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Peripheral and Macular Retinal Vascular Perfusion and Leakage in DME and RVO (PERMEATE)

Primary Purpose

Retinal Vein Occlusion, Diabetic Macular Edema, Branch Retinal Vein Occlusion

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Aflibercept
Sponsored by
Justis Ehlers
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Retinal Vein Occlusion focused on measuring macular edema, rvo, diabetic macular edema

Eligibility Criteria

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

Inclusion Criteria

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

  1. Signed Informed Consent.
  2. Men and women ≥ 18 years of age.
  3. Foveal-involving retinal edema secondary to DME or RVO based on investigator review of SDOCT.
  4. E-ETDRS best-corrected visual acuity of: 20/25 to 20/400 in the study eye or Hand Motion (HM) in the study eye.
  5. Willing, committed, and able to return for all clinic visits and complete all study related procedures.
  6. Able to read, (or, if unable to read due to visual impairment, be read to verbatim by the person administering the informed consent or a family member) understand and willing to sign the informed consent form.

Exclusion Criteria

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

  1. Any prior or concomitant therapy with another investigational agent to treat DME or RVO in the study eye.
  2. Prior panretinal photocoagulation in the study eye.
  3. Prior intravitreal anti-VEGF therapy in the study eye.
  4. Prior focal/grid laser photocoagulation in the study eye.
  5. Prior history of intravitreal steroid therapy in the study eye.
  6. Any history of allergy to fluorescein sodium or other reason that the patient is unable to undergo fluorescein angiography (e.g., inability to get vascular access, unable to tolerate procedure)
  7. Prior systemic anti-VEGF therapy, investigational or FDA-approved, is only allowed up to 3 months prior to first dose, and will not be allowed during the study.
  8. Significant vitreous hemorrhage obscuring view to the macula or the retinal periphery as determined by the investigator on clinical exam and ultra-widefield angiography.
  9. Presence of other causes of macular edema, including myopic degeneration, ocular histoplasmosis syndrome, angioid streaks, choroidal rupture, choroidal neovascularization, neovascular age-related macular degeneration or multifocal choroiditis in the study eye. Epiretinal membranes are allowed.
  10. Presence of macula-threatening traction retinal detachment.
  11. Prior vitrectomy in the study eye.
  12. History of retinal detachment or treatment or surgery for retinal detachment in the study eye.
  13. Any history of macular hole of stage 2 and above in the study eye.
  14. Any intraocular or periocular surgery within 3 months of Day 1 on the study eye, except lid surgery, which may not have taken place within 1 month of day 1, as long as it's unlikely to interfere with the injection.
  15. Prior trabeculectomy or other filtration surgery in the study eye.
  16. Uncontrolled glaucoma at baseline evaluation (defined as intraocular pressure ≥25 mmHg despite treatment with anti-glaucoma medication) in the study eye.
  17. Active intraocular inflammation in either eye.
  18. Active ocular or periocular infection in either eye.
  19. Any ocular or periocular infection within the last 2 weeks prior to Screening in either eye.
  20. Any history of uveitis in either eye.
  21. Active scleritis or episcleritis in either eye.
  22. Presence or history of scleromalacia in either eye.
  23. Aphakia in the study eye.
  24. Previous therapeutic radiation in the region of the study eye.
  25. History of full-thickness penetrating keratoplasty in the study eye. Partial thickness corneal transplants including Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty are allowed.
  26. Significant media opacities, including cataract, in the study eye which might interfere with visual acuity, assessment of safety, or fundus photography.
  27. Any concurrent intraocular condition in the study eye (e.g. cataract) that, in the opinion of the investigator, could require either medical or surgical intervention during the 52 week study period.
  28. Any concurrent ocular condition in the study eye which, in the opinion of the investigator, could either increase the risk to the subject beyond what is to be expected from standard procedures of intraocular injection, or which otherwise may interfere with the injection procedure or with evaluation of efficacy or safety.
  29. Participation as a subject in any clinical study within the 12 weeks prior to Day 1.
  30. Any systemic therapy with an investigational agent in the past 3 months prior to Day 1.
  31. Any history of allergy to povidone iodine.
  32. Pregnant or breast-feeding women
  33. 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)

    • 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

  • Cole Eye Institute, Cleveland Clinic

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Aflibercept

Arm Description

Monthly aflibercept for 6 months and then every other month for 6 months.

