Clinical Trial Results:
Clinical Efficacy and Mechanistic Evaluation of Aflibercept for Proliferative Diabetic Retinopathy
Summary
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EudraCT number |
2013-003272-12 |
Trial protocol |
GB |
Global end of trial date |
21 Dec 2016
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Results information
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Results version number |
v1(current) |
This version publication date |
23 May 2019
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First version publication date |
23 May 2019
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Other versions |
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Summary report(s) |
End of Study Summary Report |
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 |
SIVS1012
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Additional study identifiers
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ISRCTN number |
ISRCTN32207582 | ||
US NCT number |
- | ||
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 |
Tania West, Moorfields Eye Hospital, 0044 020 7253 3411 x2937 , tania.west2@nhs.net
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Scientific contact |
Tania West, Moorfields Eye Hospital, 0044 020 7253 3411 x2937 , tania.west2@nhs.net
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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 |
17 Mar 2017
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
21 Dec 2016
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Global end of trial reached? |
Yes
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Global end of trial date |
21 Dec 2016
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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 evaluate whether mean change in best corrected visual acuity following intravitreal aflibercept therapy is non-inferior to panretinal photocoagulation (PRP) in eyes with proliferative diabetic retinopathy (PDR) at 52 weeks as measured by ETDRS letters.
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Protection of trial subjects |
Laser arm (comparator arm) is the standard of care for the last 40 years. Aflibercept (intervention arm) is licensed for other intraocular conditions.
We sent the development safety update report (DSUR) annually to MHRA, ethics committee, sponsor and Bayer
Patient and public involvement (PPI) were involved in the development of patient information sheet (PIS)
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Background therapy |
None for this trial | ||
Evidence for comparator |
Laser photocoagulation has been the mainstay of treatment for diabetic macular oedema and proliferative diabetic retinopathy for over 40 years based on robust evidence base. For proliferative diabetic retinopathy, the laser treatment (panretinal photocoagulation) is applied to the peripheral retinal tissue to destroy the peripheral photoreceptors and retinal pigment epithelium to reduce retinal oxygen consumption. This reduction in hypoxic drive results in decreased growth factor production especially VEGF, which in turn causes retinal new vessel regression. Response to laser varies, while it is most desirable to see a regression of new vessels, partial regression with no further growth may also result. Although timely laser treatment is very effective in reducing visual loss compared to no treatment, laser treatments a destructive procedure with well-documented side effects. Approximately 13% develop visual loss due to development or worsening of pre-existing macular oedema. In addition, it may lead to transient or permanent loss of visual function, including peripheral visual field defects, night vision loss, loss of contrast sensitivity, and progression of visual loss in nearly 5% of individuals despite appropriate treatment. | ||
Actual start date of recruitment |
22 Aug 2014
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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: 232
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Worldwide total number of subjects |
232
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EEA total number of subjects |
232
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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) |
188
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From 65 to 84 years |
44
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85 years and over |
0
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Recruitment
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Recruitment details |
The study was conducted at the following 22 National Health Service clinical sites. We recruited 232 participants (116 per group) between Aug 22, 2014 and Nov 30, 2015. | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
Patients were identified from medical retina clinics and laser databases and contacted using an invitation letter with a pre-screening visit if required. 290 patients were assessed for eligibility. 58 excluded of which 51 eligibility criteria not met, 4 withdrawal of consent, 1 unable to come to study visits, 1 patient non compliant, 1 other | ||||||||||||||||||||||||
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 [1] | ||||||||||||||||||||||||
Blinding implementation details |
Research optometrists are the primary outcome assessors and were masked to treatment allocation. Visual fields and OCT technicians were also masked. Independent reading centre graders were masked to allocation of treatment. Investigators and patients were not masked
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Panretinal photocoagulation arm | ||||||||||||||||||||||||
Arm description |
PRP is the current standard of care and was delivered as per routine clinical practice. Naïve PDR patients requiring PRP treatment were for the first time initiated on it and completed in fractionated 2 weekly sessions up to and may include week 4 and then reviewed at week 12. Participants with persistent active new vessels that had PRP previously and were randomized to the PRP arm received fill-in PRP in 1-2 two-weekly sessions. From week 12, all patients in the PRP arm were assessed for treatment response every 8 weeks and categorised exactly as the aflibercept arm Retreatment was based on regression pattern of the new vessels | ||||||||||||||||||||||||
Arm type |
PRP | ||||||||||||||||||||||||
Investigational medicinal product name |
No investigational medicinal product assigned in this arm
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Arm title
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Aflibercept arm | ||||||||||||||||||||||||
Arm description |
All study eyes randomised to receive aflibercept received an intravitreal injection of aflibercept 2 mg/0.05ml at baseline, 4 and 8 weeks. Regression patterns of retinal neovascularisation were assessed using 4-field or wide angle fundus photography. Further treatment at week 12 was determined by the degree of regression of neovascularisation of disc and elsewhere on clinical examination with adequate visualisation of entire retina and compared to 7-field colour or wide-field photographs at screening. The patients were categorised according to treatment response into three groups: (1) No regression (2) Partial regression and (3) Total regression | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Aflibercept
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Injection
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Routes of administration |
Intravitreal use
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Dosage and administration details |
2 mg in 0.05 ml intravitreal administration
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Notes [1] - The roles blinded appear inconsistent with a simple blinded trial. Justification: Only the optometrists, technicians and reading centre graders were blinded for treatment allocation while doing assessments of outcomes |
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Baseline characteristics reporting groups
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Reporting group title |
Panretinal photocoagulation arm
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Reporting group description |
