E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Neovascular Age-Related Macular Degeneration (nAMD) |
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E.1.1.1 | Medical condition in easily understood language |
Neovascular age-related macular edema (nAMD) is a medical condition that affects older adults and results in a loss of vision in the center of the visual field because of damage to the retina. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Eye Diseases [C11] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10071129 |
E.1.2 | Term | Neovascular age-related macular degeneration |
E.1.2 | System Organ Class | 10015919 - Eye disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | SOC |
E.1.2 | Classification code | 10015919 |
E.1.2 | Term | Eye disorders |
E.1.2 | System Organ Class | 10015919 - Eye disorders |
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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 |
To compare the efficacy of 2 mg aflibercept administered by two different intravitreal (IVT) treatment regimens to subjects with nAMD. |
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E.2.2 | Secondary objectives of the trial |
To assess the safety and tolerability of aflibercept in this subject population. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
First set of inclusion criteria: All of the following criteria must have been met at the initial start of aflibercept treatment (i.e. start of aflibercept treatment prior to this study) for a subject to be eligible for this study. 1. Subject had primary subfoveal choroidal neovascularization (CNV) lesions secondary to nAMD, including juxtafoveal lesions that affect the fovea, as evidenced by FA of the study eye within 4 weeks before the initiation of aflibercept treatment. 2. The area of CNV occupied at least 50% of the total lesion within 4 weeks before the initiation of aflibercept treatment. 3. Documented BCVA was 20/40 to 20/320 (comparable to a letter score of 73 to 25) in the study eye at the initiation of treatment (the initial BCVA of the study eye before treatment initiation must be documented as Snellen equivalent in the electronic case report form [eCRF]). Second set of inclusion criteria: All of the following criteria must be met at the time of screening for participation in this study for a subject to be eligible for this study. 4. Signed written informed consent 5. Men or women ≥ 51 years of age 6. The subject's history of aflibercept treatment meets ALL of the following: a) Treatment in the study eye was initiated with three monthly (-1 week/+2 weeks) doses of 2 mg aflibercept and improvements of visual and anatomic outcomes were observed b) Following the above initiation phase, the intervals between treatments were between 6 weeks and 12 weeks (one exception will be allowed) c) The interval between the last two pre-study injections was ≥8 weeks, and visual and anatomic outcomes have been stable over this interval. d) The subject received the last IVT injection of aflibercept in the study eye 2 months (+/- 10 days) before the first treatment in this study e) Total prior treatment duration with aflibercept (i.e. from first treatment to randomization into this study) was ≥12 months 7. Subject is willing, committed, and able to return for ALL clinic visits and complete all study-related procedures. 8. Women and men of reproductive potential must agree to a method of highly effective contraception (as defined by the Clinical Trial Facilitation Group [CTFG] from 15 SEP 2014): • Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation: o oral o intravaginal o transdermal •Progestogen-only hormonal contraception associated with inhibition of ovulation: o oral o injectable o implantable • Intrauterine device • Intrauterine hormone-releasing system • Bilateral tubal occlusion • Vasectomized partner • Sexual abstinence Alternatively women and men of reproductive potential can also use two acceptable methods of contraception (as defined by the CTFG from 15 SEP 2014) simultaneously: • Progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action • Male or female condom with or without spermicide • Cap, diaphragm or sponge with spermicide Contraception has to be used from signing the informed consent form until 3 months after the last administration of study drug. Postmenopausal women must be amenorrheic for at least 12 months in order not to be considered of child bearing potential. |
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E.4 | Principal exclusion criteria |
First set of exclusion criteria: A subject who has met any of the following criteria at the initial start of aflibercept treatment (i.e. start of aflibercept treatment before this study) will be excluded from this study. 1. Any prior or concomitant therapy with an investigational or approved agent to treat neovascular AMD in the study eye. 2. Total lesion size > 12 disc areas (30.5 mm2, including blood, scars and neovascularization) as assessed by FA in the study eye 3. Subretinal hemorrhage that was: a) 50% or more of the total lesion area, or b) if the blood was under the fovea, and c) the blood under the fovea was 1 or more disc areas in size in the study eye. 4. Scar or fibrosis making up more than 50% of the total lesion in the study eye. 5. Scar, fibrosis, or atrophy involving the center of the fovea in the study eye. 6. Presence of retinal pigment epithelial tears or rips involving the macula in the study eye. 7. Causes of CNV other than AMD in the study eye. Second set of exclusion criteria: A subject who meets any of the following criteria at the time of screening for participation in this study will be excluded from this study. 8. Subjects who currently meet any of the first set of exclusion criteria with the exception of prior treatment with aflibercept 9. Any prior ocular (in the study eye) or systemic treatment or surgery for neovascular AMD, except dietary supplements, vitamins and IVT injections of aflibercept, during the time (i.e. at least 12 months) between initiation of aflibercept treatment and randomization into this study 10. Any prior treatment with anti-VEGF therapy in the study eye, with the exception of IVT injections of aflibercept, during the time (i.e. at least 12 months) between initiation of aflibercept treatment and randomization into this study 11. Prior systemic anti-VEGF therapy, investigational or approved, within the last 15 months prior to randomization 12. Any vitreous hemorrhage within 4 weeks before randomization in the study eye 13. Active intraocular, extraocular and periocular inflammation or infection in either eye. 14. Any ocular or periocular infection within 4 weeks of randomization in either eye 15. Any serious adverse event related to aflibercept during prior treatment 16. Any history of allergy or hypersensitivity to povidone iodine. 17. Known serious allergy or hypersensitivity to the fluorescein sodium for injection in angiography 18. Presence of any contraindications indicated in the EU commission/locally approved label for aflibercept: Hypersensitivity to the active substance aflibercept or to any of the excipients; active or suspected ocular or periocular infection; active severe intraocular inflammation 19. Prior vitrectomy in the study eye 20. History of vitreomacular traction in the study eye 21. History of retinal detachment or treatment or surgery for retinal detachment in the study eye. 22. Any history of macular hole of stage 2 and above in the study eye 23. Prior trabeculectomy or other filtration surgery in the study eye 24. Uncontrolled glaucoma (defined as intraocular pressure more than 25 mmHg despite treatment with antiglaucoma medication) in the study eye 25. Aphakia or pseudophakia with absence of posterior capsule (unless it occurred as a result of an yttrium aluminum garnet [YAG] posterior capsulotomy) in the study eye 26. Previous therapeutic radiation in the region of the study eye 27. History of corneal transplant or corneal dystrophy in the study eye 28. Significant media opacities, including cataract, in the study eye that interferes with visual acuity or fundus photography 29. History or clinical evidence of DME or any retinal vascular disease other than AMD in either eye 30. Any history of uveitis in either eye 31. Presence of scleromalacia in either eye 32. Pregnancy or breast-feeding (women only) 33. The use of long acting steroids, either systemically or intraocular, in the 18 months before initiating study treatment (or Iluvien IVT implant at any time) 34. 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 of an investigational drug, might affect interpretation of the results of the study, or renders the subject at high risk for treatment complications 35. Previous assignment to treatment during this study 36. Concomitant participation in another clinical study with investigational medicinal product(s) 37. Close affiliation with the investigational site; e.g. a close relative of the investigator, dependent person (e.g. employee or student of the investigational site). |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change in ETDRS BCVA letter score for the study eye from baseline to Week 52. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Efficacy assessments: - Proportion of subjects maintaining vision (i.e. loss of < 15 letters) in the study eye at Week 52 - Proportion of subjects who gained ≥ 5 letters from baseline to Week 52 - Mean change in central retinal thickness (CRT) in the study eye from baseline to Week 52 - Mean change in CNV area in the study eye from baseline to Week 52 - Proportion of subjects who lost ≥ 30 letters from baseline to Week 52 - Mean change from baseline to Week 52 in total score for NEI VFQ-25 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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) | No |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 6 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 90 |
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 | No |
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 |
Austria |
Canada |
Czech Republic |
France |
Germany |
Hungary |
Italy |
Lithuania |
Poland |
Portugal |
Slovakia |
Spain |
Switzerland |
United Kingdom |
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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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For each participating EU country, the end of the study according to the EU Clinical Trial Directive will be reached when the last visit of the last subject for all centers in the respective country has occurred. The end of the study as a whole will be reached as soon as the end of the study according to the above definition has been reached in all participating countries (EU and non-EU). |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |