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IAI Versus Sham as Prophylaxis Against Conversion to Neovascular AMD (PRO-CON)

Primary Purpose

Age-Related Macular Degeneration

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Intravitreal aflibercept injection
Placebo
Sponsored by
Jeffrey S Heier
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Age-Related Macular Degeneration

Eligibility Criteria

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

Inclusion Criteria:

  • Study eye must have a diagnosis of non-exudative age-related degeneration characterized by the presence of many intermediate sized drusen, 1 or more large drusen, and/or hyperpigmentary changes. Fellow (non-study) eye must have CNV lesion (i.e., leakage on fluorescein angiography and/or subretinal, intraretinal, or sub-RPE fluid on OCT) secondary to age-related macular degeneration OR history of CNV lesion secondary to age-related macular degeneration, as confirmed by current or past treatment or current or past diagnostic imaging.
  • Subject must be willing and able to comply with clinic visits and study-related procedures.
  • Subject must provide signed informed consent.
  • Subject must be able to understand and complete study-related questionnaires. In order to participate in the home monitoring sub-study, subjects must have an approved wireless device (i.e. iPhone, iPad, or iPod running iOS 6.0 or later) or be willing to use a loaned device and have access to a wireless Internet connection for the duration of the study.

Exclusion Criteria:

  • Evidence of neovascular AMD in the study eye at time of enrollment or anytime in the past. The reading center must confirm that there is no evidence of neovascular AMD in the study eye prior to enrollment.
  • Serous PED of any size in the study eye, as determined by the reading center.
  • Previous treatment with verteporfin PDT, anti-VEGF therapy, laser, external beam radiation or other AMD therapy in the study eye.
  • History of macular hole in study eye.
  • History of vitrectomy in study eye.
  • Lens extraction or implantation within the last 3 months.
  • Capsulotomy within the last 1 month.
  • Lens or other media opacity that would preclude good fundus photography or angiography within the next 2 years.
  • Macular edema or signs of diabetic retinopathy more severe than 10 red dots (microaneurysms or blot hemorrhages).
  • Retinal changes related to high myopia and/or myopic correction greater than 8.00 diopters spherical equivalent.
  • Any progressive ocular disease that would affect visual acuity within the next 2 years.
  • Previous participation in any studies of investigational drugs likely to have ocular effects within 30 days preceding the initial study treatment.
  • Concurrent use of systemic anti-VEGF agents.
  • Active or recent (within 4 weeks) intraocular inflammation (grade trace or above) in the study eye.
  • Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye.
  • For subjects who have undergone prior refractive or cataract surgery in the study eye, the preoperative refractive error in the study eye cannot exceed 8 diopters of myopia.
  • Uncontrolled glaucoma in the study eye (defined as intraocular pressure greater than 25 mmHg) despite treatment with anti-glaucoma medication).
  • Subjects who are unable to be photographed to document CNV due to known allergy to fluorescein dye, lack of venous access or cataract obscuring the CNV.
  • Subjects with other ocular diseases that can compromise the visual acuity of the study eye such as amblyopia and anterior ischemic optic neuropathy.
  • Current treatment for active systemic infection.
  • Evidence of significant uncontrolled concomitant diseases such as cardiovascular disease, nervous system, pulmonary, renal, hepatic, endocrine, or gastrointestinal disorders.
  • History of recurrent significant infections or bacterial infections.
  • Inability to comply with study or follow-up procedures.
  • Pregnancy (positive pregnancy test) or lactation

Sites / Locations

  • Retina-Vitreous Associates Medical GroupRecruiting
  • Ophthalmic Consultants of BostonRecruiting
  • NJ RetinaRecruiting
  • Retina Consultants of HoustonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Intravitreal aflibercept injection

Placebo

Arm Description

Subjects will be randomized to receive intravitreal aflibercept injection every three months for 24 months.

Subjects will be randomized to receive sham injection every three months for 24 months.

Outcomes

Primary Outcome Measures

Proportion of subjects converting to neovascular AMD at 24 months, characterized by the development of choroidal neovascularization (CNV).