Outcomes

Primary Outcome Measures

Change in Panretinal Leakage Index at Month 12 From Baseline
Change in panretinal leakage index (defined as the proportion of retinal area involved in angiographic leakage) at month 12 from baseline as measured by ultra-widefield angiography (UWFA).

Secondary Outcome Measures

Mean Change in Total Leakage Index
Mean change in total leakage index from baseline to month 6
Change in Panretinal Ischemic Index
Change in panretinal ischemic index from baseline to postoperative month 12
Change in Panretinal Ischemic Index From Baseline at 6 Months
Change in panretinal ischemic index (defined as the proportion of retinal area with nonperfusion) from baseline at 6 months
Mean Change From Baseline Central Subfield Thickness
OCT central subfield thickness change from baseline to 6 months
Mean Change From Baseline in Best-corrected Visual Acuity (BCVA) Score Based on ETDRS
Mean change from baseline in best-corrected visual acuity (BCVA) score from baseline to month 12
Number of Participants Who Gained 15 ETDRS Letters or More of Vision
Number of Patients Who Gained 15 ETDRS Letters or More of Vision
Number of Patients That Showed Visual Acuity 20/40 or Better
Number of Patients That Showed Visual Acuity 20/200 or Worse
Ocular Serious Adverse Events
Number of Participants Who Lost 15 ETDRS Letters or More of Vision
Number of Participants Who Lost 15 ETDRS Letters or More of Vision
Number of Patients That Showed Visual Acuity 20/40 or Better
Number of Patients That Showed Visual Acuity 20/200 or Worse
Mean Change From Baseline Central Subfield Thickness
Systemic Serious Adverse Events
Incidence of systemic SAEs

Full Information

First Posted
July 17, 2015
Last Updated
May 10, 2021
Sponsor
Justis Ehlers
Collaborators
Regeneron Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02503540
Brief Title
Peripheral and Macular Retinal Vascular Perfusion and Leakage in DME and RVO
Acronym
PERMEATE
Official Title
Peripheral and Macular Retinal Vascular Perfusion and Leakage Dynamics in Diabetic Macular Edema and Retinal Venous Occlusions During Intravitreal Aflibercept Injection (IAI) Treatment for Retinal Edema: PERMEATE Study
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
August 18, 2015 (Actual)
Primary Completion Date
February 6, 2018 (Actual)
Study Completion Date
February 6, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Justis Ehlers
Collaborators
Regeneron Pharmaceuticals

