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Intravitreal Aflibercept for Neovascular Polypoidal Choroidal Vasculopathy (RIVAL Trial) (RIVAL)

Primary Purpose

Neovascular Polypoidal Choroidal Vasculopathy

Status
Unknown status
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Rescue Intravitreal Aflibercept Injection
Rescue Therapy with PDT, Laser or Intravitreal Steroids
Sponsored by
Southeast Retina Center, Georgia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neovascular Polypoidal Choroidal Vasculopathy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Males and females ≥ 18 years of age. Females of child bearing potential will undergo urine pregnancy testing and be required to use appropriate methods of birth control
  • ICG and fluorescein angiographic characteristics consistent with active, leaking PCV with subfoveal lesions and/or subfoveal hemorrhage, lipid exudates, PED or fluid
  • Best corrected early treatment of diabetic retinopathy study (ETDRS) visual acuity at 4 meters between 20/20 - 20/400 (BCVA ETDRS letter score 85 - 20 letters in the study eye)
  • Lesion Characteristics - leaking lesions consistent with PCV. (No limitations on hemorrhage, fibrosis or atrophy)
  • Clear ocular media to allow for photography/angiography
  • Willing and able to comply with clinic visits and study-related procedures
  • Patients with bilateral disease will only be able to enroll one eye
  • Provide signed informed consent

Exclusion Criteria:

  • Any history of systemic Anti-VEGF therapy
  • Current ocular or periocular infection
  • Active intraocular inflammation
  • Any comorbid condition that may decrease visual acuity
  • Any patients who have had intraocular surgery within the past 30 days for any condition
  • For treatment naïve patients: No prior anti-VEGF, PDT, intravitreal steroids or laser (subfoveal or non foveal)
  • For previously-treated patients :
  • Prior anti-VEGF (ranibizumab, bevacizumab, pegaptanib) within 30 days
  • Prior IAI
  • Prior PDT , transpupillary thermal therapy (TTT) or radiation within 90 days (a maximum of 3 PDTs allowed)
  • Prior intravitreal steroids within 90 days
  • Prior non-foveal laser within 90 days
  • Prior subfoveal laser
  • Patients with features of dry age-related macular degeneration such as abundant drusen and symptoms/demographic features inconsistent with the diagnosis of PCV
  • Allergy to fluorescein, ICG, iodine, shellfish
  • Any other condition that the investigator believes would pose a significant hazard to the patient if the investigational therapy were initiated
  • Participation in another simultaneous medical investigation or trial
  • History of previous subfoveal laser
  • Advanced glaucoma (IOP > 25 or cup/disc ratio > 0.8)
  • 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 plus contraceptive sponge, foam, or jelly) *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

  • Southeast Retina Center, PCRecruiting

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Intravitreal Aflibercept Injection

Arm Description

All patients will receive monthly IAI 2.0 mg intravitreally for 3 months (Baseline, Months 1 and 2), followed by mandatory IAI 2.0 mg every 2 months (Months 4, 6, 8 and 10) for 12 months.

Outcomes

Primary Outcome Measures

Incidence and Severity
The primary objective of the study is the incidence and severity of ocular and systemic adverse events at Month 6.
Incidence and Severity
The primary objective of the study is the incidence and severity of ocular and systemic adverse events at Month 12.

Secondary Outcome Measures

Change in Best Corrected Visual Acuity (BCVA)
•The mean change in BCVA from Baseline to Month 6 and from Baseline up to 12 months
Change in Best Corrected Visual Acuity (BCVA)
•Proportion of patients gaining 5, 10 and 15 letters at Months 6 and 12
Change in Best Corrected Visual Acuity (BCVA)
•Proportion of patients losing 5,10, and 15 letters at Months 6 and 12
Photography Assessments
•Mean change from baseline in central subfield thickness at Months 6 and 12 as assessed on spectral domain optical coherence tomography (SD-OCT)
Photography Assessments
•Mean change from baseline in macular volume at Months 6 and 12 as assessed on SD-OCT
Photography Assessments
•Mean change from baseline in choroidal thickness at Months 6 and 12 through SD-OCT
Photography Assessments
•Proportion of patients with no evidence of pigment epithelial detachment (PED), intraretinal and subretinal fluid from choroidal neovascularization (CNV) as assessed by optical coherence tomography (OCT) at 6 and 12 months
Photography Assessments
•Mean change from baseline in the total area of CNV fluorescein angiographic leakage at months 6 and 12
Photography Assessments
•Fluorescein angiograms, indocyanine green (ICG) angiograms, OCT and fundus photographs at Months 6 and 12 compared to baseline as unchanged, resolved, improved, worsened, or cannot determine. See section 9.1.2.2
Photography Assessments
•Rate of polyp regression and resolution at 6 and 12 Months

