Clinical Trial Results:
A Multicentre Prospective Open-label Randomised Clinical Trial Comparing the Efficacy of Fixed versus PRN dosing of 700 μg Dexamethasone Posterior Segment Drug Delivery System (DEX PS DDS) in patients with refractory diabetic macular oedema
Summary
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EudraCT number |
2012-003661-17 |
Trial protocol |
GB |
Global end of trial date |
10 Nov 2014
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Results information
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Results version number |
v1(current) |
This version publication date |
23 Aug 2018
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First version publication date |
23 Aug 2018
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Other versions |
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Summary report(s) |
Study Summary Trial Results |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
Protocol SS01 Version 7.0 dated 07-
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT01892163 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Moorfields Eye Hospital
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Sponsor organisation address |
162 City Road, London, United Kingdom, EC1V 2PD
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Public contact |
Prof. Sobha Sivaprasad, Moorfields Eye Hospital, sobha.sivaprasad@moorfields.nhs.uk
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Scientific contact |
Prof. Sobha Sivaprasad, Moorfields Eye Hospital, sobha.sivaprasad@moorfields.nhs.uk
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
06 Nov 2015
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
10 Nov 2014
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To compare the clinical effectiveness and safety of 5-monthly fixed dosing versus pro-re-nata (PRN) Ozurdex treatment in patients with refractory diabetic macular oedema (DMO).
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Protection of trial subjects |
AE and SAE were reported at any point in the study. All AEs and SAEs were discussed at the DMC. The DMC reviewed the accruing trial data and on-going safety issues. There were no safety issues, but if there were any issues that needed further action, these would have been escalated to the Trial Steering Committee who would have then decided whether the study continues, terminates or if any substantial changes to the protocol were required.
There was a one week and 8 weeks visit after the baseline and all subsequent Ozurdex injections in both treatment arms. If there was any safety concern in the opinion of the investigator, patients were assessed at an optional post-injection assessment visit.
If new safety information results in significant changes in the risk/benefit assessment, the consent form should be reviewed and updated if necessary. All subjects, including those already being treated, should be informed of the new information, given a copy of the revised form and give their consent to continue in the study.
If any urgent safety measures are taken the PI/Sponsor shall immediately and in any event no later than 3 days from the date the measures are taken, give written notice to the MHRA and the relevant REC of the measures taken and the circumstances giving rise to those measures
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
05 Feb 2013
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
United Kingdom: 100
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Worldwide total number of subjects |
100
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EEA total number of subjects |
100
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
45
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From 65 to 84 years |
53
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85 years and over |
2
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Recruitment
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Recruitment details |
A total of 100 patients were enrolled from February 2013 to November 2014 and randomized to study treatment across 5 sites. All recruited patients received the baseline Ozurdex injection and 49/50 (98%) in the fixed arm and 48/50 (96%) in the PRN arm completed the study providing primary outcome data (ITT). | ||||||||||||||||||
Pre-assignment
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Screening details |
Eligible patients were at least 18 years old with diabetes, BCVA letter score 73 to 34, OCT >300 μm in the central subfield (CST) despite treatment. Exclusion was macular ischemia, previous treatment for DME with steroids in the last 6 months; anti-VEGF therapy in the last one month or macular laser in 3 months, active PDR and substantial cataract | ||||||||||||||||||
Pre-assignment period milestones
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Number of subjects started |
138 [1] | ||||||||||||||||||
Number of subjects completed |
100 | ||||||||||||||||||
Pre-assignment subject non-completion reasons
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Reason: Number of subjects |
not meeting inclusion criteria: 29 | ||||||||||||||||||
Reason: Number of subjects |
declined to participate: 6 | ||||||||||||||||||
Reason: Number of subjects |
not known: 3 | ||||||||||||||||||
Notes [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: 138 patients were screened, 100 patients were enrolled and completed, 38 patients were not enrolled. |
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Period 1
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Period 1 title |
Overall Trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Single blind | ||||||||||||||||||
Roles blinded |
Assessor [2] | ||||||||||||||||||
Blinding implementation details |
Primary outcome assessors (optometrists and OCT technicians) were masked to treatment allocation. The patients and clinicians who administered the study treatment and those who
performed the safety evaluations were not masked to the treatment arms. The subjects were advised at enrolment that they must not discuss the study arm they were in with the OCT or Visual Acuity examiner.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Fixed | ||||||||||||||||||
Arm description |
In the intervention arm (fixed dosing), mandated intravitreal Ozurdex was given at baseline, 5 and 10 months if the criteria for deferred treatment were not met at those time-points Ozurdex treatment was deferred if the BCVA was better than 83 letters or the IOP was 30 mmHg or more while on Ozurdex therapy or there was evidence of intraocular infection or severe inflammation | ||||||||||||||||||
Arm type |
intervention arm | ||||||||||||||||||
Investigational medicinal product name |
700 μg Dexamethasone Posterior Segment Drug Delivery System (DEX PS DDS)
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Investigational medicinal product code |
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Other name |
OZURDEX
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Pharmaceutical forms |
Intravitreal implant in applicator
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Routes of administration |
Intravitreal use
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Dosage and administration details |
The Ozurdex (Allergan Inc.) drug delivery system is a sustained-release formulation for posterior-segment delivery of dexamethasone, made of a polylacticglycolic acid (PLGA) matrix. It received its market authorisation (EU/1/10/638/001) on 27th July 2010 as Ozurdex 700 micrograms intravitreal implant in applicator.
