E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patient after penetrating keratoplasty who have experienced one or more rejection episodes |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10011017 |
E.1.2 | Term | Corneal graft rejection |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the safety and efficacy of LX201 implantation in the prevention of corneal allograft rejection episodes or graft failure in subjects who have experienced one or more rejection episodes following penetrating keratoplasty. |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
PROTOCOL LX201-02A; 10 August 2007 CORNEAL SLIT-LAMP PHOTOGRAPH SUBSTUDY: ASSESSMENT OF CORNEAL NEOVASCULARIZATION IN SUBJECTS UNDERGOING TREATMENT WITH LX201 IMPLANTATION FOR THE PREVENTION OF CORNEAL ALLOGRAFT REJECTION EPISODES OR GRAFT FAILURE IN SUBJECTS WHO HAVE EXPERIENCED ONE OR MORE REJECTION EPISODES FOLLOWING PENETRATING KERATOPLASTY
Corneal neovascularization is a strong risk factor for immune-mediated rejections after corneal transplantation. The angiogenic growth factor, vascular endothelial growth factor (VEGF), is an important growth factor responsible for corneal angiogenesis. Cyclosporine A inhibits VEGF signaling pathways and thus, LX201 may limit corneal neovascularization. The objective of this corneal slit lamp photograph substudy is to evaluate and quantify corneal neovascularization following penetrating keratoplasty in subjects treated with LX201 or a placebo implant. The primary analysis will be performed on photographs of the study eye. The endpoints are: • Vessel area • Maximal vessel length All sites participating in the LX201-02 study will be offered the opportunity to participate in this sub-study. All subjects randomized at participating sites will be eligible for inclusion in this sub-study. Slit lamp photographs of the study eye will be obtained prior to the implantation surgery (baseline), 1 day after surgery, Visit 1 (Week 1), Visit 5 (week 24) and Visit 12 (week 52). The photographs will be sent to the central reading center (Digital Image Laboratory in the Department of Ophthalmology at the University of Erlangen-Nürnberg/Germany). Vessel area and maximal vessel length will be quantified by automated digital image analysis.
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E.3 | Principal inclusion criteria |
• Following penetrating keratoplasty, subject must have experienced one or more episodes of corneal allograft rejection with date of diagnosis of the proximate episode within 12 months prior to study implant placement. Subject may have had a penetrating keratoplasty subsequent to the proximate rejection episode. • Subject must have recovered from the prior rejection episode(s). • Must be on a stable medical regimen for at least 14 days at the time of randomization into the study. • Study eye must be clinically quiescent for at least 14 days prior to study implant placement. • Conjunctiva must be suitable for implantation with the study device (i.e., sufficient to cover the implant and minimize the potential for extrusion). • ≥ 18 years of age • Physical condition suitable for undergoing study drug implantation surgery, as evidenced by medical history, physical examination, vital signs and 12-lead ECG. • Must sign written informed consent.
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E.4 | Principal exclusion criteria |
• Any condition that would greatly increase the risk of non-rejection graft failure such as Stevens-Johnson syndrome, xerophthalmia or severe exposure keratitis. • Schirmer’s test ≤ 5 mm within 5 minutes with eyes closed, using anesthesia. • Clinical evidence of limbal stem cell deficiency. • History of or active herpes simplex virus keratitis or other acute corneal infection • Uncontrolled glaucoma as evidenced by an intraocular pressure of >21 mmHg while on maximal medical therapy. • Hypotony as evidenced by an intraocular pressure of < 6 mmHg in the study eye. • Clinically suspected or confirmed ocular lymphoma • Treatment with a systemic immunosuppressive regimen within the previous 30 days; systemic prednisone (or its equivalent) of ≤ 10 mg daily is, however, permitted. Topical steroid medication regimen must be stable (i.e., neither intensified nor augmented) for 14 days prior to study implant placement. Note: Subjects treated with a course of intravenous corticosteroids for a severe rejection episode may be enrolled. • Any implantable corticosteroid-eluting device (e.g., Retisert™, Posurdex®, Medidur™, I-vation™ TA intravitreal implant) • Subjects who periodically require high-dose systemic steroid treatment (e.g., for exacerbation of chronic obstructive pulmonary disease). • Subjects who have received treatment with a monoclonal antibody or any other biologic therapy within the previous 30 days or alemtuzumab within the previous 12 months • Treatment with silicone oil within 12 months prior to study implant placement. • History of herpes zoster or varicella infection within 6 weeks prior to enrollment, or chicken pox exposure within 21 days before enrollment • Seropositivity for human immunodeficiency virus (HIV) • Previous exposure to cyclosporine (any formulation) within 14 days before study implant placement or known contraindication to administration of cyclosporine • Recipients of a solid organ transplant • Currently participating in another clinical trial with an investigational agent in the 30 days prior to study participation and/or has not recovered from any reversible effects or side effects of prior investigational agent • Currently pregnant or lactating. Sexually active women of childbearing potential or less than 1 year post-menopausal and sexually active men who are not surgically sterile must use a reliable form of birth control during study treatment and for at least 3 months after the last dose of study drug. Surgically sterile females are not considered to be of childbearing potential. Reliable forms of birth control include oral or depot contraceptives and double-barrier methods. • Active, extraocular and/or systemic infection requiring the prolonged or chronic use of antimicrobial agents or the presence of active hepatitis A, B or C • Patients with anemia (hemoglobin < 8 g/dL), leukopenia (WBC < 2500 mm3), thrombocytopenia (platelet count < 80,000 mm3), polycythemia (Hct > 54% [male] or Hct > 49% [female]), neutropenia (ANC < 2500 mm3) or clinically significant coagulopathy • Current malignancy or a history of malignancy (within the previous 5 years) except non-metastatic basal or squamous cell carcinoma of the skin or carcinoma-in-situ of the cervix that has been treated successfully • Non-ocular, medically significant co-morbid conditions that impair normal activities, require immunosuppression, or any medical condition that would likely have an impact on the subject’s ability to comply with the study visit schedule. • Active peptic ulcer disease • Co-morbid conditions that require immunosuppression • Medically significant co-morbid conditions that substantially impair normal activities, require or any medical condition that would likely have an impact on the subject’s ability to comply with the study visit schedule. • Any current or history of substance abuse, psychiatric disorder or a condition that, in the opinion of the investigator, may invalidate communication
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of subjects experiencing efficacy failure within 52 weeks following LX201 implantation, where efficacy failure is defined as either an episode of graft rejection or graft failure. The presence of one or more of the following will constitute evidence of rejection: • ≥ 1 keratic precipitate on the donor endothelium • subepithelial infiltrates • increased corneal thickness without aqueous cells • increased aqueous cells above the subject’s post-operative background level without an increase in corneal thickness • increased corneal thickness and increased aqueous cells • an endothelial rejection line of any length • inflammatory cells in the corneal stroma Grafts that do not clear within 10 days of surgery will be defined as primary donor failures. Grafts that clear within 10 days after surgery and later become cloudy for a continuous period of ≥ 3 months will be declared a failure. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | Yes |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 8 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |