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Comparing Intravitreal Aflibercept Monotherapy vs Aflibercept Combined With Reduced Fluence PDT in PCV Treatment

Primary Purpose

Polypoidal Choroidal Vasculopathy

Status
Recruiting
Phase
Not Applicable
Locations
Singapore
Study Type
Interventional
Intervention
Aflibercept + reduced fluence photodynamic therapy (RF-PDT)
Aflibercept + sham reduced fluence photodynamic therapy (RF-PDT)
Sponsored by
Singapore National Eye Centre
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Polypoidal Choroidal Vasculopathy

Eligibility Criteria

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

Inclusion Criteria:

  • Patients aged over 50 years old at the time of informed consent.
  • Provide written informed consent.
  • Willingness and ability to comply with all scheduled visits and study procedures.
  • Confirmed diagnosis of symptomatic macular PCV based ICGA.
  • Activity of PCV confirmed by exudative activity involving the macula on OCT or Fluorescein Angiography (FA) or both.

    • Presence of intra retinal or subretinal fluid/blood as seen on OCT
    • Treatment naïve

      • NO previous treatment with intravitreal anti-VEGF agents, regardless of the indication
      • NO previous thermal laser in the macular region, or verteporfin photodynamic therapy (vPDT), regardless of indication
      • NO other previous treatment for neovascular AMD (nAMD), except oral supplements and traditional Chinese medicine
  • An ETDRS BCVA of at least 4 letters (Snellen equivalent approximately 20/800 or better) in the study eye.
  • Greatest Linear Dimension (GLD) of the total lesion area (BVN + polyps) <5400µm (~9 mucopolysaccharidoses (MPS) Disc Areas) as delineated by ICGA.

Exclusion Criteria: - Participant

  • Medical 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).
  • Participation in an investigational trial within 30 days of enrollment which involves treatment with unapproved investigational drug.
  • Known allergy to any component of the study drug.
  • Blood pressure> 180/110 (systolic above 180 OR diastolic above 110 on repeated measurements). If blood pressure is brought below 180/110 by anti-hypertensive treatment, individual can become eligible.
  • Myocardial infarction, other acute cardiac event requiring hospitalization, stroke, transient ischemic attack, or treatment for acute congestive heart failure within 4 months prior to randomization.
  • Systemic anti-VEGF or pro-VEGF treatment within four months prior to randomization or anticipated use during the study.
  • Amblyopia or blind in one eye Study Eye
  • Eye with intra retinal or sub-retinal fluid due to other causes than PCV
  • An ocular condition is present (other than PCV) that, in the opinion of the investigator, might affect intra or sub retinal fluid or alter visual acuity during the course of the study (e.g., Diabetic Macular Edema (DME), vein occlusion, uveitis or other ocular inflammatory disease, neovascular glaucoma, etc.)
  • Substantial cataract that, in the opinion of the investigator, is likely to be decreasing visual acuity by more than three lines (i.e., cataract would be reducing acuity to worse than 20/40 if eye was otherwise normal).
  • Any intraocular surgery within 1 month of enrollment
  • Treatment with intra vitreal corticosteroids
  • History of retinal detachment or surgery for retinal detachment
  • History of vitrectomy
  • History of macular hole
  • Evidence of vitreomacular traction that may preclude resolution of macular edema &gt; 4 disc areas of intra/sub retinal hemorrhage
  • Aphakia
  • Exam evidence of external ocular infection, including conjunctivitis, chalazion, or significant blepharitis

Other Eye

  • Active intraocular inflammation
  • History of uveitis

Sites / Locations

  • Singapore National Eye CentreRecruiting
  • National University HospitalRecruiting
  • Tan Tock Seng HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Aflibercept + RF-PDT

Aflibercept + sham RF-PDT

Arm Description

Patients with symptomatic macular PCV (n=80) as confirmed by Indocyanine green Angiography(ICGA) will be treated with Aflibercept (dosage=2mg/0.05ml) through an intravitreal injection + RF-PDT ( 6mg/m2 intravenous infusion of Verteporfin followed by laser light at a dose rate of 25 Joules/cm2) at baseline. Aflibercept- 1st treatment (baseline) followed by minimum retreatment interval of 4 weeks (from Baseline to week 8) and then retreatment at intervals of 4 weeks pro re nata (PRN) retreatment( week 12-48). Primary endpoint at week 52. RF-PDT treatment at baseline followed by pro re nata (PRN) at 12 week intervals. At each visit, subjects will be assessed based on BCVA, ophthalmic examination and Optical Coherence Tomography (OCT)

Patients with symptomatic macular PCV (n=80) as confirmed by Indocyanine green Angiography(ICGA) will be treated with Aflibercept (dosage=2mg/0.05ml) through an intravitreal injection, at baseline. A minimum of 1 injection(baseline) followed by minimum pro re nata (PRN) retreatment interval of 4 weeks ( from baseline to week 8) and then a minimum of 4 weeks retreatment thereafter (week 12-48). Primary endpoint at week 52. Sham RF-PDT treatment at baseline followed by pro re nata (PRN) at 12 week intervals. At each visit, subjects will be assessed based on Best Corrected Visual Acuity (BCVA), ophthalmic examination and Optical Coherence Tomography (OCT)

Outcomes

Primary Outcome Measures

Polyp Closure rate
polyp closure rate at week 12 between the 2 treatment groups.

Secondary Outcome Measures

Optical Coherence Tomography
For evidence of intraretinal or subretinal fluid, ill-defined hyper-reflective material and/or new hemorrhage
Optical Coherence Tomography-Angiograph
For evidence of intraretinal or subretinal fluid, ill-defined hyper-reflective material and/or new hemorrhage
Color Fundus photography
inspect anomalies associated to diseases that affect the eye, and to monitor their progression
Autofluorescence Photography
Retinal imaging
Fundus Fluorescein Angiography
Retinal circulation
Intra Ocular Pressure (IOP)
Fluid Pressure in eye

Full Information

First Posted
April 24, 2019
Last Updated
April 10, 2023
Sponsor
Singapore National Eye Centre
Collaborators
National University Hospital, Singapore, Tan Tock Seng Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03941587
Brief Title
Comparing Intravitreal Aflibercept Monotherapy vs Aflibercept Combined With Reduced Fluence PDT in PCV Treatment
Official Title
A Multi-center Randomized Clinical Trial Comparing Intravitreal Aflibercept Monotherapy vs Aflibercept Combined With Reduced Fluence PDT for the Treatment of Polypoidal Choroidal Vasculopathy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 1, 2021 (Actual)
Primary Completion Date
July 31, 2024 (Anticipated)
Study Completion Date
July 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Singapore National Eye Centre
Collaborators
National University Hospital, Singapore, Tan Tock Seng Hospital

