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    Clinical Trial Results:
    A 12-month, prospective, multicenter, open-label, single arm, interventional study assessing the safety and tolerability of 0.5 mg ranibizumab in mono/bilateral wet AMD patients in eyes with BCVA below 2/10 and/or second affected eye

    Summary
    EudraCT number
    2013-003333-15
    Trial protocol
    IT  
    Global end of trial date
    15 Jun 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Jul 2017
    First version publication date
    01 Jul 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CRFB002AIT02
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01986907
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002, Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG, 41 613241111,
    Scientific contact
    Study Director, Novartis Pharma AG, +41 613241111, trialandresults.registries@novartis.com
    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
    11 Apr 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Jun 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective was to evaluate the annual incidence rate of both ocular and systemic drug-related adverse events (AE) following ranibizumab treatment in subjects diagnosed with wet AMD and Best Corrected Visual Acuity (BCVA) < 2/10 and/or second eye affected, regardless of BCVA. In order to provide the most comprehensive and objective ranibizumab-related AE profile, the primary analysis was extended to include not only AEs with causal relationship established by the Investigators, but also all AEs possibly related to ranibizumab as per latest Periodic Safety Update Report (PSUR) and Risk Management Plan (RMP), AEs hereinafter referred to as Adverse Events of Special Interest (AESI).
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    04 Mar 2016
    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
    Italy: 936
    Worldwide total number of subjects
    936
    EEA total number of subjects
    936
    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)
    33
    From 65 to 84 years
    695
    85 years and over
    208

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Of the 944 screened patients, nine hundred forty-one (941) subjects were enrolled in the study and 936 were treated with ranibizumab at least once. Seven hundred seventy-four (774) subjects completed the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Ranibizumab
    Arm description
    patients treated with 0.5mg ranibizumab
    Arm type
    Experimental

    Investigational medicinal product name
    Ranibizumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for injection
    Routes of administration
    Intramuscular and intravenous use
    Dosage and administration details
    Injection

    Number of subjects in period 1
    Ranibizumab
    Started
    936
    Completed
    769
    Not completed
    167
         Adverse event, serious fatal
    9
         Consent withdrawn by subject
    76
         Adverse event, non-fatal
    11
         Did not receive study drug
    5
         Lost to follow-up
    38
         Lack of efficacy
    24
         Protocol deviation
    4

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Ranibizumab
    Reporting group description
    patients treated with 0.5mg ranibizumab

    Reporting group values
    Ranibizumab Total
    Number of subjects
    936 936
    Age Categorical
    Units: Subjects
        18<65 years
    33 33
        65-<85 years
    695 695
        >=85 years
    208 208
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    78.68 ± 7.34 -
    Gender, Male/Female
    Units: Subjects
        Female
    582 582
        Male
    354 354

    End points

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    End points reporting groups
    Reporting group title
    Ranibizumab
    Reporting group description
    patients treated with 0.5mg ranibizumab

    Primary: Number of participants with systemic drug-related adverse events by SOC and PT

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    End point title
    Number of participants with systemic drug-related adverse events by SOC and PT [1]
    End point description
    Monitoring and recording all adverse events, including serious adverse events.
    End point type
    Primary
    End point timeframe
    Baseline to Month 12
    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: no statistical analysis as this is a single arm study
    End point values
    Ranibizumab
    Number of subjects analysed
    936
    Units: Eyes naive to Ranibizumab
        Serious Adverse Events
    3
        Non Serious Adverse Events
    0
    No statistical analyses for this end point

    Primary: Number of eyes with ocular drug-related adverse events

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    End point title
    Number of eyes with ocular drug-related adverse events [2]
    End point description
    Monitoring and recording all adverse events, including serious adverse events.
    End point type
    Primary
    End point timeframe
    Baseline to Month 12
    Notes
    [2] - 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: no statistical analysis as this is a single arm study.
    End point values
    Ranibizumab
    Number of subjects analysed
    936
    Units: Eyes
        Serious Adverse Events
    1
        Non Serious Adverse Events
    8
    No statistical analyses for this end point

