Clinical Trial Results:
A phase 3 multi-centre double-masked randomised controlled trial of adjunctive intraocular and periocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma; the adjunctive steroid combination in ocular trauma (ASCOT) trial
Summary
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EudraCT number |
2014-002193-37 |
Trial protocol |
GB |
Global end of trial date |
30 Sep 2020
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Results information
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Results version number |
v1(current) |
This version publication date |
01 Dec 2021
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First version publication date |
01 Dec 2021
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Other versions |
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 |
CHAD1031
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Moorfields Eye Hospital NHS Foundation Trust
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Sponsor organisation address |
162 City Road , LONDON, United Kingdom, EC1V 2PD
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Public contact |
Hayley Boston, Moorfields Eye Hospital NHS Foundation Trust, 0044 20 7253 3411 x2937 , moorfields.resadmin@nhs.net
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Scientific contact |
Daniela Narvaez, Moorfields Eye Hospital NHS Foundation Trust, 207253341 020 7253 3411 x2937 , moorfields.resadmin@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 Sep 2021
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
30 Sep 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
30 Sep 2020
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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 |
In patients who have sustained an open globe injury (severe trauma) and are undergoing vitrectomy surgery as a result(procedure to clear the gel in the back of the eye) , does the use of a steroid injection into and around the eye improve the visual outcome at 6 months?
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Protection of trial subjects |
Trial subjects were able to access the trial team and raise any issues. trail subjects were seen and dealt with promptly by hospital vitreoretinal services which are configured to manage acute and urgent situations.
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Background therapy |
Standard vitreoretinal surgical care for penetrating eye injuries. | ||
Evidence for comparator |
Multiple publications on vitreoretinal surgical outcomes in trauma: Desai, P., et al., Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol, 1996. 80(7): p. 592-6. Pinna, A., et al., Epidemiology, visual outcome, and hospitalization costs of open globe injury in northern Sardinia, Italy. Ophthalmic Epidemiol, 2007. 14(5): p. 299-305. Cillino, S., et al., A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmol, 2008. 8: p. 6. Cardillo, J.A., et al., Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome. Ophthalmology, 1997. 104(7): p. 1166-73. Spiegel, D., et al., Severe ocular trauma managed with primary pars plana vitrectomy and silicone oil. Retina, 1997. 17(4): p. 275-85. Framme, C. and J. Roider, [Epidemiology of open globe injuries]. Klin Monbl Augenheilkd, 1999. 215(5): p. 287-93. Mittra, R.A. and W.F. Mieler, Controversies in the management of open-globe injuries involving the posterior segment. Surv Ophthalmol, 1999. 44(3): p. 215-25. | ||
Actual start date of recruitment |
01 Oct 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: 280
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Worldwide total number of subjects |
280
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EEA total number of subjects |
0
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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) |
220
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From 65 to 84 years |
45
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85 years and over |
15
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Recruitment
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Recruitment details |
Recruitment of 280 cases took place between December 2014 and March 2020 | |||||||||||||||||||||
Pre-assignment
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Screening details |
792 patient screened | |||||||||||||||||||||
Period 1
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Period 1 title |
Recruitment
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Is this the baseline period? |
Yes | |||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Assessor | |||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Treatment | |||||||||||||||||||||
Arm description |
Intra0cular and sub Tenons triamcinolone acetonide | |||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||
Investigational medicinal product name |
triamcinolone acetonide
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Investigational medicinal product code |
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Other name |
Kenolog
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Pharmaceutical forms |
Suspension for injection
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Routes of administration |
Subconjunctival use, Intraocular use
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Dosage and administration details |
steroid combination (triamcinolone acetonide) - 4mg/0.1ml into the vitreous cavity and 40mg/1ml subtenons
given at the end of vitreoretinal surgery
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Arm title
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Control | |||||||||||||||||||||
Arm description |
Standard vitreoretinal surgery | |||||||||||||||||||||
Arm type |
No intervention | |||||||||||||||||||||
Investigational medicinal product name |
No investigational medicinal product assigned in this arm
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Period 2
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Period 2 title |
Follow up and end point
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Is this the baseline period? |
No | |||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Assessor | |||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Treatment | |||||||||||||||||||||
Arm description |
Intra0cular and sub Tenons triamcinolone acetonide | |||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||
Investigational medicinal product name |