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This interventional study will evaluate the retinal vascular dynamics associated with Intravitreal Aflibercept Injection (IAI) therapy in eyes with diabetic macular edema (DME) or macular edema secondary to retinal vein occlusion (RVO). Ultra-widefield fluorescein angiography and optical coherence tomography (OCT) angiography will be performed at multiple timepoints to assess the changes in retinal vascular leakage, ischemia, and vascular abnormalities throughout the study duration and compare these alterations to baseline.
Detailed Description
Diabetic macular edema (DME) and macular edema secondary to retinal venous occlusive diseases are the most common cause of vision loss from a retinal vascular disease. Recently, vascular endothelial growth factor (VEGF) inhibitors (bevacizumab, aflibercept, and ranibizumab) have been described as new first-line therapies for these conditions. Aflibercept is the most recently approved VEGF inhibitor for the management of these conditions. Clinical trials have shown that treatment with aflibercept improves visual acuity and reduces macular edema in a large percentage of patients. This study will examine the changes that occur with intravitreal aflibercept to perfusion and leakage in treatment naive eyes over the course of 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Retinal Vein Occlusion, Diabetic Macular Edema, Branch Retinal Vein Occlusion, Central Retinal Vein Occlusion
Keywords
macular edema, rvo, 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
31 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Aflibercept
Arm Type
Other
Arm Description
Monthly aflibercept for 6 months and then every other month for 6 months.
Intervention Type
Drug
Intervention Name(s)
Aflibercept
Other Intervention Name(s)
Eylea
Intervention Description
Intravitreal aflibercept will be given q4 wks for 6 treatments and then q 8 weeks through month 12.
Primary Outcome Measure Information:
Title
Change in Panretinal Leakage Index at Month 12 From Baseline
Description
Change in panretinal leakage index (defined as the proportion of retinal area involved in angiographic leakage) at month 12 from baseline as measured by ultra-widefield angiography (UWFA).
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Mean Change in Total Leakage Index
Description
Mean change in total leakage index from baseline to month 6
Time Frame
6 months
Title
Change in Panretinal Ischemic Index
Description
Change in panretinal ischemic index from baseline to postoperative month 12
Time Frame
12 months
Title
Change in Panretinal Ischemic Index From Baseline at 6 Months
Description
Change in panretinal ischemic index (defined as the proportion of retinal area with nonperfusion) from baseline at 6 months
Time Frame
6 months
Title
Mean Change From Baseline Central Subfield Thickness
Description
OCT central subfield thickness change from baseline to 6 months
Time Frame
6 months
Title
Mean Change From Baseline in Best-corrected Visual Acuity (BCVA) Score Based on ETDRS
Description
Mean change from baseline in best-corrected visual acuity (BCVA) score from baseline to month 12
Time Frame
12 months
Title
Number of Participants Who Gained 15 ETDRS Letters or More of Vision
Time Frame
12 months
Title
Number of Patients Who Gained 15 ETDRS Letters or More of Vision
Time Frame
6 months
Title
Number of Patients That Showed Visual Acuity 20/40 or Better
Time Frame
6 months
Title
Number of Patients That Showed Visual Acuity 20/200 or Worse
Time Frame
6 months
Title
Ocular Serious Adverse Events
Time Frame
12 months
Title
Number of Participants Who Lost 15 ETDRS Letters or More of Vision
Time Frame
12 months
Title
Number of Participants Who Lost 15 ETDRS Letters or More of Vision
Time Frame
6 months
Title
Number of Patients That Showed Visual Acuity 20/40 or Better
Time Frame
12 months
Title
Number of Patients That Showed Visual Acuity 20/200 or Worse
Time Frame
12 months
Title
Mean Change From Baseline Central Subfield Thickness
Time Frame
12 months
Title
Systemic Serious Adverse Events
Description
Incidence of systemic SAEs
Time Frame
12 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria A subject must meet the following criteria to be eligible for inclusion in the study: Signed Informed Consent. Men and women ≥ 18 years of age. Foveal-involving retinal edema secondary to DME or RVO based on investigator review of SDOCT. E-ETDRS best-corrected visual acuity of: 20/25 to 20/400 in the study eye or Hand Motion (HM) in the study eye. Willing, committed, and able to return for all clinic visits and complete all study related procedures. Able to read, (or, if unable to read due to visual impairment, be read to verbatim by the person administering the informed consent or a family member) understand and willing to sign the informed consent form. Exclusion Criteria A subject who meets any of the following criteria will be excluded from the study: Any prior or concomitant therapy with another investigational agent to treat DME or RVO in the study eye. Prior panretinal photocoagulation in the study eye. Prior intravitreal anti-VEGF therapy in the study eye. Prior focal/grid laser photocoagulation in the study eye. Prior history of intravitreal steroid therapy in the study eye. Any history of allergy to fluorescein sodium or other reason that the patient is unable to undergo fluorescein angiography (e.g., inability to get vascular access, unable to tolerate procedure) Prior systemic anti-VEGF therapy, investigational