Secondary Outcome Measures

Mean change in visual acuity at 24 months compared to baseline
Percentage of subjects losing less than 15 ETDRS letters at 24 months compared to baseline
Incidence and severity of potential ocular side effects including endophthamitis, retinal detachment, cataract, and intraocular inflammation
Incidence and severity of systemic side effects

Full Information

First Posted
June 2, 2015
Last Updated
March 29, 2016
Sponsor
Jeffrey S Heier
Collaborators
Regeneron Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02462889
Brief Title
IAI Versus Sham as Prophylaxis Against Conversion to Neovascular AMD
Acronym
PRO-CON
Official Title
A Prospective, Single-Blind, Randomized Study to Evaluate Intravitreal Aflibercept Injection (IAI) Versus Sham as PROphylaxis Against CONversion to Neovascular Age-Related Macular Degeneration (AMD) in High-Risk Eyes
Study Type
Interventional

2. Study Status

Record Verification Date
March 2016
Overall Recruitment Status
Unknown status
Study Start Date
June 2015 (undefined)
Primary Completion Date
December 2018 (Anticipated)
Study Completion Date
December 2018 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jeffrey S Heier
Collaborators
Regeneron Pharmaceuticals

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a prospective, single-blind, randomized study to evaluate intravitreal aflibercept injection (IAI) versus sham as prophylaxis against conversion to neovascular age-related macular degeneration (AMD) in "high-risk" subjects.
Detailed Description
128 subjects will be enrolled in the trial and randomized in a 1:1 ratio to receive either IAI every three months for 24 months or sham injections. Enrollment will be stratified in order to ensure a balance between the two treatment groups for subjects who were diagnosed with exudative AMD within the past two years versus those diagnosed more than two years prior to Baseline. Study assessments will be conducted at required visits every three months and include manifest refraction and ETDRS visual acuity testing, slit lamp exam and dilated fundus exam, spectral-domain optical coherence tomography (SD-OCT) using Avanti device, and OCT angiography using Avanti AngioVueTM, and fluorescein angiography. Fundus photography will also be performed at Baseline, Month 12 and Month 24 visits. In the event of conversion to neovascular AMD in the study eye at any point during the study, the Investigator will treat the subject with IAI at a frequency per his/her discretion.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Age-Related Macular Degeneration

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
128 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Intravitreal aflibercept injection
Arm Type
Experimental
Arm Description
Subjects will be randomized to receive intravitreal aflibercept injection every three months for 24 months.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subjects will be randomized to receive sham injection every three months for 24 months.
Intervention Type
Drug
Intervention Name(s)
Intravitreal aflibercept injection
Other Intervention Name(s)
Eylea
Intervention Description
Intravitreal aflibercept injection
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Sham injection
Intervention Description
Sham injection
Primary Outcome Measure Information:
Title
Proportion of subjects converting to neovascular AMD at 24 months, characterized by the development of choroidal neovascularization (CNV).
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Mean change in visual acuity at 24 months compared to baseline
Time Frame
24 months
Title
Percentage of subjects losing less than 15 ETDRS letters at 24 months compared to baseline
Time Frame
24 months
Title
Incidence and severity of potential ocular side effects including endophthamitis, retinal detachment, cataract, and intraocular inflammation
Time Frame
up to Month 24
Title
Incidence and severity of systemic side effects
Time Frame
up to Month 24

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Study eye must have a diagnosis of non-exudative age-related degeneration characterized by the presence of many intermediate sized drusen, 1 or more large drusen, and/or hyperpigmentary changes. Fellow (non-study) eye must have CNV lesion (i.e., leakage on fluorescein angiography and/or subretinal, intraretinal, or sub-RPE fluid on OCT) secondary to age-related macular degeneration OR history of CNV lesion secondary to age-related macular degeneration, as confirmed by current or past treatment or current or past diagnostic imaging. Subject must be willing and able to comply with clinic visits and study-related procedures. Subject must provide signed informed consent. Subject must be able to understand and complete study-related questionnaires. In order to participate in the home monitoring sub-study, subjects must have an approved wireless device (i.e. iPhone, iPad, or iPod running iOS 6.0 or later) or be willing to use a loaned device and have access to a wireless Internet connection for the duration of the study. Exclusion Criteria: Evidence of neovascular AMD in the study eye at time of enrollment or anytime in the past. The reading center must confirm that there is no evidence of neovascular AMD in the study eye prior to enrollment. Serous PED of any size in the study eye, as determined by the reading center. Previous treatment with verteporfin PDT, anti-VEGF therapy, laser, external beam radiation or other AMD therapy in the study eye. History of macular hole in study eye. History of vitrectomy in study eye. Lens extraction or implantation within the last 3 months. Capsulotomy within the last 1 month. Lens or other media opacity that would preclude good fundus photography or angiography within the next 2 years. Macular edema or signs of diabetic retinopathy more severe than 10 red dots (microaneurysms or blot hemorrhages). Retinal changes related to high myopia and/or myopic correction greater than 8.00 diopters spherical equivalent. Any progressive ocular disease that would affect visual acuity within the next 2 years. Previous participation in any studies of investigational drugs likely to have ocular effects within 30 days preceding the initial study treatment. Concurrent use of systemic anti-VEGF agents. Active or recent (within 4 weeks) intraocular inflammation (grade trace or above) in the study eye. Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye. For subjects who have undergone prior refractive or cataract surgery in the study eye, the preoperative refractive error in the study eye cannot exceed 8 diopters of myopia. Uncontrolled glaucoma in the study eye (defined as intraocular pressure greater than 25 mmHg) despite treatment with anti-glaucoma medication). Subjects who are unable to be photographed to document CNV due to known allergy to fluorescein dye, lack of venous access or cataract obscuring the CNV. Subjects with other ocular diseases that can compromise the visual acuity of the study eye such as amblyopia and anterior ischemic optic neuropathy. Current treatment for active systemic infection. Evidence of significant uncontrolled concomitant diseases such as cardiovascular disease, nervous system, pulmonary, renal, hepatic, endocrine, or gastrointestinal disorders. History of recurrent significant infections or bacterial infections. Inability to comply with study or follow-up procedures. Pregnancy (positive pregnancy test) or lactation
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alison M Nowak, BBS
Phone
617-314-2694
Email
anowak@eyeboston.com
First Name & Middle Initial & Last Name or Official Title & Degree
Jeffrey S Heier, MD
Phone
617-314-2694
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey S Heier, MD
Organizational Affiliation
Ophthalmic Consultants of Boston
Official's Role
Principal Investigator
Facility Information:
Facility Name
Retina-Vitreous Associates Medical Group
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90211
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sara Ahmed
Phone
310-289-2478
Ext
1244
Email
sahmed@laretina.com
First Name & Middle Initial & Last Name & Degree
David S Boyer, MD
Facility Name
Ophthalmic Consultants of Boston
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alison M Nowak, BBA
Phone
617-314-2694
Email
anowak@eyeboston.com
First Name & Middle Initial & Last Name & Degree
Jeffrey S Heier, MD
Phone
617-314-2694
Facility Name
NJ Retina
City
Edison
State/Province
New Jersey
ZIP/Postal Code
08817
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Laura Gadless
Phone
732-906-1887
Email
lgadless@arcnj.com
First Name & Middle Initial & Last Name & Degree
Sumit P Shah, MD
Facility Name
Retina Consultants of Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cassie Cone
Phone
713-394-7537
Email
cassandra.cone@houstonretina.com
First Name & Middle Initial & Last Name & Degree
David M Brown, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
Citations:
PubMed Identifier
33734306
Citation
Heier JS, Brown DM, Shah SP, Saroj N, Dang S, Waheed NK, Wykoff CC, Prenner JL, Boyer DS. Intravitreal Aflibercept Injection vs Sham as Prophylaxis Against Conversion to Exudative Age-Related Macular Degeneration in High-risk Eyes: A Randomized Clinical Trial. JAMA Ophthalmol. 2021 May 1;139(5):542-547. doi: 10.1001/jamaophthalmol.2021.0221.
Results Reference
derived

Learn more about this trial

IAI Versus Sham as Prophylaxis Against Conversion to Neovascular AMD

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