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IAI for Persistent DME After Treatment With Bevacizumab And Ranibizumab (ROTATED)

Primary Purpose

Diabetic Macular Edema

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Alflibercept
Sponsored by
Southeast Retina Center, Georgia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Macular Edema

Eligibility Criteria

18 Years - 95 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

A patient must meet the following criteria to be eligible for inclusion in the study:

1. Adults with Diabetes Mellitus 2. Documented history of ROTATE study completion (within 3 months +/- 1 week of exit visit) 3. BCVA ETDRS visual acuity letter score 20/25-20/400 4. Thickening due to DME involving the center of the macula evident on clinical exam 5. DME on OCT at baseline (>305 microns if male or >290 microns if female) as assessed on Heidelberg Spectralis SD OCT 6. At least 30 days but less than 45 days since prior 0.3 mg ranibizumab injection 7. Willing and able to comply with clinic visits and study-related procedures 8. Provide signed HIPAA statement and informed consent prior to any study procedures

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Exclusion Criteria:

A patient who meets any of the following criteria will be excluded from the study:

  1. Macular edema considered to be due to a cause other than DME (ERM, Vein Occlusion, Postop CME, uveitis)
  2. History of PRP within 3 months prior to enrollment or anticipated need for PRP
  3. History of idiopathic or autoimmune uveitis in the study eye
  4. Cataract surgery in the study eye within 90 days of baseline
  5. Any intraocular surgery within 90 days of baseline
  6. Vitreomacular traction or epiretinal membrane in the study eye that is thought to affect vision
  7. Clinically significant pre-retinal fibrosis involving the macula in the study eye per investigator judgment
  8. Intraocular inflammation of trace or above in the study eye
  9. Evidence of active infection in either eye
  10. Uncontrolled glaucoma in the study eye defined as a pressure of > 25 on maximal medical therapy.
  11. Concurrent disease in the study eye, other than DME, that could compromise VA, require medical or surgical intervention during the study or could confound interpretation of the results
  12. Ocular media of insufficient quality to obtain fundus and OCT images
  13. Current treatment for a serious systemic infection
  14. Administration of systemic anti-angiogenic agents within 180 days of screen
  15. History of yag capsulotomy within 1 month prior to enrollment
  16. Receipt of any treatment for DME, other than ranibizumab 0.3 mg, in the study eye at any time in the past 3 months following ROTATE study exit, (such as focal/grid macular photocoagulation, intravitreal or peribulbar corticosteroids or other anti-VEGF agents such as Macugen, 2 mg IAI,, 0.5 mg ranibizumab, or intravitreal bevacizumab)
  17. Any women who are pregnant, breast-feeding, or attempting to become pregnant
  18. 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

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Open Label Single Arm Trial

Arm Description

Evaluating the efficacy of Alflibercept Injections in DME Following Treatment With Bevacizumab and Ranibizumab

Outcomes

Primary Outcome Measures

Reduction in Macular Edema
Reduction in macular edema measured as Proportion of eyes with baseline SD OCT CST >350 um demonstrating >15% reduction at week 52 from baseline Proportion of eyes that demonstrate SD OCT CST <305um (males) and <290 um (females) at week 52 from baseline

Secondary Outcome Measures

Full Information

First Posted
November 8, 2017
Last Updated
May 8, 2019
Sponsor
Southeast Retina Center, Georgia
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1. Study Identification

Unique Protocol Identification Number
NCT03340610
Brief Title
IAI for Persistent DME After Treatment With Bevacizumab And Ranibizumab
Acronym
ROTATED
Official Title
Intravitreal Alflibercept Injection (IAI) for Persistent Diabetic Macular Edema (DME) After Treatment With Bevacizumab And Ranibizumab
Study Type
Interventional