triamcinolone acetonide
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Investigational medicinal product code |
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Other name |
Kenolog
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Pharmaceutical forms |
Suspension for injection
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Routes of administration |
Subconjunctival use, Intraocular use
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Dosage and administration details |
steroid combination (triamcinolone acetonide) - 4mg/0.1ml into the vitreous cavity and 40mg/1ml subtenons
given at the end of vitreoretinal surgery
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Arm title
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Control | |||||||||||||||||||||
Arm description |
Standard vitreoretinal surgery | |||||||||||||||||||||
Arm type |
No intervention | |||||||||||||||||||||
Investigational medicinal product name |
No investigational medicinal product assigned in this arm
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Baseline characteristics reporting groups
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Reporting group title |
Recruitment
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Treatment
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Reporting group description |
Intra0cular and sub Tenons triamcinolone acetonide | ||
Reporting group title |
Control
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Reporting group description |
Standard vitreoretinal surgery | ||
Reporting group title |
Treatment
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Reporting group description |
Intra0cular and sub Tenons triamcinolone acetonide | ||
Reporting group title |
Control
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Reporting group description |
Standard vitreoretinal surgery |
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End point title |
Clinically meaningful change in visual acuity | |||||||||
End point description |
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End point type |
Primary
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End point timeframe |
6 months
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Statistical analysis title |
Mixed logistic regression model | |||||||||
Comparison groups |
Treatment v Control
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Number of subjects included in analysis |
259
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||
P-value |
= 0.994 | |||||||||
Method |
Regression, Linear | |||||||||
Parameter type |
Odds ratio (OR) | |||||||||
Point estimate |
1
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
0.59 | |||||||||
upper limit |
1.68 |
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End point title |
Change in visual acuity - continuous | ||||||||||||
End point description |
Visual acuity change as a continuous measure
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End point type |
Secondary
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End point timeframe |
6 months
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Statistical analysis title |
Linear mixed regression model | ||||||||||||
Comparison groups |
Treatment v Control
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Number of subjects included in analysis |
259
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.361 | ||||||||||||
Method |
Regression, Linear | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-3.08
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-9.67 | ||||||||||||
upper limit |
3.52 |
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End point title |
Stable complete retinal reattachment (without internal tamponade present) at 6 months | |||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
6 months
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Statistical analysis title |
Mixed logistic regression model | |||||||||
Comparison groups |
Treatment v Control
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Number of subjects included in analysis |
249
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||
P-value |
= 0.044 | |||||||||
Method |
Regression, Logistic | |||||||||
Parameter type |
Odds ratio (OR) | |||||||||
Point estimate |
0.59
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
0.36 | |||||||||
upper limit |
0.99 |
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End point title |
Retinal detachment with PVR within 6 months of vitrectomy | |||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
6 months
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Statistical analysis title |
Mixed logistic regression model | |||||||||
Comparison groups |
Treatment v Control
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Number of subjects included in analysis |
248
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||
P-value |
= 0.327 | |||||||||
Method |
Regression, Logistic | |||||||||
Parameter type |
Odds ratio (OR) | |||||||||
Point estimate |
1.31
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
0.76 | |||||||||
upper limit |
2.27 |
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Adverse events information
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Timeframe for reporting adverse events |
6 months after trial finished recruitment
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Adverse event reporting additional description |
Adverse events were recorded with clinical symptoms and accompanied with a simple, brief description of the event, including dates as appropriate. Adverse events were reported on the eCRF. Serious adverse events were reported in an expedited manner to the Sponsor for each participant for their duration in the trial.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
17.0
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Reporting groups
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Reporting group title |
Treatment
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Reporting group description |
Intra0cular and sub Tenons triamcinolone acetonide | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Control
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Reporting group description |
Standard vitreoretinal surgery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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? 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. | |||
None reported |