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Study of the Safety and Efficacy of APX3330 in Diabetic Retinopathy (ZETA-1)

Primary Purpose

Diabetic Retinopathy, Diabetic Macular Edema, NPDR - Non Proliferative Diabetic Retinopathy

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
APX3330
Placebo
Sponsored by
Ocuphire Pharma, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Retinopathy focused on measuring diabetes, diabetic retinopathy, NPDR, PDR

Eligibility Criteria

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

Inclusion Criteria:

  1. Males or non-pregnant females ≥ 18 years of age
  2. At least one eye with DR graded at least moderately severe to severe NPDR or mild PDR (corresponding to DRSS 47, 53, or 61)
  3. BCVA assessed by ETDRS protocol letters score of ≥ 60 letters (Snellen equivalent ≥ 20/63)
  4. Body mass index (BMI) between 18 and 40 kg/m2, inclusive

Exclusion Criteria:

Ophthalmic:

  1. Any prior treatment in the study eye with:

    1. Focal or grid laser photocoagulation within the past year or PRP at any time
    2. Systemic or intravitreal anti-VEGF agents within the last 6 months
    3. Intraocular steroids including triamcinolone and dexamethasone implant within the last 6 months
    4. Fluocinolone implant within the last 3 years
  2. Active uveitis, vitritis, or infection in either eye including infectious conjunctivitis, keratitis, scleritis, or endophthalmitis.
  3. Ocular incisional surgery including cataract surgery in the study eye within 3 months.
  4. Clinically significant ocular disease in either eye.
  5. Presence of macular or retinal vascular disease including diabetic macular edema, retinopathy from causes other than diabetes, age-related macular degeneration, pattern dystrophy, choroidal neovascularization of any cause, retinal vein occlusion, retinal artery occlusion in the study eye.
  6. History of retinal detachment, full-thickness macular hole in the study eye, or idiopathic or autoimmune uveitis in either eye.

Systemic:

  1. Known hypersensitivity or contraindication to study drug.
  2. Any disease or medical condition that in the opinion of the Investigator would interfere with the study, prevent the subject from successfully participating in the study, or which might confound the study results.
  3. Participation in any investigational study within 30 days prior to screening or planning to participate in any other investigational drug or device clinical trials within 30 days of study completion.
  4. Resting HR outside the specified range (50-110 beats per minute).
  5. Known to be immunocompromised or receiving immunosuppressive therapy.
  6. Hypertension with resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 200 mmHg.
  7. History of chronic liver disease or presence of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) consistent with such diagnosis.
  8. Women of childbearing potential who are pregnant, nursing, planning a pregnancy, or not using a medically acceptable form of birth control.

Sites / Locations

  • Clinical Site 9
  • Clinical Site 8
  • Clinical Site 5
  • Clinical Site 11
  • Clinical Site 2
  • Clinical Site 24
  • Clinical Site 19
  • Clinical Site 7
  • Clinical Site 6
  • Clinical Site 14
  • Clinical Site 22
  • Clinical Site 17
  • Clinical Site 12
  • Clinical Site 15
  • Clinical Site 20
  • Clinical Site 1
  • Clinical Site 18
  • Clinical Site 16
  • Clinical Site 10
  • Clinical Site 4
  • Clinical Site 3
  • Clinical Site 23
  • Clinical Site 13
  • Clinical Site 21

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

APX3330

Placebo

Arm Description

Five 120 mg tablets will be taken by mouth as follows: 3 tablets every morning and 2 tablets every evening.

Five 120 mg tablets will be taken by mouth as follows: 3 tablets every morning and 2 tablets every evening.

Outcomes

Primary Outcome Measures

Percent of Subjects with an improvement in Diabetic Retinopathy Severity Score (DRSS)
Percent of subjects with a ≥ 2-step improvement in DRSS in the study eye

Secondary Outcome Measures

Percent of Subjects with change in Diabetic Retinopathy Severity Scale (DRSS) Scores
Percent of subjects with an improvement or worsening in DRSS of ≥ 1, ≥ 2, ≥ 3, and ≥ 4 steps at Week 12 and Week 24
Mean Change in Diabetic Retinopathy Severity Scale (DRSS) Score
Mean change from baseline in DRSS at Week 24. DRSS is scored on a range from 10 to 90 with 13 discrete scores given within that range and where higher scores indicate a worse outcome.
Percent of Subjects without DR/DME Disease Progression
Percent of subjects not developing center-involved DME or moderate PDR or PDR-related AEs during the study at Week 12 and Week 24
Mean Change in Best-Corrected Visual Acuity (BCVA)
Mean change in BCVA at Week 24
Mean Change in Central Subfield Thickness (CST)
Mean Change in CST at Week 24

