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Intravitreal Adalimumab Versus Subcutaneous Adalimumab in Non-infectious Uveitis (IVAS)

Primary Purpose

Uveitis, Non-Infectious Uveitis

Status
Recruiting
Phase
Phase 2
Locations
Lebanon
Study Type
Interventional
Intervention
Adalimumab
Sponsored by
American University of Beirut Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Uveitis focused on measuring Intravitreal Adalimumab, Subcutaneous Adalimumab

Eligibility Criteria

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

Inclusion Criteria:

  • Subject is ≥ 18 years of age.
  • Subject is diagnosed with non-infectious intermediate-, posterior-, or pan-uveitis.
  • Subject must have active disease at baseline as defined by the presence of at least 1 of the following parameters in at least one eye despite at least 2 weeks of prednisone ≥ 10 mg/day (or oral corticosteroid equivalent):

    • Active, inflammatory, chorioretinal and/or inflammatory retinal vascular lesion
    • ≥ 1+ anterior chamber cells (Standardization of Uveitis Nomenclature [SUN] criteria)
    • ≥ 1+ vitreous haze (National Eye Institute [NEI]/SUN criteria)
  • Subject with documented prior adequate response to oral corticosteroids (equivalent of oral prednisone up to 1 mg/kg/day).
  • If subject is on prednisone >=10 mg (or corticosteroid equivalent) at baseline, the dose has not been increased or decreased in the past 14 days.
  • No increase in the immune modulatory therapy in the past three months
  • Negative PPD test.
  • Positive PPD test on anti Tb medications.

Exclusion Criteria:

  • Subject with isolated anterior uveitis.
  • Subject with confirmed or suspected infectious uveitis, including but not limited to infectious uveitis due to TB, cytomegalovirus, lyme disease, toxoplasmosis and herpes simplex virus (HSV).
  • Subject with serpiginous choroidopathy.
  • Subject with corneal or lens opacity that precludes visualization of the fundus or that likely requires cataract surgery during the duration of the trial.
  • Subject with corneal or lens opacities that preclude the evaluation of the vitreous haze.
  • Subject with uncontrolled high intraocular pressure of ≥ 25 mmHg on maximal therapy.
  • Subject with intermediate uveitis and symptoms and/or MRI findings suggestive of a demyelinating disease such as multiple sclerosis. All subjects with intermediate uveitis must have had a prior brain MRI at time of or after diagnosis of intermediate uveitis.
  • Subject has received glucocorticosteroids implant (Retisert®), or Ozurdex within 6 months prior to baseline visit.
  • Subject has received intraocular or periocular corticosteroids or intravitreal methotrexate within 90 days prior to Baseline visit.
  • Subject with proliferative or severe non-proliferative diabetic retinopathy.
  • Subject with neovascular/wet age-related macular degeneration
  • Subject with abnormality of vitreo-retinal interface (i.e., vitreomacular traction, epiretinal membranes, etc.) with the potential for macular structural damage independent of the inflammatory process.
  • Subject with a systemic inflammatory disease and requires additional therapy with a systemic immunosuppressive agent at the time of study entry.
  • Subjects with history of active or latent Mycobacterium tuberculosis documented by Purified Protein Derivative (PPD) and chest X-ray and not anti tuberculosis (TB) treatment.

Sites / Locations

  • American University of Beirut Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Intravitreal

Systemic

Arm Description

Intravitreal injection of 1.5mg/0.03ml adalimumab given at zero, 2 weeks, and then every 4 weeks.

Subcutaneous injection of 40 mg adalimumab (Humira) given every 2 weeks.

Outcomes

Primary Outcome Measures

Vitreous Haze
Change in Vitreous Haze grade in each eye [National Eye Institute (NEI)/ Standardization of Uveitis Nomenclature (SUN) criteria]
Anterior Chamber Cells
Change in Anterior Chamber (AC) cell grade in each eye.

