Evaluation of Bromocriptine, Metoprolol and Tamsulosin in Eyes With Non-Central DME
Primary Purpose
Diabetic Macular Edema
Status
Withdrawn
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Bromocriptine 2.5 MG
Metoprolol 25 MG
Tamsulosin 0.4 MG
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Diabetic Macular Edema
Eligibility Criteria
Inclusion Criteria:
- Age >18 years
- Type 1 or type 2 diabetes mellitus
- Best corrected visual acuity using the early treatment diabetic retinopathy study (ETDRS) visual acuity test letter score ≥ 74 (i.e., 20/32 or better) within 30 days of enrollment.
- On clinical exam, definite retinal thickening due to DME within 3,000 μm of the center of the macula but not involving the 500 μm central subfield.
- Thickened non-central macular subfields on the spectral domain OCT macular map
- Central subfield thickness within threshold definition for normal central subfield thickness
- No focal/grid laser within the last 6 months or other treatment for DME within the last 4 months.
- Pseudophakia
Exclusion Criteria:
- Patients with active proliferative diabetic retinopathy
- Pan retinal photocoagulation within the last 12 months of study initiation
- A condition that, in the opinion of the investigator, would preclude participation in the study, e.g., unstable medical status including blood pressure, cardiovascular disease, and glycemic control.
- Subjects experiencing poor glycemic control who, within the last 4 months, initiated intensive insulin treatment (a pump or multiple daily injections) or plan to do so in the next 4 months.
- Use of systemic corticosteroids or anti-VEGF (vascular endothelial growth factor) therapy.
- Participation in an investigational trial that involves treatment with any drug within 30 days of randomization that has not received regulatory approval at the time of study entry.
Note: study participants cannot receive another investigational drug while participating in this study.
- Known allergy or hypersensitivity to any component of the study drugs.
- Postpartum women with a history of coronary artery disease or other severe cardiovascular conditions (a bromocriptine contraindication).
- Planned glaucoma surgery (floppy iris syndrome associated with tamsulosin therapy).
- Blood pressure > 180/110 mmHg (systolic above 180 or diastolic above 110 mmHg).
- If blood pressure is brought below 180/110 by anti-hypertensive treatment, an individual can become eligible.
- Subjects with second or third degree heart block (metoprolol contraindication).
- Subjects with asthma or other bronchospastic disease (metoprolol precaution).
- Individuals currently taking one of the study medications or a medication in the same therapeutic class (beta receptor antagonists, alpha-1 receptor antagonists, or bromocriptine).
- Participants expecting to move out of the area of the clinical center to an area not covered by another clinical center during the 12 months of the study.
- For women of child-bearing potential: pregnant or lactating or intending to become pregnant within the next 12 months. Women who are potential study participants should be questioned about the potential for pregnancy. Investigator judgment will be used to determine when a pregnancy test is needed.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Combination regiment
Placebo
Arm Description
A combination regiment of Bromocriptine (2.5 mg/day), Metoprolol (25 mg/day) and Tamsulosin (0.4 mg/day)
Three placebo pills, matching the external appearance of active drugs
Outcomes
Primary Outcome Measures
Change in retinal volume
Effects of bromocriptine/metoprolol/tamsulosin combination therapy on macular retinal volume compared with placebo in eyes with non-central diabetic macular edema (DME)
Secondary Outcome Measures
Progression of non-central DME compared to central DME
Effects of therapy with bromocriptine/metoprolol/tamsulosin on central subfield thickness and compare the progression of non-central DME to central DME as determined by stereoscopic fundus photographs.
Progression of non-central DME compared to central DME
Effects of therapy with bromocriptine/metoprolol/tamsulosin on central subfield thickness and compare the progression of non-central DME to central DME as determined by Optical Coherence Tomography (OCT).
Change in retinal density
Measured by OCT-angiography
Foveal avascular changes
Measured by fluorescein angiography.
Full Information
NCT ID
NCT03384524
First Posted
December 15, 2017
Last Updated
March 28, 2019
Sponsor
Andrew Moshfeghi, MD, MBA
Collaborators
Case Western Reserve University
1. Study Identification
Unique Protocol Identification Number
NCT03384524
Brief Title
Evaluation of Bromocriptine, Metoprolol and Tamsulosin in Eyes With Non-Central DME
Official Title
A Phase I/II Evaluation of Bromocriptine, Metoprolol and Tamsulosin Combination Therapy in Eyes With Non-Central Diabetic Macular Edema
Study Type
Interventional
2. Study Status
Record Verification Date
March 2019
Overall Recruitment Status
Withdrawn
Why Stopped
withdrawn during planning stages
Study Start Date
March 2018 (Anticipated)
Primary Completion Date
May 2019 (Anticipated)
Study Completion Date
May 2019 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Andrew Moshfeghi, MD, MBA
Collaborators
Case Western Reserve University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This phase I/II trial is designed to provide proof of concept evidence that combination therapy can have a beneficial effect on DME and possibly prevent increases in retinal volume or progression of non-central DME into the central subfield of the macula. If a beneficial effect is apparent in this phase I/II study involving a relatively small sample size and short follow-up period, its results could be used to in plan future phase III trials. We believe this study will be the first to show that a systems pharmacology approach can successfully address diabetic macular edema, and thus revolutionize the treatment of complex retinal diseases for which there are a paucity of effective treatment options.