2. Study Status

Record Verification Date
May 2019
Overall Recruitment Status
Completed
Study Start Date
June 2015 (Actual)
Primary Completion Date
December 2018 (Actual)
Study Completion Date
December 12, 2018 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a phase 4 prospective, nonrandomized, open label, interventional clinical trial. Study eyes will receive 5 required initial monthly Intravitreal Aflibercept (IAI) doses of 2 mg followed by 2q8 IAI for a total of 52 weeks; only one study eye from each patient will be enrolled.
Detailed Description
This is a phase 4 prospective, nonrandomized, open label, interventional clinical trial. Study eyes will receive 5 required initial monthly IAI doses of 2 mg followed by 2q8 IAI for a total of 52 weeks; only one study eye from each patient will be enrolled. Starting at week 24, patients may be eligible to receive additional 2mg IAI (2q4) treatment if both of the following criteria is met and the investigator feels additional treatment would be beneficial: Loss of >5 letters from baseline or best previously recorded best corrected visual acuity (BCVA) Presence of new or recurrent intraretinal fluid or subretinal fluid as assessed by SD OCT Starting at week 24, rescue therapy with macular laser photocoagulation may be administered if any the following criteria are met Loss of > 15 letters from baseline or best previously recorded BCVA and loss of acuity felt to be secondary to Diabetic Macular Edema (DME) and not from other cause (i.e., cataract, epiretinal membrane, vitreous hemorrhage, etc) and investigator feels patient would benefit from rescue therapy Increase in SD OCT CSF > 100 um from baseline or best previously recorded SD OCT CSF and investigator feels patient would benefit from rescue therapy. Every 4 week visit will include ETDRS BCVA, IOP measurement, Slit lamp biomicroscopy, Indirect ophthalmoscopy, Heidelberg Spectralis SD-OCT and evaluation for systemic and ocular adverse events. Fundus Photography and Wide field Optos fluorescein angiography will be performed at baseline and at week 20and week 52. STUDY DURATION: Approximately 52 weeks to the end of the study. Primary endpoint will be evaluated at week 52.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Macular Edema

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Open Label Single Arm Trial
Arm Type
Other
Arm Description
Evaluating the efficacy of Alflibercept Injections in DME Following Treatment With Bevacizumab and Ranibizumab
Intervention Type
Drug
Intervention Name(s)
Alflibercept
Other Intervention Name(s)
Eylea
Intervention Description
Intravitreal Injection
Primary Outcome Measure Information:
Title
Reduction in Macular Edema
Description
Reduction in macular edema measured as Proportion of eyes with baseline SD OCT CST >350 um demonstrating >15% reduction at week 52 from baseline Proportion of eyes that demonstrate SD OCT CST <305um (males) and <290 um (females) at week 52 from baseline
Time Frame
52 weeks from baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
95 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: A patient must meet the following criteria to be eligible for inclusion in the study: 1. Adults with Diabetes Mellitus 2. Documented history of ROTATE study completion (within 3 months +/- 1 week of exit visit) 3. BCVA ETDRS visual acuity letter score 20/25-20/400 4. Thickening due to DME involving the center of the macula evident on clinical exam 5. DME on OCT at baseline (>305 microns if male or >290 microns if female) as assessed on Heidelberg Spectralis SD OCT 6. At least 30 days but less than 45 days since prior 0.3 mg ranibizumab injection 7. Willing and able to comply with clinic visits and study-related procedures 8. Provide signed HIPAA statement and informed consent prior to any study procedures - Exclusion Criteria: A patient who meets any of the following criteria will be excluded from the study: Macular edema considered to be due to a cause other than DME (ERM, Vein Occlusion, Postop CME, uveitis) History of PRP within 3 months prior to enrollment or anticipated need for PRP History of idiopathic or autoimmune uveitis in the study eye Cataract surgery in the study eye within 90 days of baseline Any intraocular surgery within 90 days of baseline Vitreomacular traction or epiretinal membrane in the study eye that is thought to affect vision Clinically significant pre-retinal fibrosis involving the macula in the study eye per investigator judgment Intraocular inflammation of trace or above in the study eye Evidence of active infection in either eye Uncontrolled glaucoma in the study eye defined as a pressure of > 25 on maximal medical therapy. Concurrent disease in the study eye, other than DME, that could compromise VA, require medical or surgical intervention during the study or could confound interpretation of the results Ocular media of insufficient quality to obtain fundus and OCT images Current treatment for a serious systemic infection Administration of systemic anti-angiogenic agents within 180 days of screen History of yag capsulotomy within 1 month prior to enrollment Receipt of any treatment for DME, other than ranibizumab 0.3 mg, in the study eye at any time in the past 3 months following ROTATE study exit, (such as focal/grid macular photocoagulation, intravitreal or peribulbar corticosteroids or other anti-VEGF agents such as Macugen, 2 mg IAI,, 0.5 mg ranibizumab, or intravitreal bevacizumab) Any women who are pregnant, breast-feeding, or attempting to become pregnant 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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dennis M Marcus, MD
Organizational Affiliation
Southeast Retina Center, PC.
Official's Role
Principal Investigator
Facility Information:
Facility Name
Southeast Retina Center
City
Augusta
State/Province
Georgia
ZIP/Postal Code
30809
Country
United States

12. IPD Sharing Statement

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IAI for Persistent DME After Treatment With Bevacizumab And Ranibizumab

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