Full Information

First Posted
March 13, 2014
Last Updated
October 14, 2014
Sponsor
Southeast Retina Center, Georgia
Collaborators
Regeneron Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02092532
Brief Title
Intravitreal Aflibercept for Neovascular Polypoidal Choroidal Vasculopathy (RIVAL Trial)
Acronym
RIVAL
Official Title
Open-label, Non-randomized, Unmasked, Study of IAI in Patients Which Choroidal Neovascularization Secondary to Polypoidal Choroidal Vasculopathy (PCV)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2014
Overall Recruitment Status
Unknown status
Study Start Date
March 2014 (undefined)
Primary Completion Date
March 2015 (Anticipated)
Study Completion Date
March 2016 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Southeast Retina Center, Georgia
Collaborators
Regeneron Pharmaceuticals

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to evaluate the safety and efficacy of intravitreal aflibercept injection (IAI) in patients with neovascular polypoidal choroidal vasculopathy.
Detailed Description
This is an open-label, non-randomized, unmasked, study of IAI in patients with choroidal neovascularization secondary to polypoidal choroidal vasculopathy (PCV). Twenty treatment naïve and previously treated PCV eyes will be enrolled (only one study eye per patient will be enrolled). A maximum of 10 previously treated eyes will be enrolled. Consented, enrolled patients will be followed monthly. All patients will receive monthly IAI 2.0 mg intravitreally for 3 months (Baseline, Months 1 and 2), followed by mandatory IAI 2.0 mg every 2 months (Months 4, 6, 8 and 10) for 12 months. Patients can receive additional IAI treatment (Months 3, 5, 7, 9, and 11) if the re-treatment criteria are met. Starting at Month 3, patients can receive non-anti vascular endothelial growth factor (VEGF) rescue therapy (ie: Photodynamic Therapy (PDT), laser, intravitreal steroids) if the pre-defined criteria are met.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neovascular Polypoidal Choroidal Vasculopathy

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
Intravitreal Aflibercept Injection
Arm Type
Other
Arm Description
All patients will receive monthly IAI 2.0 mg intravitreally for 3 months (Baseline, Months 1 and 2), followed by mandatory IAI 2.0 mg every 2 months (Months 4, 6, 8 and 10) for 12 months.
Intervention Type
Drug
Intervention Name(s)
Rescue Intravitreal Aflibercept Injection
Intervention Description
Patients can receive additional IAI treatment (Months 3, 5, 7, 9, and 11) if the re-treatment criteria are met.
Intervention Type
Procedure
Intervention Name(s)
Rescue Therapy with PDT, Laser or Intravitreal Steroids
Intervention Description
Starting at Month 3, patients can receive non-anti VEGF rescue therapy (ie: PDT, laser, intravitreal steroids) if the pre-defined criteria are met.
Primary Outcome Measure Information:
Title
Incidence and Severity
Description
The primary objective of the study is the incidence and severity of ocular and systemic adverse events at Month 6.
Time Frame
Month 6
Title
Incidence and Severity
Description
The primary objective of the study is the incidence and severity of ocular and systemic adverse events at Month 12.
Time Frame
Month 12
Secondary Outcome Measure Information:
Title
Change in Best Corrected Visual Acuity (BCVA)
Description
•The mean change in BCVA from Baseline to Month 6 and from Baseline up to 12 months
Time Frame
Months 6 and 12
Title
Change in Best Corrected Visual Acuity (BCVA)
Description
•Proportion of patients gaining 5, 10 and 15 letters at Months 6 and 12
Time Frame
Months 6 and 12
Title
Change in Best Corrected Visual Acuity (BCVA)
Description
•Proportion of patients losing 5,10, and 15 letters at Months 6 and 12
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Mean change from baseline in central subfield thickness at Months 6 and 12 as assessed on spectral domain optical coherence tomography (SD-OCT)
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Mean change from baseline in macular volume at Months 6 and 12 as assessed on SD-OCT
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Mean change from baseline in choroidal thickness at Months 6 and 12 through SD-OCT
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Proportion of patients with no evidence of pigment epithelial detachment (PED), intraretinal and subretinal fluid from choroidal neovascularization (CNV) as assessed by optical coherence tomography (OCT) at 6 and 12 months
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Mean change from baseline in the total area of CNV fluorescein angiographic leakage at months 6 and 12
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Fluorescein angiograms, indocyanine green (ICG) angiograms, OCT and fundus photographs at Months 6 and 12 compared to baseline as unchanged, resolved, improved, worsened, or cannot determine. See section 9.1.2.2
Time Frame
Months 6 and 12
Title
Photography Assessments
Description
•Rate of polyp regression and resolution at 6 and 12 Months
Time Frame
Months 6 and 12
Other Pre-specified Outcome Measures:
Title
Rescue Therapy
Description
•Mean number of injections of IAI
Time Frame
Month 12
Title
Rescue Therapy
Description
•Incidence of need and administration of rescue therapy with PDT, laser, or intravitreal steroids
Time Frame
Month 12
Title
Rescue Therapy
Description
•Incidence and need of administration of additional IAI therapy
Time Frame
Month 12