All patients received baseline Ozurdex injection. Intravitreal Ozurdex injections were performed under local anaesthesia and post-injection topical antibiotics were used. Further Ozurdex injections in each arm were performed according to protocol-defined retreatment criteria. In the intervention arm (fixed dosing), mandated intravitreal Ozurdex was given at baseline, 5 and 10 months if the criteria for deferred treatment were not met at those time-points. In addition, safety visits were done at 1 and 8 weeks after any Ozurdex injection in either treatment arms.
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Arm title
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PRN dosing arm | ||||||||||||||||||
Arm description |
In the standard arm (PRN), participants were seen at baseline, 4 months and then monthly to assess the need for re-treatment. If the participants in standard arm were re-treated at any point, the next visit was after 4 months. Re-treatment with Ozurdex was indicated if the CST on OCT exceeded 300 μm and the intraocular pressure (IOP) was ≤ 25 mmHg. If the IOP was between 26 and 30mmHg, topical anti-glaucoma eye drops were given before treatment with Ozurdex at the same sitting. If the IOP recorded was 30 mmHg or more, anti-glaucoma eye drops were given and the patient was reviewed a week later and Ozurdex was injected only if the IOP had reduced to less than 30mmHg. Ozurdex treatment was deferred if the BCVA was better than 83 letters or the IOP was 30 mmHg or more while on Ozurdex therapy or there was evidence of intraocular infection or severe inflammation. | ||||||||||||||||||
Arm type |
standard | ||||||||||||||||||
Investigational medicinal product name |
700 μg Dexamethasone Posterior Segment Drug Delivery System (DEX PS DDS)
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Investigational medicinal product code |
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Other name |
OZURDEX
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Pharmaceutical forms |
Intravitreal implant in applicator
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Routes of administration |
Intravitreal use
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Dosage and administration details |
The Ozurdex (Allergan Inc.) drug delivery system is a sustained-release formulation for posterior-segment delivery of dexamethasone, made of a polylacticglycolic acid (PLGA) matrix. It received its market authorisation (EU/1/10/638/001) on 27th July 2010 as Ozurdex 700 micrograms intravitreal implant in applicator.
All patients received baseline Ozurdex injection. Intravitreal Ozurdex injections were performed under local anaesthesia and post-injection topical antibiotics were used. Further Ozurdex injections in each arm were performed according to protocol-defined retreatment criteria. In the intervention arm (fixed dosing), mandated intravitreal Ozurdex was given at baseline, 5 and 10 months if the criteria for deferred treatment were not met at those time-points. In addition, safety visits were done at 1 and 8 weeks after any Ozurdex injection in either treatment arms.
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Investigational medicinal product name |
700 μg Dexamethasone Posterior Segment Drug Delivery System (DEX PS DDS)
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Investigational medicinal product code |
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Other name |
Ozurdex
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Pharmaceutical forms |
Intravitreal implant in applicator
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Routes of administration |
Intravitreal use
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Dosage and administration details |
In the intervention arm (fixed dosing) mandated dose of intravitreal Ozurdex is given at baseline, 5 and 10 months.
In the standard (PRN dosing), re-treatment with Ozurdex is given after the baseline injection if retreatment criteria are met provided the interval between two consecutive injections should exceed 16 weeks. Re-treatment with Ozurdex is indicated in this arm if the following criteria are met:
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Investigational medicinal product name |
Dexamethasone Posterior Segment Drug Delivery System (DEX PS DDS)
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Investigational medicinal product code |
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Other name |
Ozurdex
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Pharmaceutical forms |
Intravitreal implant in applicator
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Routes of administration |
Intravitreal use
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Dosage and administration details |
Both treatment arms will receive intravitreal Ozurdex 700μg at all treatment time-points
In the intervention arm (fixed dosing) mandated dose of intravitreal Ozurdex is given at baseline, 5 and 10 months.
