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Prospective triAl of Modified Treat-and-extend Regimens With BroLucizumab in pachychOroid Neovasculopathy (PABLO)

Primary Purpose

Age-Related Macular Degeneration, Pachychoroid Neovasculopathy

Status
Not yet recruiting
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Brolucizumab Injection [Beovu]
Sponsored by
Yeungnam University College of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

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

Eligibility Criteria

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

Inclusion Criteria: Signed informed consent must be obtained prior to participation in the study. Male or female patients ≥ 19 years of age at screening Treatment-na¨ıve pachychoroid neovasculopathy (Minimum cutoff value of SFCT 300 μm) Presence of intraretinal fluid (IRF) or subretinal fluid (SRF) that affects the central subfield, as seen by Spectral Domain Optical Coherence Tomography (SD-OCT) (study eye) Best-corrected visual acuity (BCVA) score between 83 and 23 letters, inclusive, using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing charts at both screening and baseline visit (study eye) If both eyes are eligible as per the inclusion and exclusion criteria described below, the eye with the worse visual acuity should be selected for study eye, unless the Investigator deems it more appropriate to select the eye with better visual acuity, based on medical reasons or local ethical requirements. Exclusion Criteria: Ocular conditions/disorders at screening or baseline which could, in the opinion of the investigator, prevent response to study treatment or may confound interpretation of study results, compromise visual acuity or require planned medical or surgical intervention during the first 12-month study period, structural damage of the fovea, atrophy or fibrosis at the center of the fovea (study eye) A history of any evidence of type 2 or type 3 neovascularization, polypoidal choroidal vasculopathy (aneurysmal type-1 neovascularization), myopic choroidal neovascularization, or other ocular disorders requiring anti-VEGF treatment. Any active intraocular or periocular infection or active intraocular inflammation, at screening or baseline (study eye) Uncontrolled glaucoma defined as intraocular pressure (IOP) > 25 mmHg on medication, or according to investigator's judgment, at screening or baseline (study eye) Ocular treatments: previous treatment with any anti-vascular endothelial growth factor (VEGF) drugs or investigational drugs, previous use of intraocular or periocular steroids within the 6-month period prior to baseline, history of any macular laser treatment or PDT, ocular surgery except cataract surgery within 3 months prior to baseline will be excluded. Stroke or myocardial infarction during the 6-month period prior to baseline Uncontrolled blood pressure defined as a systolic value ≥160 mmHg or diastolic value ≥100 mmHg at Screening or Baseline. (In case there is an elevated blood pressure measurement, it should be repeated after 20 minutes. If the repeat measurement is elevated, then the participant is not eligible to be enrolled into the study). Systemic anti-VEGF therapy at any time. History of hypersensitivity to any of the study treatment or its excipients or to drugs of similar chemical classes, or clinically relevant sensitivity to fluorescein dye as assessed by the Investigator. History of malignancy of any organ system (other than localized basal cell carcinoma of the skin or in situ cervical cancer), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases. Use of other investigational drugs within 5 half-lives of Baseline, or within 30 days /until the expected pharmacodynamic effect has returned to Baseline, whichever is longer; or longer if required by local regulations (observational clinical studies solely involving over-the-counter vitamins, supplements, or diets are not exclusionary). Physically absence of fellow eye (last eye) Presence of amblyopia, amaurosis or ocular disorders in the fellow eye with BCVA <20/200 at Screening (except when due to conditions whose surgery may improve visual acuity (VA), e.g. cataract). Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during the study treatment administration and for one month after stopping the investigational medication. Highly effective contraception methods include: Total abstinence (when this is in line with the preferred and usual lifestyle of the participant). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment Male sterilization (at least 6 months prior to Screening). For female participants on the study, the vasectomized male partner should be the sole partner for that participant Use of oral (estrogen and progesterone), injected or implanted hormonal methods of contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS), or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Brolucizumab treated

    Arm Description

    Intravitreal brolucizumab 6mg injection. Initial treatment consists of a loading dose of three intravitreal injections of brolucizumab at monthly intervals. After 3 loading doses, patients are followed by monthly observation visits until the month 6 and bimonthly afterwards until disease-recurrence interval is determined (It can be monthly as per the investigator's judgement.). Following loading phase, the first treatment interval is determined by patients' disease recurrent interval, 1 month shorter than first recurrence interval (maximum first injection interval is 16 weeks). The injection interval is shortened if there is any fluid change or decreased visual acuity. If the criteria for treatment adjustment were not met and residual fluid was decreased from the previous visit, the injection interval is maintained. And the interval is extended if there was no fluid on OCT. The minimum and maximum injection intervals are 8 and 16 weeks, respectively.

    Outcomes

    Primary Outcome Measures

    Mean change from baseline in best corrected visual acuity
    Mean change from baseline in best corrected visual acuity

    Secondary Outcome Measures

    Distribution of the last interval
    Distribution of the last interval with no disease activity
    Distribution of the maximal interval
    Distribution of the maximal intervals with no disease activity
    Time from the last loading injection to the first visit with no disease activity
    Time from the last loading injection to the first visit with no disease activity
    Proportion of patients with no disease activity
    Proportion of patients with no disease activity
    Proportion of patients with complete fluid absorption
    Proportion of patients with complete fluid absorption

    Full Information

    First Posted
    December 21, 2022
    Last Updated
    December 21, 2022
    Sponsor
    Yeungnam University College of Medicine
    Collaborators
    Novartis
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05672979
    Brief Title
    Prospective triAl of Modified Treat-and-extend Regimens With BroLucizumab in pachychOroid Neovasculopathy
    Acronym
    PABLO
    Official Title
    Prospective triAl of Modified Treat-and-extend Regimens With BroLucizumab in pachychOroid Neovasculopathy
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    December 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    January 1, 2023 (Anticipated)
    Primary Completion Date
    December 31, 2024 (Anticipated)
    Study Completion Date
    December 31, 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Yeungnam University College of Medicine
    Collaborators
    Novartis

    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

    5. Study Description

    Brief Summary
    PNV is a recently described clinical entity; therefore, studies about treatment efficacy and safety are few, with limited follow-up and a small number of participants. Treatment is based on intravitreal anti-VEGF injections, similar to neovascular AMD. According to reported results however, efficacy seems different in fluid reabsorption among anti-VEGF agents. A newly developed anti-VEGF molecule for the treatment of neovascular AMD, brolucizumab, has been shown in clinical studies to have longer durability and improved visual outcomes using a q12-week regimen, thus having the potential to reduce treatment burden and serve as an important therapeutic tool in the management of neovascular AMD. Nevertheless, there have been no reports specifically focusing on the efficacy of brolucizumab in the treatment of PNV. The purpose of this study is to evaluate the efficacy and safety profile of the modified treat-and-extend regimen to 64 weeks by intravitreal brolucizumab injection in eyes with treatment-naive pachychoroid neovasculopathy (PNV) patients.

    6. Conditions and Keywords

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

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    36 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Brolucizumab treated
    Arm Type
    Experimental
    Arm Description
    Intravitreal brolucizumab 6mg injection. Initial treatment consists of a loading dose of three intravitreal injections of brolucizumab at monthly intervals. After 3 loading doses, patients are followed by monthly observation visits until the month 6 and bimonthly afterwards until disease-recurrence interval is determined (It can be monthly as per the investigator's judgement.). Following loading phase, the first treatment interval is determined by patients' disease recurrent interval, 1 month shorter than first recurrence interval (maximum first injection interval is 16 weeks). The injection interval is shortened if there is any fluid change or decreased visual acuity. If the criteria for treatment adjustment were not met and residual fluid was decreased from the previous visit, the injection interval is maintained. And the interval is extended if there was no fluid on OCT. The minimum and maximum injection intervals are 8 and 16 weeks, respectively.
    Intervention Type
    Drug
    Intervention Name(s)
    Brolucizumab Injection [Beovu]
    Intervention Description
    brolucizumab 6mg intravitreal injection
    Primary Outcome Measure Information:
    Title
    Mean change from baseline in best corrected visual acuity
    Description
    Mean change from baseline in best corrected visual acuity
    Time Frame
    Week 32
    Secondary Outcome Measure Information:
    Title
    Distribution of the last interval
    Description
    Distribution of the last interval with no disease activity
    Time Frame
    up to Week 32 and Week 64
    Title
    Distribution of the maximal interval
    Description
    Distribution of the maximal intervals with no disease activity
    Time Frame
    Week 64
    Title
    Time from the last loading injection to the first visit with no disease activity
    Description
    Time from the last loading injection to the first visit with no disease activity
    Time Frame
    Week 64
    Title
    Proportion of patients with no disease activity
    Description
    Proportion of patients with no disease activity
    Time Frame
    Week 12
    Title
    Proportion of patients with complete fluid absorption
    Description
    Proportion of patients with complete fluid absorption
    Time Frame
    Week 12, Week 16

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    19 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Signed informed consent must be obtained prior to participation in the study. Male or female patients ≥ 19 years of age at screening Treatment-na¨ıve pachychoroid neovasculopathy (Minimum cutoff value of SFCT 300 μm) Presence of intraretinal fluid (IRF) or subretinal fluid (SRF) that affects the central subfield, as seen by Spectral Domain Optical Coherence Tomography (SD-OCT) (study eye) Best-corrected visual acuity (BCVA) score between 83 and 23 letters, inclusive, using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing charts at both screening and baseline visit (study eye) If both eyes are eligible as per the inclusion and exclusion criteria described below, the eye with the worse visual acuity should be selected for study eye, unless the Investigator deems it more appropriate to select the eye with better visual acuity, based on medical reasons or local ethical requirements. Exclusion Criteria: Ocular conditions/disorders at screening or baseline which could, in the opinion of the investigator, prevent response to study treatment or may confound interpretation of study results, compromise visual acuity or require planned medical or surgical intervention during the first 12-month study period, structural damage of the fovea, atrophy or fibrosis at the center of the fovea (study eye) A history of any evidence of type 2 or type 3 neovascularization, polypoidal choroidal vasculopathy (aneurysmal type-1 neovascularization), myopic choroidal neovascularization, or other ocular disorders requiring anti-VEGF treatment. Any active intraocular or periocular infection or active intraocular inflammation, at screening or baseline (study eye) Uncontrolled glaucoma defined as intraocular pressure (IOP) > 25 mmHg on medication, or according to investigator's judgment, at screening or baseline (study eye) Ocular treatments: previous treatment with any anti-vascular endothelial growth factor (VEGF) drugs or investigational drugs, previous use of intraocular or periocular steroids within the 6-month period prior to baseline, history of any macular laser treatment or PDT, ocular surgery except cataract surgery within 3 months prior to baseline will be excluded. Stroke or myocardial infarction during the 6-month period prior to baseline Uncontrolled blood pressure defined as a systolic value ≥160 mmHg or diastolic value ≥100 mmHg at Screening or Baseline. (In case there is an elevated blood pressure measurement, it should be repeated after 20 minutes. If the repeat measurement is elevated, then the participant is not eligible to be enrolled into the study). Systemic anti-VEGF therapy at any time. History of hypersensitivity to any of the study treatment or its excipients or to drugs of similar chemical classes, or clinically relevant sensitivity to fluorescein dye as assessed by the Investigator. History of malignancy of any organ system (other than localized basal cell carcinoma of the skin or in situ cervical cancer), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases. Use of other investigational drugs within 5 half-lives of Baseline, or within 30 days /until the expected pharmacodynamic effect has returned to Baseline, whichever is longer; or longer if required by local regulations (observational clinical studies solely involving over-the-counter vitamins, supplements, or diets are not exclusionary). Physically absence of fellow eye (last eye) Presence of amblyopia, amaurosis or ocular disorders in the fellow eye with BCVA <20/200 at Screening (except when due to conditions whose surgery may improve visual acuity (VA), e.g. cataract). Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during the study treatment administration and for one month after stopping the investigational medication. Highly effective contraception methods include: Total abstinence (when this is in line with the preferred and usual lifestyle of the participant). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment Male sterilization (at least 6 months prior to Screening). For female participants on the study, the vasectomized male partner should be the sole partner for that participant Use of oral (estrogen and progesterone), injected or implanted hormonal methods of contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS), or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Min Sagong, PhD
    Phone
    82536203443
    Email
    msagong@ynu.ac.kr

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided

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    Prospective triAl of Modified Treat-and-extend Regimens With BroLucizumab in pachychOroid Neovasculopathy

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