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
In this study, we aim to evaluate the efficacy and safety of an individualized dosing schedule comprising Aflibercept and RF-PDT in patients with polypoidal choroidal vasculopathy (PCV). The primary objective is to compare the polyp closure rate at week 12 between the 2 treatment groups. The secondary aims include comparing visual, anatomical, treatment burden and clinical biomarkers between each treatment group.
Detailed Description
Age related macular degeneration (AMD) is one of the leading causes of blindness worldwide. In its exudative or wet form, choroidal neovascularization (CNV) causes an exudative maculopathy resulting in sudden loss of vision with severe effects on patients' quality of life. Intravitreal injections of anti-vascular endothelial growth factor agents (anti-VEGF) have become the mainstay of treatment for AMD CNV and has been shown to have favorable outcomes in most AMD CNV subtypes. In the Asian population, however, a particular subtype called polypoidal choroidal vasculopathy (PCV), which affects about 50% of exudative maculopathy, has been shown to have less favorable response to anti-VEGF therapy. The best treatment option for PCV has remained unclear. Current best evidence is from 2 recent randomized controlled trials, the EVEREST II trial which compares the efficacy of ranibizumab with or without photodynamic therapy (PDT) for treatment of PCV and the PLANET trial which compares Aflibercept monotherapy against a rescue PDT when Aflibercept is deemed ineffective. Both trials have reported significant improvement in visual outcomes, however there remain significant unanswered questions and unmet needs regarding the use of Aflibercept and PDT as the best treatment for PCV. In this study, we aim to compare the efficacy of combination Aflibercept with RF-PDT (at baseline) and Aflibercept monotherapy. This particular strategy has not been studies before and represents the amalgamation of unanswered questions from the best evidence to date for the treatment of PCV.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Polypoidal Choroidal Vasculopathy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Multi-center randomized, double-masked clinical trial.
Masking
Care ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
160 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Aflibercept + RF-PDT
Arm Type
Active Comparator
Arm Description
Patients with symptomatic macular PCV (n=80) as confirmed by Indocyanine green Angiography(ICGA) will be treated with Aflibercept (dosage=2mg/0.05ml) through an intravitreal injection + RF-PDT ( 6mg/m2 intravenous infusion of Verteporfin followed by laser light at a dose rate of 25 Joules/cm2) at baseline. Aflibercept- 1st treatment (baseline) followed by minimum retreatment interval of 4 weeks (from Baseline to week 8) and then retreatment at intervals of 4 weeks pro re nata (PRN) retreatment( week 12-48). Primary endpoint at week 52. RF-PDT treatment at baseline followed by pro re nata (PRN) at 12 week intervals. At each visit, subjects will be assessed based on BCVA, ophthalmic examination and Optical Coherence Tomography (OCT)
Arm Title
Aflibercept + sham RF-PDT
Arm Type
Active Comparator
Arm Description
Patients with symptomatic macular PCV (n=80) as confirmed by Indocyanine green Angiography(ICGA) will be treated with Aflibercept (dosage=2mg/0.05ml) through an intravitreal injection, at baseline. A minimum of 1 injection(baseline) followed by minimum pro re nata (PRN) retreatment interval of 4 weeks ( from baseline to week 8) and then a minimum of 4 weeks retreatment thereafter (week 12-48). Primary endpoint at week 52. Sham RF-PDT treatment at baseline followed by pro re nata (PRN) at 12 week intervals. At each visit, subjects will be assessed based on Best Corrected Visual Acuity (BCVA), ophthalmic examination and Optical Coherence Tomography (OCT)
Intervention Type
Drug
Intervention Name(s)
Aflibercept + reduced fluence photodynamic therapy (RF-PDT)
Other Intervention Name(s)
Eylea, Visudyne
Intervention Description
Aflibercept dosage of 2mg in 0.05ml along with intravenous infusion of Verteporfin (6mg/m2)followed by laser light at a dosage of 25Joule/cm2
Intervention Type
Drug
Intervention Name(s)
Aflibercept + sham reduced fluence photodynamic therapy (RF-PDT)
Other Intervention Name(s)
Eylea
Intervention Description
Aflibercept dosage of 2mg in 0.05ml along with sham photodynamic therapy
Primary Outcome Measure Information:
Title
Polyp Closure rate
Description
polyp closure rate at week 12 between the 2 treatment groups.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Optical Coherence Tomography
Description
For evidence of intraretinal or subretinal fluid, ill-defined hyper-reflective material and/or new hemorrhage
Time Frame
12 months
Title
Optical Coherence Tomography-Angiograph
Description
For evidence of intraretinal or subretinal fluid, ill-defined hyper-reflective material and/or new hemorrhage