    Secondary: Mean number of ranibizumab injections

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    End point title
    Mean number of ranibizumab injections
    End point description
    Treatment patterns for ranibizumab in the study population is described by the overall number of injections (mean, standard deviation, median, 25th and 75th percentiles, minimum and maximum), number of visits, time-interval between injections in bilateral disease, number and reasons for retreatment, number and reasons for treatment terminations.
    End point type
    Secondary
    End point timeframe
    Baseline to month 12
    End point values
    Ranibizumab
    Number of subjects analysed
    936
    Units: injections
        arithmetic mean (standard deviation)
    5.97 ± 3.62
    No statistical analyses for this end point

    Secondary: Time interval between injections in bilateral disease

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    End point title
    Time interval between injections in bilateral disease
    End point description
    Mean number of days between two consecutive injections per eye (Treated eyes naïve to Ranibizumab, N=771 Eyes)
    End point type
    Secondary
    End point timeframe
    Baseline to month 12
    End point values
    Ranibizumab
    Number of subjects analysed
    771
    Units: days
        arithmetic mean (standard deviation)
    51.94 ± 26.56
    No statistical analyses for this end point

    Secondary: Number of injections

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    End point title
    Number of injections
    End point description
    Number of injections per patient. The reason for re-treatment was (accordingly with SmPC) All subjects were to be treated as per approved label: treatment was given monthly until maximum Visual Acuity (VA) was achieved (i.e. stable VA for three consecutive months). Thereafter, subjects were monitored for visual acuity and treatment was to be resumed in case of VA loss due to disease activity.
    End point type
    Secondary
    End point timeframe
    Baseline to month 12
    End point values
    Ranibizumab
    Number of subjects analysed
    936
    Units: injections
        01
    28
        02
    56
        03
    203
        04
    103
        05
    108
        06
    118
        07
    74
        08
    50
        09
    57
        10
    38
        11
    26
        12
    21
        13
    27
        14
    5
        15
    7
        16
    1
        17
    4
        18
    2
        19
    1
        20
    1
        21
    1
        22
    1
        23
    1
        24
    1
        25
    3
        26
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Timeframe for AE
    Adverse event reporting additional description
    AE additional description
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Ranibizumab 0.5 mg
    Reporting group description
    Ranibizumab 0.5 mg

    Serious adverse events
    Ranibizumab 0.5 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    63 / 936 (6.73%)
         number of deaths (all causes)
    9
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Breast cancer
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung neoplasm malignant
         subjects affected / exposed
    3 / 936 (0.32%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 3
    Metastases to central nervous system
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Prostate cancer recurrent
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Peripheral artery stenosis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Peripheral ischaemia
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Mastectomy
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transurethral prostatectomy
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung disorder
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Pneumothorax
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Pulmonary oedema
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Respiratory disorder
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory failure
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Femur fracture
         subjects affected / exposed
    7 / 936 (0.75%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    Humerus fracture
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lower limb fracture
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatic injury
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pelvic fracture
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Atrioventricular block
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Cardiac failure
         subjects affected / exposed
    3 / 936 (0.32%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 2
    Myocardial infarction
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Myocardial ischaemia
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Nervous system disorders
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cognitive disorder
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Dizziness
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myasthenia gravis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    3 / 936 (0.32%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Bone marrow disorder
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Ocular hypertension
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Retinal haemorrhage
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Vitreous haemorrhage
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Faecaloma
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastritis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal haemorrhage
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Large intestine polyp
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lumbar hernia
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Hepatic lesion
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Haematuria
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal cyst
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Endocrine disorders
    Goitre
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthritis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteoarthritis
         subjects affected / exposed
    2 / 936 (0.21%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Escherichia sepsis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Herpes zoster
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    5 / 936 (0.53%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Sepsis
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Urinary tract infection
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Hyponatraemia
         subjects affected / exposed
    1 / 936 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    Ranibizumab 0.5 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    76 / 936 (8.12%)
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    10 / 936 (1.07%)
         occurrences all number
    10
    Eye disorders
    Cataract
         subjects affected / exposed
    10 / 936 (1.07%)
         occurrences all number
    13
    Conjunctival haemorrhage
         subjects affected / exposed
    13 / 936 (1.39%)
         occurrences all number
    13
    Neovascular age-related macular degeneration
         subjects affected / exposed
    34 / 936 (3.63%)
         occurrences all number
    39
    Infections and infestations
    Influenza
         subjects affected / exposed
    15 / 936 (1.60%)
         occurrences all number
    17

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Single arm study does not have Statistical Analysis
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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