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 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Combination regiment
Arm Type
Active Comparator
Arm Description
A combination regiment of Bromocriptine (2.5 mg/day), Metoprolol (25 mg/day) and Tamsulosin (0.4 mg/day)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Three placebo pills, matching the external appearance of active drugs
Intervention Type
Drug
Intervention Name(s)
Bromocriptine 2.5 MG
Other Intervention Name(s)
Bromocriptine Mesylate
Intervention Description
Administered daily
Intervention Type
Drug
Intervention Name(s)
Metoprolol 25 MG
Other Intervention Name(s)
Metoprolol Tartrate
Intervention Description
Administered daily
Intervention Type
Drug
Intervention Name(s)
Tamsulosin 0.4 MG
Other Intervention Name(s)
Tamsulosin HCL, Tamsulosin Hydrochloride
Intervention Description
Administered daily
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Three pills, matching active drugs to be administered daily
Primary Outcome Measure Information:
Title
Change in retinal volume
Description
Effects of bromocriptine/metoprolol/tamsulosin combination therapy on macular retinal volume compared with placebo in eyes with non-central diabetic macular edema (DME)
Time Frame
14 months
Secondary Outcome Measure Information:
Title
Progression of non-central DME compared to central DME
Description
Effects of therapy with bromocriptine/metoprolol/tamsulosin on central subfield thickness and compare the progression of non-central DME to central DME as determined by stereoscopic fundus photographs.
Time Frame
14 months
Title
Progression of non-central DME compared to central DME
Description
Effects of therapy with bromocriptine/metoprolol/tamsulosin on central subfield thickness and compare the progression of non-central DME to central DME as determined by Optical Coherence Tomography (OCT).
Time Frame
14 months
Title
Change in retinal density
Description
Measured by OCT-angiography
Time Frame
14 months
Title
Foveal avascular changes
Description
Measured by fluorescein angiography.
Time Frame
14 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age >18 years
Type 1 or type 2 diabetes mellitus
Best corrected visual acuity using the early treatment diabetic retinopathy study (ETDRS) visual acuity test letter score ≥ 74 (i.e., 20/32 or better) within 30 days of enrollment.
On clinical exam, definite retinal thickening due to DME within 3,000 μm of the center of the macula but not involving the 500 μm central subfield.
Thickened non-central macular subfields on the spectral domain OCT macular map
Central subfield thickness within threshold definition for normal central subfield thickness
No focal/grid laser within the last 6 months or other treatment for DME within the last 4 months.
Pseudophakia
Exclusion Criteria:
Patients with active proliferative diabetic retinopathy
Pan retinal photocoagulation within the last 12 months of study initiation
A condition that, in the opinion of the investigator, would preclude participation in the study, e.g., unstable medical status including blood pressure, cardiovascular disease, and glycemic control.
Subjects experiencing poor glycemic control who, within the last 4 months, initiated intensive insulin treatment (a pump or multiple daily injections) or plan to do so in the next 4 months.
Use of systemic corticosteroids or anti-VEGF (vascular endothelial growth factor) therapy.
Participation in an investigational trial that involves treatment with any drug within 30 days of randomization that has not received regulatory approval at the time of study entry.
Note: study participants cannot receive another investigational drug while participating in this study.
Known allergy or hypersensitivity to any component of the study drugs.
Postpartum women with a history of coronary artery disease or other severe cardiovascular conditions (a bromocriptine contraindication).
Planned glaucoma surgery (floppy iris syndrome associated with tamsulosin therapy).
Blood pressure > 180/110 mmHg (systolic above 180 or diastolic above 110 mmHg).
If blood pressure is brought below 180/110 by anti-hypertensive treatment, an individual can become eligible.
Subjects with second or third degree heart block (metoprolol contraindication).
Subjects with asthma or other bronchospastic disease (metoprolol precaution).
Individuals currently taking one of the study medications or a medication in the same therapeutic class (beta receptor antagonists, alpha-1 receptor antagonists, or bromocriptine).
Participants expecting to move out of the area of the clinical center to an area not covered by another clinical center during the 12 months of the study.
For women of child-bearing potential: pregnant or lactating or intending to become pregnant within the next 12 months. Women who are potential study participants should be questioned about the potential for pregnancy. Investigator judgment will be used to determine when a pregnancy test is needed.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew A. Moshfeghi, MD, MBA
Organizational Affiliation
Associate Professor of Ophthalmology; Director of Vitreoretinal Surgery and Medical Retina Fellowship; Director of Clinical Trials Unit
Official's Role
Principal Investigator
12. IPD Sharing Statement
Learn more about this trial
Evaluation of Bromocriptine, Metoprolol and Tamsulosin in Eyes With Non-Central DME
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