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Males and females ≥ 18 years of age. Females of child bearing potential will undergo urine pregnancy testing and be required to use appropriate methods of birth control ICG and fluorescein angiographic characteristics consistent with active, leaking PCV with subfoveal lesions and/or subfoveal hemorrhage, lipid exudates, PED or fluid Best corrected early treatment of diabetic retinopathy study (ETDRS) visual acuity at 4 meters between 20/20 - 20/400 (BCVA ETDRS letter score 85 - 20 letters in the study eye) Lesion Characteristics - leaking lesions consistent with PCV. (No limitations on hemorrhage, fibrosis or atrophy) Clear ocular media to allow for photography/angiography Willing and able to comply with clinic visits and study-related procedures Patients with bilateral disease will only be able to enroll one eye Provide signed informed consent Exclusion Criteria: Any history of systemic Anti-VEGF therapy Current ocular or periocular infection Active intraocular inflammation Any comorbid condition that may decrease visual acuity Any patients who have had intraocular surgery within the past 30 days for any condition For treatment naïve patients: No prior anti-VEGF, PDT, intravitreal steroids or laser (subfoveal or non foveal) For previously-treated patients : Prior anti-VEGF (ranibizumab, bevacizumab, pegaptanib) within 30 days Prior IAI Prior PDT , transpupillary thermal therapy (TTT) or radiation within 90 days (a maximum of 3 PDTs allowed) Prior intravitreal steroids within 90 days Prior non-foveal laser within 90 days Prior subfoveal laser Patients with features of dry age-related macular degeneration such as abundant drusen and symptoms/demographic features inconsistent with the diagnosis of PCV Allergy to fluorescein, ICG, iodine, shellfish Any other condition that the investigator believes would pose a significant hazard to the patient if the investigational therapy were initiated Participation in another simultaneous medical investigation or trial History of previous subfoveal laser Advanced glaucoma (IOP > 25 or cup/disc ratio > 0.8) 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 plus contraceptive sponge, foam, or jelly) *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.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Siobhan Ortiz
Phone
706-650-0061
Email
siobhan@southeastretina.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dennis M Marcus, MD
Organizational Affiliation
Part-Owner of Southeast Retina Center, PC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Southeast Retina Center, PC
City
Augusta
State/Province
Georgia
ZIP/Postal Code
30909
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dennis M Marcus, MD
Phone
706-650-0061
Email
dmarcus@southeastretina.com
First Name & Middle Initial & Last Name & Degree
Jared Gardner, BS
Phone
706-650-0061
Email
jgardner@southeastretina.com
First Name & Middle Initial & Last Name & Degree
Dennis M Marcus, MD
First Name & Middle Initial & Last Name & Degree
Harinderjit Singh, MD

12. IPD Sharing Statement

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Intravitreal Aflibercept for Neovascular Polypoidal Choroidal Vasculopathy (RIVAL Trial)

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