In the standard (PRN dosing), re-treatment with Ozurdex is given after the baseline injection if retreatment criteria are met provided the interval between two consecutive injections should exceed 16 weeks. Re-treatment with Ozurdex is indicated in this arm if the following criteria are met:
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Notes [2] - The roles blinded appear inconsistent with a simple blinded trial. Justification: The trial was single blinded (the optometrists and OCT technicians were blinded to treatment allocation. The patients and clinicians who administered the study treatment and those who performed the safety evaluations were not blinded to the treatment arms). |
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Baseline characteristics reporting groups
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Reporting group title |
Fixed
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Reporting group description |
In the intervention arm (fixed dosing), mandated intravitreal Ozurdex was given at baseline, 5 and 10 months if the criteria for deferred treatment were not met at those time-points Ozurdex treatment was deferred if the BCVA was better than 83 letters or the IOP was 30 mmHg or more while on Ozurdex therapy or there was evidence of intraocular infection or severe inflammation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
PRN dosing arm
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Reporting group description |
In the standard arm (PRN), participants were seen at baseline, 4 months and then monthly to assess the need for re-treatment. If the participants in standard arm were re-treated at any point, the next visit was after 4 months. Re-treatment with Ozurdex was indicated if the CST on OCT exceeded 300 μm and the intraocular pressure (IOP) was ≤ 25 mmHg. If the IOP was between 26 and 30mmHg, topical anti-glaucoma eye drops were given before treatment with Ozurdex at the same sitting. If the IOP recorded was 30 mmHg or more, anti-glaucoma eye drops were given and the patient was reviewed a week later and Ozurdex was injected only if the IOP had reduced to less than 30mmHg. Ozurdex treatment was deferred if the BCVA was better than 83 letters or the IOP was 30 mmHg or more while on Ozurdex therapy or there was evidence of intraocular infection or severe inflammation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Fixed
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Reporting group description |
In the intervention arm (fixed dosing), mandated intravitreal Ozurdex was given at baseline, 5 and 10 months if the criteria for deferred treatment were not met at those time-points Ozurdex treatment was deferred if the BCVA was better than 83 letters or the IOP was 30 mmHg or more while on Ozurdex therapy or there was evidence of intraocular infection or severe inflammation | ||
Reporting group title |
PRN dosing arm
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Reporting group description |
In the standard arm (PRN), participants were seen at baseline, 4 months and then monthly to assess the need for re-treatment. If the participants in standard arm were re-treated at any point, the next visit was after 4 months. Re-treatment with Ozurdex was indicated if the CST on OCT exceeded 300 μm and the intraocular pressure (IOP) was ≤ 25 mmHg. If the IOP was between 26 and 30mmHg, topical anti-glaucoma eye drops were given before treatment with Ozurdex at the same sitting. If the IOP recorded was 30 mmHg or more, anti-glaucoma eye drops were given and the patient was reviewed a week later and Ozurdex was injected only if the IOP had reduced to less than 30mmHg. Ozurdex treatment was deferred if the BCVA was better than 83 letters or the IOP was 30 mmHg or more while on Ozurdex therapy or there was evidence of intraocular infection or severe inflammation. |
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End point title |
BCVA at 12 months ITT analysis | ||||||||||||
End point description |
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End point type |
Primary
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End point timeframe |
12 months
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Statistical analysis title |
Primary endpoint analysis | ||||||||||||
Statistical analysis description |
The primary outcome is the difference in mean change in baseline best corrected ETDRS visual acuity (BCVA) letter score at 12 months between the two study arms, after adjusting for baseline BCVA and study site.
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Comparison groups |
Fixed v PRN dosing arm
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Number of subjects included in analysis |
97
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Analysis specification |
Pre-specified
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Analysis type |
non-inferiority | ||||||||||||
P-value |
< 0.05 | ||||||||||||
Method |
descriptive | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Confidence interval |
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95% | ||||||||||||
sides |
1-sided
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lower limit |
- | ||||||||||||
upper limit |
- | ||||||||||||
Variability estimate |
Standard deviation
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End point title |
Change in central retinal thickness on OCT at 12 months | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
12 months
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No statistical analyses for this end point |
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End point title |
No of injections per patient | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
12 months
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
February 2013 to November 2014
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
not used dictionary | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
0
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Reporting groups
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Reporting group title |
Fixed dose arm
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Reporting group description |
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Reporting group title |
PRN dose arm
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 0% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? No | |||
Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
12 month cut off of the study favouring Fixed dose patients, as they had injections at 10 months - so better 12 month results, than PRN Non-inferiority margin of 5 letters might be considered large by some The sample size is a limitation |