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    Clinical Trial Results:
    EFFECT OF BEVACIZUMAB SUBCONJUNCTIVAL INJECTIONS ON CORNEAL NEWVESSELS

    Summary
    EudraCT number
    2010-022858-16
    Trial protocol
    FR  
    Global end of trial date
    13 Apr 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    03 May 2021
    First version publication date
    03 May 2021
    Other versions
    Summary report(s)
    Summary of the final report

    Trial information

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    Trial identification
    Sponsor protocol code
    I07034
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01501760
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    CHU de Limoges
    Sponsor organisation address
    2 Avenue MArtin Luther KING, Limoges, France, 87000
    Public contact
    DR A BENTALEB, CHU de Limoges, 33 0555058616, abdeslam.bentaleb@chu-limoges.fr
    Scientific contact
    Pr Pierre Yves ROBERT, CHU de Limoges, 33 05 55 05 62 31, pierre-yves.robert@unilim.fr-limoges.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    17 Jun 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    13 Apr 2018
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To demonstrate Bevacizumab subconjunctival injections effectiveness on corneal neovascularisation reduction after 3 monthly injections
    Protection of trial subjects
    This study was conducted in conformance with Good Clinical Practice standards and applicable French statutes and regulations regarding ethical committee review,competent authority , informed consent, and the protection of human subjects participating in biomedical research. Subjects were fully informed of all pertinent aspects of the clinical trial as well as the possibility to discontinue at any time in language and terms appropriate for the subject . During this pre-inclusion visit, investigator informs the patient and answers all his questions concerning the objective, the nature of the constraints, the foreseeable risks and the expected benefits of the research. It also specifies the patient's rights in the context of biomedical research. After this information session, the patient has a reflection period. In addition, a DSMB has been set up to supervise the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Sep 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 38
    Worldwide total number of subjects
    38
    EEA total number of subjects
    38
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    23
    From 65 to 84 years
    14
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 6 study centers in FRance between 03/02/2012 (first subject first visit) and 12/09/2017 (last subject last visit).

    Pre-assignment
    Screening details
    A total of 38 subjects were enrolled, received treatment and completed the study.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    The syringes prepared at the pharmacy (bevacizumab or placebo), will be presented in a strictly identical manner. The labeling of the syringes will ensure that the doctor and the patient are not aware of it.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    BEVACIZUMAB
    Arm description
    Subjects received 1 subconjunctival injection of 0.2 ml of Bevacizumab (i.e. 5 mg) to be repeated twice, 1 month apart, i.e. 3 injections
    Arm type
    Experimental

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    Other name
    Avastin*
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Conjunctival use
    Dosage and administration details
    1 subconjunctival injection of 0.2 ml of Bevacizumab (i.e. 5 mg)

    Arm title
    PLACEBO
    Arm description
    Subjects received 1 subconjunctival injection of 0f 0.2 ml of 0.9% NaCl to be repeated twice, 1 month apart, i.e. 3 injections
    Arm type
    Placebo

    Investigational medicinal product name
    PLacebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Subconjunctival use
    Dosage and administration details
    Dosage: 1 subconjunctival injection of 0.2 ml of 0.9% NaCl Ready-to-use pre-filled syringe prepared at the pharmacy of the investigating center

    Number of subjects in period 1
    BEVACIZUMAB PLACEBO
    Started
    20
    18
    Completed
    20
    18

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    38 38
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    57.5 ± 18.1 -
    Gender categorical
    Units: Subjects
        Female
    13 13
        Male
    25 25

    End points

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    End points reporting groups
    Reporting group title
    BEVACIZUMAB
    Reporting group description
    Subjects received 1 subconjunctival injection of 0.2 ml of Bevacizumab (i.e. 5 mg) to be repeated twice, 1 month apart, i.e. 3 injections

    Reporting group title
    PLACEBO
    Reporting group description
    Subjects received 1 subconjunctival injection of 0f 0.2 ml of 0.9% NaCl to be repeated twice, 1 month apart, i.e. 3 injections

    Primary: Subconjunctival injections effectiveness at month 3

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    End point title
    Subconjunctival injections effectiveness at month 3
    End point description
    The outcome measure associated with this primary objective is the efficacy of Bevacizumab administered by the subconjunctival route in reducing corneal neovascularization. It was evaluated by comparing in each group the proportion of responder patients defined by a percentage of corneal surface area occupied by neovessels at 3 months reduced by more than 30%, evaluated on photos by surface measurement software.
    End point type
    Primary
    End point timeframe
    After 3 injections (3 month)
    End point values
    BEVACIZUMAB PLACEBO
    Number of subjects analysed
    16
    17
    Units: Percentage of subjects
        arithmetic mean (standard deviation)
    -8.6 ± 32.8
    2.6 ± 20.8
    Statistical analysis title
    Treatment difference
    Statistical analysis description
    This end point was evaluated by comparing in each group the proportion of responder patients defined by a percentage of corneal surface area occupied by neovessels at 3 months reduced by more than 30%, evaluated on photos by software for measuring surfaces according to a pre-established scale. The statistical analysis associated with this primary objective consisted of a Fisher exact test
    Comparison groups
    PLACEBO v BEVACIZUMAB
    Number of subjects included in analysis
    33
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.5284
    Method
    Fisher exact
    Confidence interval