Secondary Outcome Measures

Visual Acuity
Change in ETDRS letters and logarithm of the minimum angle of resolution (log MAR) best-corrected visual acuity (BCVA) in each eye.
Macular Edema
Change in central retinal thickness on Optical Coherence Tomography (OCT).
Angiography Score
Change in fluorescein angiography score
Steroids Tapering
If the patient is initially on steroids (pre-enrolment); Success in tapering steroid dose as a response to the protocol.

Full Information

First Posted
March 8, 2016
Last Updated
July 20, 2023
Sponsor
American University of Beirut Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT02706704
Brief Title
Intravitreal Adalimumab Versus Subcutaneous Adalimumab in Non-infectious Uveitis
Acronym
IVAS
Official Title
Efficacy of Intravitreal Adalimumab Compared to Subcutaneous Adalimumab in Patients With Non-infectious Uveitis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 2016 (undefined)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
February 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
American University of Beirut Medical Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this study is to compare and evaluate the efficacy of subcutaneous (40mg) adalimumab biweekly injections to intravitreal adalimumab (1.5 mg/ 0.03 mL) administration, given at zero, 2 weeks then every four weeks, in subjects with active non-infectious intermediate-, posterior-, or pan-uveitis.
Detailed Description
Subject groups: 32 subjects will be enrolled in this study, 16 in each arm. They will be randomized to receive either 1.5 mg/ 0.03 mL of adalimumab by intravitreal injection or 40 mg of adalimumab subcutaneously at their first treatment visit and at the 2 weeks visit if eligible for a repeat injection. Follow up will be every 2 days the first week then one week later and after that every 4-week intervals for total of 26 weeks. Intervention Details: Systemic adalimumab: Subcutaneous injection of 40 mg adalimumab (Humira) given every 2 weeks. Local adalimumab: Intravitreal injection of 1.5mg/0.03ml adalimumab given at zero, 2 weeks, and then every 4 weeks. Pre-treatment work up Patients will undergo a comprehensive eye exam: Visual acuity, slit-lamp examination of the anterior segment, dilated fundus examination, electroretinography (ERG) and fluorescein angiography (FA). Central macular thickness of all eyes will be measured with ocular coherence tomography before treatment. Purified Protein Derivative (PPD), Complete blood count (CBC) and SGPT. Post-injection follow-up Patients will be followed up every 2 days during the first week then one week later and after that every 4-week intervals. On follow up visits, if deterioration in vision of two or more ETDRS lines or worsening of ocular inflammation by more than 1+ cells/haze is detected at any visit, patients will be removed from the study and receive appropriate treatment. Otherwise, if vision was stable or improved and/or inflammation is same or better, patients will be re-injected. Follow up is for 26 weeks. OCT and fluorescein angiography each visit. ERG will be performed at baseline and 26 weeks. Blood studies (CBC and SGPT) will be performed at baseline, 14 weeks and at 26 weeks. Injections would be delayed if a patient has an acute infection and would be given when it subsides.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Uveitis, Non-Infectious Uveitis
Keywords
Intravitreal Adalimumab, Subcutaneous Adalimumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
32 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Intravitreal
Arm Type
Active Comparator
Arm Description
Intravitreal injection of 1.5mg/0.03ml adalimumab given at zero, 2 weeks, and then every 4 weeks.
Arm Title
Systemic
Arm Type
Active Comparator
Arm Description
Subcutaneous injection of 40 mg adalimumab (Humira) given every 2 weeks.
Intervention Type
Drug
Intervention Name(s)
Adalimumab
Primary Outcome Measure Information:
Title
Vitreous Haze
Description
Change in Vitreous Haze grade in each eye [National Eye Institute (NEI)/ Standardization of Uveitis Nomenclature (SUN) criteria]
Time Frame
26 Weeks
Title
Anterior Chamber Cells
Description
Change in Anterior Chamber (AC) cell grade in each eye.
Time Frame
26 Weeks
Secondary Outcome Measure Information:
Title
Visual Acuity
Description