or FDA-approved, is only allowed up to 3 months prior to first dose, and will not be allowed during the study. Significant vitreous hemorrhage obscuring view to the macula or the retinal periphery as determined by the investigator on clinical exam and ultra-widefield angiography. Presence of other causes of macular edema, including myopic degeneration, ocular histoplasmosis syndrome, angioid streaks, choroidal rupture, choroidal neovascularization, neovascular age-related macular degeneration or multifocal choroiditis in the study eye. Epiretinal membranes are allowed. Presence of macula-threatening traction retinal detachment. Prior vitrectomy in the study eye. History of retinal detachment or treatment or surgery for retinal detachment in the study eye. Any history of macular hole of stage 2 and above in the study eye. Any intraocular or periocular surgery within 3 months of Day 1 on the study eye, except lid surgery, which may not have taken place within 1 month of day 1, as long as it's unlikely to interfere with the injection. Prior trabeculectomy or other filtration surgery in the study eye. Uncontrolled glaucoma at baseline evaluation (defined as intraocular pressure ≥25 mmHg despite treatment with anti-glaucoma medication) in the study eye. Active intraocular inflammation in either eye. Active ocular or periocular infection in either eye. Any ocular or periocular infection within the last 2 weeks prior to Screening in either eye. Any history of uveitis in either eye. Active scleritis or episcleritis in either eye. Presence or history of scleromalacia in either eye. Aphakia in the study eye. Previous therapeutic radiation in the region of the study eye. History of full-thickness penetrating keratoplasty in the study eye. Partial thickness corneal transplants including Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty are allowed. Significant media opacities, including cataract, in the study eye which might interfere with visual acuity, assessment of safety, or fundus photography. Any concurrent intraocular condition in the study eye (e.g. cataract) that, in the opinion of the investigator, could require either medical or surgical intervention during the 52 week study period. Any concurrent ocular condition in the study eye which, in the opinion of the investigator, could either increase the risk to the subject beyond what is to be expected from standard procedures of intraocular injection, or which otherwise may interfere with the injection procedure or with evaluation of efficacy or safety. Participation as a subject in any clinical study within the 12 weeks prior to Day 1. Any systemic therapy with an investigational agent in the past 3 months prior to Day 1. Any history of allergy to povidone iodine. Pregnant or breast-feeding women 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) 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
Justis P Ehlers, MD
Organizational Affiliation
Cole Eye Institute, Cleveland Clinic, OH 44195
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cole Eye Institute, Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
22423055
Citation
Wessel MM, Nair N, Aaker GD, Ehrlich JR, D'Amico DJ, Kiss S. Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular oedema. Br J Ophthalmol. 2012 May;96(5):694-8. doi: 10.1136/bjophthalmol-2011-300774. Epub 2012 Mar 15.
Results Reference
background
PubMed Identifier
10413724
Citation
Thickett DR, Armstrong L, Millar AB. Vascular endothelial growth factor (VEGF) in inflammatory and malignant pleural effusions. Thorax. 1999 Aug;54(8):707-10. doi: 10.1136/thx.54.8.707.
Results Reference
background
PubMed Identifier
24732695
Citation
Singer M, Tan CS, Bell D, Sadda SR. Area of peripheral retinal nonperfusion and treatment response in branch and central retinal vein occlusion. Retina. 2014 Sep;34(9):1736-42. doi: 10.1097/IAE.0000000000000148.
Results Reference
background
PubMed Identifier
12824270
Citation
Rakic JM, Lambert V, Devy L, Luttun A, Carmeliet P, Claes C, Nguyen L, Foidart JM, Noel A, Munaut C. Placental growth factor, a member of the VEGF family, contributes to the development of choroidal neovascularization. Invest Ophthalmol Vis Sci. 2003 Jul;44(7):3186-93. doi: 10.1167/iovs.02-1092.
Results Reference
background
PubMed Identifier
11036931
Citation
Ferrara N. Vascular endothelial growth factor and the regulation of angiogenesis. Recent Prog Horm Res. 2000;55:15-35; discussion 35-6.
Results Reference
background
PubMed Identifier
1791185
Citation
Ferrara N, Houck KA, Jakeman LB, Winer J, Leung DW. The vascular endothelial growth factor family of polypeptides. J Cell Biochem. 1991 Nov;47(3):211-8. doi: 10.1002/jcb.240470305.
Results Reference
background
PubMed Identifier
9034784
Citation
Ferrara N, Davis-Smyth T. The biology of vascular endothelial growth factor. Endocr Rev. 1997 Feb;18(1):4-25. doi: 10.1210/edrv.18.1.0287. No abstract available.
Results Reference
background
PubMed Identifier
31757691
Citation
Figueiredo N, Srivastava SK, Singh RP, Babiuch A, Sharma S, Rachitskaya A, Talcott K, Reese J, Hu M, Ehlers JP. Longitudinal Panretinal Leakage and Ischemic Indices in Retinal Vascular Disease after Aflibercept Therapy: The PERMEATE Study. Ophthalmol Retina. 2020 Feb;4(2):154-163. doi: 10.1016/j.oret.2019.09.001. Epub 2019 Sep 10.
Results Reference
derived

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Peripheral and Macular Retinal Vascular Perfusion and Leakage in DME and RVO

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