E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
persistent diabetic macula edema or persistent diabetic proliferative retinopathy after lasercoagulation |
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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 | 10012689 |
E.1.2 | Term | Diabetic retinopathy |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• For Group A (persitient macular edema): To investigate the change in macular edema measured with standard optical coherence tomography (OCT) and the absolute change in visual acuity following intravitreal administered injections of Bevacizumab (Avastin®) compared with intravitreal administered injections of Ranibizumab (Lucentis®) in patients with persistent diabetic macular edema following grid lasercoagulation. • For Group B (persistent neovascularisation): To investigate the change of neovascularisation and vitreous hemorrhage following intravitreal administered injections of Bevacizumab (Avastin®) compared with intravitreal administered injections of Ranibizumab (Lucentis®) as assessed by fundus photography and fluorescence angiography and the absolute change in visual acuity. |
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E.2.2 | Secondary objectives of the trial |
• To explore the structural mechanisms of Bevacizumab (Avastin®) and Ranibizumab (Lucentis®) on persistent diabetic macular edema or persistent neovascularisation as assessed by fundus photography, fluorescein angiography, and ultra high-resolution optical coherence tomography. • To investigate the safety and tolerability of Bevacizumab (Avastin®), a recombinant humanized anti VEGF monoclonal antibody, administered as multiple intravitreal injections in patients with persistent diabetic macular edema or persistent neovascularisation following lasercoagulation. • To assess the effect of Bevacizumab (Avastin™) and Ranibizumab (Lucentis) on intraocular concentrations of inflammatory cytokines and growth factors |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Signed informed consent • Age ≥18 years • Patients with type 1 or type 2 diabetes mellitus • HbA1C between 6% and 9 %. • Patients with persistent diabetic macular edema with center involvement following completed grid lasercoagulation in the study eye • Last perifoveolar laser treatment 3 months before study entry • Central macular thickness (macular edema) of at least 300 - 550 microns in the central subfield as measured by OCT • Not eligible for any currently approved treatments or experimental protocols • Best corrected visual acuity, using ETDRS charts, of 20/25 to 20/200 (Snellen equivalent) in the study eye • Patients with decrease in vision in the study eye due to foveal thickening from diabetic macular edema and not to other causes, in the opinion of the investigator • Patients without a necessity for panretinal laser photocoagulation for at least 3 months after study inclusion • If both eyes are eligible, the one with the worse visual acuity will be selected for study treatment unless, based on medical reason, the investigator deems the other eye have got more benefit from study treatment. |
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E.4 | Principal exclusion criteria |
• A condition that would preclude a patient for participation in the study in opinion of investigator, e.g., unstable medical status including glycemic control and blood pressure • History of systemic corticosteroids within 3 months prior to randomization or topical, rectal or inhaled corticosteroids in current use more than 3 times per week Prior/Concomitant Treatment • Panretinal laser photocoagulation within the past 3 months or macular laser photocoagulation within the past 3 months in the study eye • Previous treatment with intravitreal or sub-Tenon triamcinolone within the past 3 months in the study eye • Previous participation in clinical trial involving anti-angiogenic drugs (pegabtanib sodium, ranibizumab, anecortave acetate, protein kinase C inhibitor, etc.) • History of submacular surgery or other surgical intervention for diabetic macular edema except grid lasercoagulation in the study eye • Previous participation in any studies of investigational drugs within 1 month preceding Day 0 (excluding vitamins and minerals) Diabetic Retinopathy Characteristics • High risk proliferative diabetic retinopathy in the study eye without complete panretinal lasercoagulation and having a risk for intravitreal bleeding Concurrent Ocular Conditions • Active intraocular inflammation (grade trace or above) in either eye • Vitreomacular traction in the study eye evident by OCT • Current vitreous hemorrhage in the study eye (Group A) • Infectious conjunctivitis, keratitis, scleritis, endophthalmitis as well as idiopathic or autoimmuneassociated uveitis in either eye • Structural damage to the center of macula in the study eye likely to preclude improvement in visual acuity following the resolution of macular edema, including atrophy of retinal pigment epithelium, subretinal fibrosis, laser scar within foveal avascular zone (FAZ) or organized hard exudate plaques (Group A) • Ocular disorders in the study eye including retinal vascular occlusion, retinal detachment, macular hole, choroidal neovascularisation • Intraocular surgery (including cataract surgery, YAG laser capsulotomy) in the study eye within 3 months preceding Day 0 • Uncontrolled glaucoma in the study eye (defined as intraocular pressure ≥25 mmHg despite treatment with anti-glaucoma medication) • History of glaucoma filtration surgery, corneal transplantation in the study eye Concurrent Systemic Conditions • Systemic hypertension (> 150/100 mmHg) • History of myocardial infarction (in anamnesis or signs in ECG) • History of congestive heart failure • History of stroke or transient ischemic attacks • Significant abnormalities on laboratory testing (signs on failure of kidney, liver disease) • Premenopausal women not using adequate contraception and pregnant or nursing women The following are considered effective means of contraception: surgical sterilization; use of oral contraceptives; barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel; an IUD; or contraceptive hormone implant or patch. • History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use an investigational drug or that might affect interpretation of the results of the study or render the subject at high risk for treatment complications • Current treatment for active systemic infection Other • History of allergy to fluorescein, not amenable to treatment • Inability to obtain fundus photographs or fluorescein angiograms of sufficient quality to be analyzed and graded • Inability to comply with study or follow up procedures |
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E.5 End points |
E.5.1 | Primary end point(s) |
Efficacy of the treatment with intravitreal administered injections of Bevacizumab (Avastin®) compared with intravitreal administered injections of Ranbizumab (Lucentis) in patients with persistent diabetic macular edema following grid lasercoagulation and with persistent active neovasculariasation following panretinal scatter coagulation is examined using the following parameters:Visual acuity measured by ETDRS chartsCentral retinal thickness as measured by standard Optical Coherence Tomography (OCT) in Group A.Reduction of neaovascularisation and Retinopathy Severity Score as measured by FLA and documented with fundus photography in Group B. |
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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 | No |
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 | No |
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) | No |
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 | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
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 |