Change in ETDRS letters and logarithm of the minimum angle of resolution (log MAR) best-corrected visual acuity (BCVA) in each eye.
Time Frame
26 Weeks
Title
Macular Edema
Description
Change in central retinal thickness on Optical Coherence Tomography (OCT).
Time Frame
26 Weeks
Title
Angiography Score
Description
Change in fluorescein angiography score
Time Frame
26 Weeks
Title
Steroids Tapering
Description
If the patient is initially on steroids (pre-enrolment); Success in tapering steroid dose as a response to the protocol.
Time Frame
26 Weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is ≥ 18 years of age. Subject is diagnosed with non-infectious intermediate-, posterior-, or pan-uveitis. Subject must have active disease at baseline as defined by the presence of at least 1 of the following parameters in at least one eye despite at least 2 weeks of prednisone ≥ 10 mg/day (or oral corticosteroid equivalent): Active, inflammatory, chorioretinal and/or inflammatory retinal vascular lesion ≥ 1+ anterior chamber cells (Standardization of Uveitis Nomenclature [SUN] criteria) ≥ 1+ vitreous haze (National Eye Institute [NEI]/SUN criteria) Subject with documented prior adequate response to oral corticosteroids (equivalent of oral prednisone up to 1 mg/kg/day). If subject is on prednisone >=10 mg (or corticosteroid equivalent) at baseline, the dose has not been increased or decreased in the past 14 days. No increase in the immune modulatory therapy in the past three months Negative PPD test. Positive PPD test on anti Tb medications. Exclusion Criteria: Subject with isolated anterior uveitis. Subject with confirmed or suspected infectious uveitis, including but not limited to infectious uveitis due to TB, cytomegalovirus, lyme disease, toxoplasmosis and herpes simplex virus (HSV). Subject with serpiginous choroidopathy. Subject with corneal or lens opacity that precludes visualization of the fundus or that likely requires cataract surgery during the duration of the trial. Subject with corneal or lens opacities that preclude the evaluation of the vitreous haze. Subject with uncontrolled high intraocular pressure of ≥ 25 mmHg on maximal therapy. Subject with intermediate uveitis and symptoms and/or MRI findings suggestive of a demyelinating disease such as multiple sclerosis. All subjects with intermediate uveitis must have had a prior brain MRI at time of or after diagnosis of intermediate uveitis. Subject has received glucocorticosteroids implant (Retisert®), or Ozurdex within 6 months prior to baseline visit. Subject has received intraocular or periocular corticosteroids or intravitreal methotrexate within 90 days prior to Baseline visit. Subject with proliferative or severe non-proliferative diabetic retinopathy. Subject with neovascular/wet age-related macular degeneration Subject with abnormality of vitreo-retinal interface (i.e., vitreomacular traction, epiretinal membranes, etc.) with the potential for macular structural damage independent of the inflammatory process. Subject with a systemic inflammatory disease and requires additional therapy with a systemic immunosuppressive agent at the time of study entry. Subjects with history of active or latent Mycobacterium tuberculosis documented by Purified Protein Derivative (PPD) and chest X-ray and not anti tuberculosis (TB) treatment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rola N Hamam, MD
Phone
+961-1-350000
Ext
5550
Email
rh46@aub.edu.lb
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rola N Hamam, MD
Organizational Affiliation
American University of Beirut Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
American University of Beirut Medical Center
City
Beirut
Country
Lebanon
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rola N Hamam, MD
Phone
+961-1-350000
Ext
5550
Email
rh46@aub.edu.lb

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
25549063
Citation
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Results Reference
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Androudi S, Tsironi E, Kalogeropoulos C, Theodoridou A, Brazitikos P. Intravitreal adalimumab for refractory uveitis-related macular edema. Ophthalmology. 2010 Aug;117(8):1612-6. doi: 10.1016/j.ophtha.2009.12.011. Epub 2010 Apr 8.
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Intravitreal Adalimumab Versus Subcutaneous Adalimumab in Non-infectious Uveitis

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