PRP is the current standard of care and was delivered as per routine clinical practice. Naïve PDR patients requiring PRP treatment were for the first time initiated on it and completed in fractionated 2 weekly sessions up to and may include week 4 and then reviewed at week 12. Participants with persistent active new vessels that had PRP previously and were randomized to the PRP arm received fill-in PRP in 1-2 two-weekly sessions. From week 12, all patients in the PRP arm were assessed for treatment response every 8 weeks and categorised exactly as the aflibercept arm Retreatment was based on regression pattern of the new vessels | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Aflibercept arm
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Reporting group description |
All study eyes randomised to receive aflibercept received an intravitreal injection of aflibercept 2 mg/0.05ml at baseline, 4 and 8 weeks. Regression patterns of retinal neovascularisation were assessed using 4-field or wide angle fundus photography. Further treatment at week 12 was determined by the degree of regression of neovascularisation of disc and elsewhere on clinical examination with adequate visualisation of entire retina and compared to 7-field colour or wide-field photographs at screening. The patients were categorised according to treatment response into three groups: (1) No regression (2) Partial regression and (3) Total regression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Panretinal photocoagulation arm
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Reporting group description |
PRP is the current standard of care and was delivered as per routine clinical practice. Naïve PDR patients requiring PRP treatment were for the first time initiated on it and completed in fractionated 2 weekly sessions up to and may include week 4 and then reviewed at week 12. Participants with persistent active new vessels that had PRP previously and were randomized to the PRP arm received fill-in PRP in 1-2 two-weekly sessions. From week 12, all patients in the PRP arm were assessed for treatment response every 8 weeks and categorised exactly as the aflibercept arm Retreatment was based on regression pattern of the new vessels | ||
Reporting group title |
Aflibercept arm
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Reporting group description |
All study eyes randomised to receive aflibercept received an intravitreal injection of aflibercept 2 mg/0.05ml at baseline, 4 and 8 weeks. Regression patterns of retinal neovascularisation were assessed using 4-field or wide angle fundus photography. Further treatment at week 12 was determined by the degree of regression of neovascularisation of disc and elsewhere on clinical examination with adequate visualisation of entire retina and compared to 7-field colour or wide-field photographs at screening. The patients were categorised according to treatment response into three groups: (1) No regression (2) Partial regression and (3) Total regression |
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End point title |
Change in best corrected visual acuity ITT analysis [1] | ||||||||||||
End point description |
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End point type |
Primary
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End point timeframe |
52 weeks
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: It was an intention to treat analysis using linear mixed model |
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No statistical analyses for this end point |
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End point title |
Change in uniocular Esterman visual fields defects | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in binocular Esterman visual fields defects | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in binocular visual acuity | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in low luminance visual acuity | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in contrast sensitivity | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in VFQ 25 composite score | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in RetDQoL impact score | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in RetTSQ total score | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in central subfield thickness | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Regression pattern | ||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
12 weeks
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No statistical analyses for this end point |
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End point title |
Regression pattern | |||||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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No statistical analyses for this end point |
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End point title |
Change in diabetic retinopathy score levels | |||||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
12 weeks
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No statistical analyses for this end point |
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End point title |
Change in diabetic retinopathy score levels | |||||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
52 weeks
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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 |
August 2014 to December 2016
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Assessment type |
Non-systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
no dictionary used | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
0.0
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Reporting groups
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Reporting group title |
Panretinal photocoagulation arm
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Reporting group description |
PRP is the current standard of care and was delivered as per routine clinical practice. Naïve PDR patients requiring PRP treatment were for the first time initiated on it and completed in fractionated 2 weekly sessions up to and may include week 4 and then reviewed at week 12. Participants with persistent active new vessels that had PRP previously and were randomized to the PRP arm received fill-in PRP in 1-2 two-weekly sessions. From week 12, all patients in the PRP arm were assessed for treatment response every 8 weeks and categorised exactly as the aflibercept arm Retreatment was based on regression pattern of the new vessels | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Aflibercept arm
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Reporting group description |
All study eyes randomised to receive aflibercept received an intravitreal injection of aflibercept 2 mg/0.05ml at baseline, 4 and 8 weeks. Regression patterns of retinal neovascularisation were assessed using 4-field or wide angle fundus photography. Further treatment at week 12 was determined by the degree of regression of neovascularisation of disc and elsewhere on clinical examination with adequate visualisation of entire retina and compared to 7-field colour or wide-field photographs at screening. The patients were categorised according to treatment response into three groups: (1) No regression (2) Partial regression and (3) Total regression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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31 Jul 2014 |
Labelling of IMP |
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10 Oct 2014 |
Letter of invitation, patient consent form, patient information sheet revision and addition of 5 sites |
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17 Sep 2015 |
Inclusion of qualified trained nurse injectors |
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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. | |||
It was a phase 2b study with follow-up for only 52 weeks. As a 5 year study, it will provide long-term outcomes of ranibizumab in PDR, information about the disease-modifying effect of anti-VEGF, and the long-term compliance of patients. | |||
Online references |
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http://www.ncbi.nlm.nih.gov/pubmed/30303670 http://www.ncbi.nlm.nih.gov/pubmed/28494920 |