitreal Aflibercept on Treatment Interval
Mean number of weeks between each injection where there is no macular edema

Secondary Outcome Measures

Change in Visual Acuity
Mean change in EDTRS BCVA
Retinal Thickness
Mean change in Central Subfoveal Thickness by OCT
Adverse Events
Incidence and severity of ocular and systemic AE's
Number of Treatments
Mean number of Intravitreal Injections

Full Information

First Posted
May 25, 2013
Last Updated
December 7, 2016
Sponsor
Northern California Retina Vitreous Associates
Collaborators
Regeneron Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01870427
Brief Title
NEWTON: Aflibercept Injection for Previously Treated Macular Edema Associated With Central Retinal Vein Occlusions
Acronym
NEWTON
Official Title
NEWTON: A Single-center Open Label Study Evaluating Intravitreal Aflibercept Injection (IAI) for Previously Treated Macular Edema Associated With Central Retinal Vein Occlusions
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Completed
Study Start Date
June 2013 (undefined)
Primary Completion Date
August 2015 (Actual)
Study Completion Date
August 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Northern California Retina Vitreous Associates
Collaborators
Regeneron Pharmaceuticals

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to determine the effect of Intravitreal Aflibercept Injection (IAI) on previously treated Central Retinal Vein Occlusions (CRVOs) with other Anti-VEGF agents.
Detailed Description
This prospective, open-label, single-center, nonrandomized, investigator-sponsored clinical study seeks to investigate the visual outcomes of a treat and extend dosing regimen of intravitreal aflibercept injection for macular edema following CRVO. All patients will receive IAI 2 mg at baseline and Week 4. If the pre-defined extension criteria are met at the 4-week visit, and at any follow up visit, the patient will receive a mandated treatment, and the next visit will be extended by two weeks. If the extension criteria are not met on a follow-up visit, the treatment interval will be continued to be reduced by 1 week. If criteria are still not met despite treatment at the reduced interval, treatment will be administered as usual and follow up interval will continue to be reduced by 1 week until the criteria are met or a 4-week interval is reached. Treatment of IAI is rendered at every visit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Macular Edema With Central Retinal Vein Occlusions
Keywords
Macular Edema, Central Retinal Vein Occlusion, CRVO, Aflibercept, VEGF Trap-Eye, Eylea, Ranibizumab, Bevacizumab

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 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Aflibercept (2.0 mg)
Arm Type
Experimental
Arm Description
Intravitreal Aflibercept (2.0 mg)
Intervention Type
Drug
Intervention Name(s)
Aflibercept (2.0 mg)
Other Intervention Name(s)
Eylea, VEGF Trap-EYE
Intervention Description
Intravitreal Aflibercept (2.0 mg)
Primary Outcome Measure Information:
Title
Duration of Intravitreal Aflibercept on Treatment Interval
Description
Mean number of weeks between each injection where there is no macular edema
Time Frame
52 Weeks
Secondary Outcome Measure Information:
Title
Change in Visual Acuity
Description
Mean change in EDTRS BCVA
Time Frame
52 Weeks
Title
Retinal Thickness
Description
Mean change in Central Subfoveal Thickness by OCT
Time Frame
52 Weeks
Title
Adverse Events
Description
Incidence and severity of ocular and systemic AE's
Time Frame
52 Weeks
Title
Number of Treatments
Description
Mean number of Intravitreal Injections
Time Frame
52 Weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients aged 18 and above with documented history of center-involved macular edema secondary to CRVO. Patients must have received treatment for at least 6 months before baseline, with 3 initial loading doses, and evidence of recurrence of edema when extended beyond 4 weeks. Protocol refracted ETDRS BCVA of 20/25 to 20/320 (73-24 letters). Willing and able to comply with clinic visits and study-related procedures. Provide signed informed consent. Exclusion Criteria: Prior panretinal or macular laser photocoagulation Previous use of intraocular corticosteroids or use of periocular corticosteroids within the 3 months prior to day 1 Prior treatment with systemic anti-VEGF agents Presence of iris neovascularization Vitreous hemorrhage in the Study Eye Traction retinal detachment, or preretinal fibrosis involving the macula Diabetic macular edema or diabetic retinopathy, defined as eyes of diabetic patients with more than 1 microaneurysm outside the area of the vein occlusion. Infectious blepharitis, keratitis, scleritis, or conjunctivitis. Active intraocular inflammation (grade trace or above) in the study eye, or history of idiopathic or autoimmune-associated uveitis in either eye. Uncontrolled glaucoma in the study eye (defined as intraocular pressure equal or greater than 30mmHg despite treatment with anti-glaucoma medication) Concurrent eye disease in the study eye that could compromise visual acuity (e.g. advanced glaucoma, age-related macular degeneration, etc) Any concurrent intraocular condition in the study eye (e.g. glaucoma) that, in the opinion of the investigator, could either require medical or surgical intervention during the 52 weeks study period to prevent or treat visual loss that might result from that condition. Pregnant or breast-feeding women Sexually active men* or women of childbearing potential** who are unwilling to practice adequate contraception during the study (adequate contraceptive measures include stable use of oral contraceptives or other prescription pharmaceutical contraceptives for 2 or more menstrual cycles prior to screening; intrauterine device [IUD]; bilateral tubal ligation; vasectomy; condom plus, contraceptive sponge, foam or jelly, or diaphragm) *Contraception is not required for men with documented vasectomy. **Postmenopausal women must be amenorrheic for at least 12 months in order not to be considered of child bearing potential. Pregnancy testing and contraception are not required for women with documented hysterectomy or tubal ligation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rahul N Khurana, MD
Organizational Affiliation
Northern California Retina Vitreous Associates
Official's Role
Principal Investigator
Facility Information:
Facility Name
Northern California Retina Vitreous Associates
City
Mountain View
State/Province
California
ZIP/Postal Code
94040
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
23218699
Citation
Brown DM, Heier JS, Clark WL, Boyer DS, Vitti R, Berliner AJ, Zeitz O, Sandbrink R, Zhu X, Haller JA. Intravitreal aflibercept injection for macular edema secondary to central retinal vein occlusion: 1-year results from the phase 3 COPERNICUS study. Am J Ophthalmol. 2013 Mar;155(3):429-437.e7. doi: 10.1016/j.ajo.2012.09.026. Epub 2012 Dec 4.
Results Reference
background
PubMed Identifier
22440275
Citation
Boyer D, Heier J, Brown DM, Clark WL, Vitti R, Berliner AJ, Groetzbach G, Zeitz O, Sandbrink R, Zhu X, Beckmann K, Haller JA. Vascular endothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmology. 2012 May;119(5):1024-32. doi: 10.1016/j.ophtha.2012.01.042. Epub 2012 Mar 21. Erratum In: Ophthalmology. 2012 Nov;119(11):2204.
Results Reference
background
PubMed Identifier
22301066
Citation
Heier JS, Campochiaro PA, Yau L, Li Z, Saroj N, Rubio RG, Lai P. Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology. 2012 Apr;119(4):802-9. doi: 10.1016/j.ophtha.2011.12.005. Epub 2012 Feb 1.
Results Reference
background
PubMed Identifier
21715011
Citation
Campochiaro PA, Brown DM, Awh CC, Lee SY, Gray S, Saroj N, Murahashi WY, Rubio RG. Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology. 2011 Oct;118(10):2041-9. doi: 10.1016/j.ophtha.2011.02.038. Epub 2011 Jun 29.
Results Reference
background
PubMed Identifier
31016030
Citation
Khurana RN, Chang LK, Bansal AS, Palmer JD, Wu C, Wieland MR. Treat and extend regimen with aflibercept for chronic central retinal vein occlusions: 2 year results of the NEWTON study. Int J Retina Vitreous. 2019 Apr 15;5:10. doi: 10.1186/s40942-019-0159-x. eCollection 2019.
Results Reference
derived

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NEWTON: Aflibercept Injection for Previously Treated Macular Edema Associated With Central Retinal Vein Occlusions

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