Full Information

First Posted
December 29, 2020
Last Updated
February 24, 2023
Sponsor
Ocuphire Pharma, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04692688
Brief Title
Study of the Safety and Efficacy of APX3330 in Diabetic Retinopathy
Acronym
ZETA-1
Official Title
Randomized, Placebo-Controlled, Double-Masked Study of the Safety and Efficacy of Orally Administered APX3330 in Subjects With Moderately Severe to Severe Non-Proliferative Diabetic Retinopathy and Mild Proliferative Diabetic Retinopathy
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Completed
Study Start Date
April 8, 2021 (Actual)
Primary Completion Date
January 25, 2023 (Actual)
Study Completion Date
January 25, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ocuphire Pharma, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this study is to evaluate the safety and efficacy of APX3330 to treat diabetic retinopathy (DR) and diabetic macular edema (DME).
Detailed Description
The objective of this study is to evaluate the efficacy of APX3330 to improve Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Score (DRSS) in one hundred (100) subjects with moderately severe to severe NPDR or mild PDR. Subjects with moderately severe to severe NPDR and mild PDR will be selected for study participation and be screened for study eligibility. The eligible eye with the highest DRSS, as assessed by the central reading center, will be designated as the study eye for the primary efficacy analysis. If the subject meets all eligibility criteria, then the subject will be randomized into the study and receive study medication. Blood will be drawn for biomarker analysis. The total length of subject participation is approximately 26 weeks, with 5 clinic visits, 4 telephone safety calls, and one telephone call follow-up visit. The execution of the entire study (first subject screen through last randomized subject completed) is expected to be approximately 12 to 15 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Retinopathy, Diabetic Macular Edema, NPDR - Non Proliferative Diabetic Retinopathy, PDR - Proliferative Diabetic Retinopathy
Keywords
diabetes, diabetic retinopathy, NPDR, PDR

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
This is a placebo-controlled, double-masked, randomized, Phase 2 study in approximately 100 subjects with moderately severe to severe non-proliferative diabetic retinopathy (NPDR), or mild proliferative diabetic retinopathy (PDR), evaluating safety and efficacy following administration of APX3330 twice daily for 24 weeks. The study will have a 1:1 randomization (placebo: APX3330). Randomization will be stratified by level of disease severity (NPDR or PDR). Subjects with mild PDR will be capped at 20% for each arm.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double-masked
Allocation
Randomized
Enrollment
103 (Actual)