    Secondary: Effectiveness of Bevacizumab at Month 6

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    End point title
    Effectiveness of Bevacizumab at Month 6
    End point description
    To evaluate the effectiveness of Bevacizumab, a on the proportion of responder patients compared to a placebo at 6 months . The judgment criterion associated with this secondary objective was the patient's response at 6 months (the percentage of corneal surface area occupied by neovessels at 6 months is compared between the two groups) The statistical analysis associated consisted of Fisher's exact test.
    End point type
    Secondary
    End point timeframe
    At month 6
    End point values
    BEVACIZUMAB PLACEBO
    Number of subjects analysed
    17
    15
    Units: Percentage of subjects
        arithmetic mean (standard deviation)
    -6.1 ± 32.5
    1 ± 27.6
    Statistical analysis title
    Treatment difference at month 6
    Comparison groups
    PLACEBO v BEVACIZUMAB
    Number of subjects included in analysis
    32
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7625
    Method
    Fisher exact
    Confidence interval

    Secondary: The effectiveness of bevacizumab on reducing the use of corneal graft

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    End point title
    The effectiveness of bevacizumab on reducing the use of corneal graft
    End point description
    The outcome measure associated with this secondary objective was the proportion of patients with indication of keratoplasty at 6 months. The statistical analysis associated with this secondary objective 2 consisted of a Chi² test.
    End point type
    Secondary
    End point timeframe
    At month 6
    End point values
    BEVACIZUMAB PLACEBO
    Number of subjects analysed
    20
    16
    Units: Number of subjects
    7
    6
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events are collected from First Patient First Visit (FPFV) until Last Patient Last Visit (LPLV). All adverse events reported in this record are from date of First Patient First Treatment until Last Patient Last Visit.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21.1
    Reporting groups
    Reporting group title
    BEVACIZUMAB
    Reporting group description
    Subjects received 1 subconjunctival injection of 0.2 ml of Bevacizumab (i.e. 5 mg) to be repeated twice, 1 month apart, i.e. 3 injections

    Reporting group title
    PLACEBO
    Reporting group description
    - 0.9% sodium chloride - ready-to-use pre-filled syringe prepared at the pharmacy of the investigating center CHU - Dosage: 1 subconjunctival injection of 0.2 ml of 0.9% NaCl to be repeated twice, 1 month apart, i.e. 3 injections

    Serious adverse events
    BEVACIZUMAB PLACEBO
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 20 (0.00%)
    0 / 18 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    BEVACIZUMAB PLACEBO
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    16 / 20 (80.00%)
    15 / 18 (83.33%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    5 / 20 (25.00%)
    2 / 18 (11.11%)
         occurrences all number
    6
    2
    General disorders and administration site conditions
    Injection site pain
         subjects affected / exposed
    9 / 20 (45.00%)
    4 / 18 (22.22%)
         occurrences all number
    19
    8
    Eye disorders
    Lacrimal disorder
         subjects affected / exposed
    5 / 20 (25.00%)
    6 / 18 (33.33%)
         occurrences all number
    6
    8
    Visual acuity reduced
         subjects affected / exposed
    5 / 20 (25.00%)
    5 / 18 (27.78%)
         occurrences all number
    4
    4
    Pain
         subjects affected / exposed
    11 / 20 (55.00%)
    8 / 18 (44.44%)
         occurrences all number
    17
    12
    Hyperthermia
         subjects affected / exposed
    6 / 20 (30.00%)
    5 / 18 (27.78%)
         occurrences all number
    11
    7
    Foreign body
         subjects affected / exposed
    5 / 20 (25.00%)
    4 / 18 (22.22%)
         occurrences all number
    6
    6
    Conjunctival hemorrhage
         subjects affected / exposed
    2 / 20 (10.00%)
    6 / 18 (33.33%)
         occurrences all number
    4
    7
    Photophobia
         subjects affected / exposed
    6 / 20 (30.00%)
    4 / 18 (22.22%)
         occurrences all number
    7
    4
    Floating Glass Bodies
         subjects affected / exposed
    5 / 20 (25.00%)
    4 / 18 (22.22%)
         occurrences all number
    6
    6

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    03 Mar 2016
    Recruitment has been a major problem since the start of the research despite a much larger number of “selected” patients (72% non-selection in Limoges for example). One of the obstacles stems from the application of the criterion of cardiovascular non-inclusion (Patient with unbalanced arterial hypertension and Patient with a history of stroke, myocardial infarction, angina, thrombophlebitis, Raynaud.). The relaxation of these 2 criteria would undoubtedly allow a better recruitment since no serious cardiovascular effect was identified in the 21 patients already included, the quantity of product injected locally is low and the current literature does not seem to demonstrate it. serious systemic cardiovascular effects after ocular injection of bevacizumab. Changes to non-inclusion criteria as follows: -Patient with unbalanced arterial hypertension -Patient with a history of an acute cardiovascular event less than 6 months old and / or progressive such as stroke, myocardial infarction, thrombophlebitis -Patient with a history of angina, Raynaud's syndrome considered unstable This amendment, apppuived by trhe DSMB, has been submitted and approved by the Ethic committee and the Competent authority.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    29 Sep 2017
    The trial was terminated after 38 inclusions. Indeed, it has become very difficult to recruit new patients.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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