Time Frame
12 months
Title
Color Fundus photography
Description
inspect anomalies associated to diseases that affect the eye, and to monitor their progression
Time Frame
baseline, month 3, month12
Title
Autofluorescence Photography
Description
Retinal imaging
Time Frame
baseline, month 3, month12
Title
Fundus Fluorescein Angiography
Description
Retinal circulation
Time Frame
Baseline, month 3, month 12
Title
Intra Ocular Pressure (IOP)
Description
Fluid Pressure in eye
Time Frame
Baseline, 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients aged over 50 years old at the time of informed consent. Provide written informed consent. Willingness and ability to comply with all scheduled visits and study procedures. Confirmed diagnosis of symptomatic macular PCV based ICGA. Activity of PCV confirmed by exudative activity involving the macula on OCT or Fluorescein Angiography (FA) or both. Presence of intra retinal or subretinal fluid/blood as seen on OCT Treatment naïve NO previous treatment with intravitreal anti-VEGF agents, regardless of the indication NO previous thermal laser in the macular region, or verteporfin photodynamic therapy (vPDT), regardless of indication NO other previous treatment for neovascular AMD (nAMD), except oral supplements and traditional Chinese medicine An ETDRS BCVA of at least 4 letters (Snellen equivalent approximately 20/800 or better) in the study eye. Greatest Linear Dimension (GLD) of the total lesion area (BVN + polyps) <5400µm (~9 mucopolysaccharidoses (MPS) Disc Areas) as delineated by ICGA. Exclusion Criteria: - Participant Medical 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). Participation in an investigational trial within 30 days of enrollment which involves treatment with unapproved investigational drug. Known allergy to any component of the study drug. Blood pressure> 180/110 (systolic above 180 OR diastolic above 110 on repeated measurements). If blood pressure is brought below 180/110 by anti-hypertensive treatment, individual can become eligible. Myocardial infarction, other acute cardiac event requiring hospitalization, stroke, transient ischemic attack, or treatment for acute congestive heart failure within 4 months prior to randomization. Systemic anti-VEGF or pro-VEGF treatment within four months prior to randomization or anticipated use during the study. Amblyopia or blind in one eye Study Eye Eye with intra retinal or sub-retinal fluid due to other causes than PCV An ocular condition is present (other than PCV) that, in the opinion of the investigator, might affect intra or sub retinal fluid or alter visual acuity during the course of the study (e.g., Diabetic Macular Edema (DME), vein occlusion, uveitis or other ocular inflammatory disease, neovascular glaucoma, etc.) Substantial cataract that, in the opinion of the investigator, is likely to be decreasing visual acuity by more than three lines (i.e., cataract would be reducing acuity to worse than 20/40 if eye was otherwise normal). Any intraocular surgery within 1 month of enrollment Treatment with intra vitreal corticosteroids History of retinal detachment or surgery for retinal detachment History of vitrectomy History of macular hole Evidence of vitreomacular traction that may preclude resolution of macular edema &gt; 4 disc areas of intra/sub retinal hemorrhage Aphakia Exam evidence of external ocular infection, including conjunctivitis, chalazion, or significant blepharitis Other Eye Active intraocular inflammation History of uveitis
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gemmy Cheung Chui Ming
Phone
63227460
Email
gemmy.cheung.c.m@singhealth.com.sg
First Name & Middle Initial & Last Name or Official Title & Degree
Kelvin Teo Yi Chong
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gemmy Cheung Chui Ming
Organizational Affiliation
Singapore National Eye Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Singapore National Eye Centre
City
Singapore
ZIP/Postal Code
168751
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gemmy Cheung, MBBS
Phone
6322 4500
Facility Name
National University Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Caroline Chee, MBBS
Facility Name
Tan Tock Seng Hospital
City
Singapore
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Colin Tan, MBBS

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
34266844
Citation
Vyas CH, Cheung CMG, Tan C, Chee C, Wong K, Jordan-Yu JMN, Wong TY, Tan A, Fenner B, Sim S, Teo KYC. Multicentre, randomised clinical trial comparing intravitreal aflibercept monotherapy versus aflibercept combined with reduced-fluence photodynamic therapy (RF-PDT) for the treatment of polypoidal choroidal vasculopathy. BMJ Open. 2021 Jul 15;11(7):e050252. doi: 10.1136/bmjopen-2021-050252.
Results Reference
derived

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Comparing Intravitreal Aflibercept Monotherapy vs Aflibercept Combined With Reduced Fluence PDT in PCV Treatment

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