8. Arms, Groups, and Interventions

Arm Title
APX3330
Arm Type
Experimental
Arm Description
Five 120 mg tablets will be taken by mouth as follows: 3 tablets every morning and 2 tablets every evening.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Five 120 mg tablets will be taken by mouth as follows: 3 tablets every morning and 2 tablets every evening.
Intervention Type
Drug
Intervention Name(s)
APX3330
Intervention Description
APX3330, a small-molecule oral tablet, is a Ref-1 inhibitor that can potentially reduce proinflammatory and hypoxic signaling that contributes to several eye diseases.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo tablets are identical to APX3330 tablets except for the absence of the active pharmaceutical ingredient.
Primary Outcome Measure Information:
Title
Percent of Subjects with an improvement in Diabetic Retinopathy Severity Score (DRSS)
Description
Percent of subjects with a ≥ 2-step improvement in DRSS in the study eye
Time Frame
24 Weeks
Secondary Outcome Measure Information:
Title
Percent of Subjects with change in Diabetic Retinopathy Severity Scale (DRSS) Scores
Description
Percent of subjects with an improvement or worsening in DRSS of ≥ 1, ≥ 2, ≥ 3, and ≥ 4 steps at Week 12 and Week 24
Time Frame
Up to 24 Weeks
Title
Mean Change in Diabetic Retinopathy Severity Scale (DRSS) Score
Description
Mean change from baseline in DRSS at Week 24. DRSS is scored on a range from 10 to 90 with 13 discrete scores given within that range and where higher scores indicate a worse outcome.
Time Frame
24 Weeks
Title
Percent of Subjects without DR/DME Disease Progression
Description
Percent of subjects not developing center-involved DME or moderate PDR or PDR-related AEs during the study at Week 12 and Week 24
Time Frame
24 Weeks
Title
Mean Change in Best-Corrected Visual Acuity (BCVA)
Description
Mean change in BCVA at Week 24
Time Frame
24 Weeks
Title
Mean Change in Central Subfield Thickness (CST)
Description
Mean Change in CST at Week 24
Time Frame
24 Weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Males or non-pregnant females ≥ 18 years of age At least one eye with DR graded at least moderately severe to severe NPDR or mild PDR (corresponding to DRSS 47, 53, or 61) BCVA assessed by ETDRS protocol letters score of ≥ 60 letters (Snellen equivalent ≥ 20/63) Body mass index (BMI) between 18 and 40 kg/m2, inclusive Exclusion Criteria: Ophthalmic: Any prior treatment in the study eye with: Focal or grid laser photocoagulation within the past year or PRP at any time Systemic or intravitreal anti-VEGF agents within the last 6 months Intraocular steroids including triamcinolone and dexamethasone implant within the last 6 months Fluocinolone implant within the last 3 years Active uveitis, vitritis, or infection in either eye including infectious conjunctivitis, keratitis, scleritis, or endophthalmitis. Ocular incisional surgery including cataract surgery in the study eye within 3 months. Clinically significant ocular disease in either eye. Presence of macular or retinal vascular disease including diabetic macular edema, retinopathy from causes other than diabetes, age-related macular degeneration, pattern dystrophy, choroidal neovascularization of any cause, retinal vein occlusion, retinal artery occlusion in the study eye. History of retinal detachment, full-thickness macular hole in the study eye, or idiopathic or autoimmune uveitis in either eye. Systemic: Known hypersensitivity or contraindication to study drug. Any disease or medical condition that in the opinion of the Investigator would interfere with the study, prevent the subject from successfully participating in the study, or which might confound the study results. Participation in any investigational study within 30 days prior to screening or planning to participate in any other investigational drug or device clinical trials within 30 days of study completion. Resting HR outside the specified range (50-110 beats per minute). Known to be immunocompromised or receiving immunosuppressive therapy. Hypertension with resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 200 mmHg. History of chronic liver disease or presence of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) consistent with such diagnosis. Women of childbearing potential who are pregnant, nursing, planning a pregnancy, or not using a medically acceptable form of birth control.
Facility Information:
Facility Name
Clinical Site 9
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85014
Country
United States
Facility Name
Clinical Site 8
City
Bakersfield
State/Province
California
ZIP/Postal Code
93309
Country
United States
Facility Name
Clinical Site 5
City
Beverly Hills
State/Province
California
ZIP/Postal Code
91607
Country
United States
Facility Name
Clinical Site 11
City
Palm Desert
State/Province
California
ZIP/Postal Code
92260
Country
United States
Facility Name
Clinical Site 2
City
Sacramento
State/Province
California
ZIP/Postal Code
95825
Country
United States
Facility Name
Clinical Site 24
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States
Facility Name
Clinical Site 19
City
Miami
State/Province
Florida
ZIP/Postal Code
33143
Country
United States
Facility Name
Clinical Site 7
City
Winter Haven
State/Province
Florida
ZIP/Postal Code
33880
Country
United States
Facility Name
Clinical Site 6
City
Carmel
State/Province
Indiana
ZIP/Postal Code
46290
Country
United States
Facility Name
Clinical Site 14
City
Hagerstown
State/Province
Maryland
ZIP/Postal Code
21740
Country
United States
Facility Name
Clinical Site 22
City
Springfield
State/Province
Massachusetts
ZIP/Postal Code
01107
Country
United States
Facility Name
Clinical Site 17
City
Grand Blanc
State/Province
Michigan
ZIP/Postal Code
48439
Country
United States
Facility Name
Clinical Site 12
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87113
Country
United States
Facility Name
Clinical Site 15
City
Shirley
State/Province
New York
ZIP/Postal Code
11967
Country
United States
Facility Name
Clinical Site 20
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28210
Country
United States
Facility Name
Clinical Site 1
City
Rapid City
State/Province
South Dakota
ZIP/Postal Code
57701
Country
United States
Facility Name
Clinical Site 18
City
Austin
State/Province
Texas
ZIP/Postal Code
78705
Country
United States
Facility Name
Clinical Site 16
City
Bellaire
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Clinical Site 10
City
Fort Worth
State/Province
Texas
ZIP/Postal Code
76104
Country
United States
Facility Name
Clinical Site 4
City
McAllen
State/Province
Texas
ZIP/Postal Code
78550
Country
United States
Facility Name
Clinical Site 3
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78240
Country
United States
Facility Name
Clinical Site 23
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78624
Country
United States
Facility Name
Clinical Site 13
City
Southlake
State/Province
Texas
ZIP/Postal Code
76092
Country
United States
Facility Name
Clinical Site 21
City
Ogden
State/Province
Utah
ZIP/Postal Code
84010
Country
United States

12. IPD Sharing Statement

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Study of the Safety and Efficacy of APX3330 in Diabetic Retinopathy

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