E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
To evaluate if Aflibercept given every eighth week from start after an initial loading dose in age-related macular degeneration (AMD), is as effective as dosing as "Treat and extend" where treating intervalls are prolonged after stability in visual acuity is achieved. Followed for 18 months.
The secondary objective is to evaluate the safety of Aflibercept assessed with ERG, and a quality of life questioner will be put to all patients at start and at follow-up after 18 months.
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Primär målsättning: Att undersöka om Aflibercept doserat varannan månad efter tre initial månatliga injektioner är lika effektivt som att dosera enligt treat-and-extend regimen där intervallen förlängs efter att maximal synskärpa uppnåtts hos patienter med våt AMD under 18 månader.
Sekundär målsättning: Undersöka retinala funktionen efter injektion av Aflibercept mätt med ERG, samt ett livskvalitetsformulär kommer att distribueras till patienterna före/efter behandling.
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E.1.1.1 | Medical condition in easily understood language |
To evaluate if Eylea injections into the eye for wet macular degenerations, can be extended and given with longer intervals. |
Att undersöka om intervallen mellan Eylea sprutat i ögat vid våt maculasjukdom kan förlängas |
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E.1.1.2 | Therapeutic area | Diseases [C] - Eye Diseases [C11] |
MedDRA Classification |
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 |
The primary objective is to evaluate if Aflibercept given every eighth week from start is as effective as given with an initial loading dose in age-related macular degeneration (AMD), after 6 months and after 18 months administered with a treat-and-extend regimen after the first 6 months.
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Primär målsättning: Att undersöka om Aflibercept doserat varannan månadvecka efter tre initial månatliga injektioner är lika effektivt so m att dosera enligt treat-and-extend regimen där intervallen förlängs efter att maximal synskärpa uppnåtts hos patienter med våt AMD under 18 månaders uppföljning.
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E.2.2 | Secondary objectives of the trial |
The secondary objective is to evaluate the safety of Aflibercept assessed with ERG, and a quality of life questioner will be put to all patients at a number of occasions throughout the study to evaluate these patients’ quality of life.
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Sekundär målsättning: Vi vill också titta på den retinala funktionen efter injektion av Aflibercept mätt med ERG, samt ett livskvalitetsformulär kommer att distribueras till patienterna vid ett flertal tillfällen under studien för att undersöka upplevelsen av behandlingen.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Men and women age >50 years having an active subfoveal choroidal neovascularisation (CNV). Clinical indicated due to CNV with a visual impairment down to 0.1.
Signed informed consent form
• Corrected distance logMAR visual acuity more than 25 letters read on a standard ETDRS chart at 1 metre.
• Age ≥ 50 years of either gender
• Any component of neovascularlesion (CNV, Blood, serious pigment epithelial detachment, elevated blocked fluorescence) involving the centre of the fovea.
Eligibility criteria for study eye
• Study eye must meet the following criteria for entry into the study:
• Newly diagnosed, angiographically documented, previously untreated, active CNV lesion (i.e., leakage on fluorescein angiography AND subretinal, intraretinal, or sub-RPE fluid on OCT) secondary to age-related macular degeneration.
• Best corrected visual acuity in the study eye, using e-ETDRS testing, between 20/25 and 20/320 (Snellen equivalent), inclusive. Only one eye will be enrolled in the Study. If both eyes are eligible, the patient and study ophthalmologist will select the eye for entry.
• The CNV or sequela of the CNV (i.e., pigment epithelium detachment, subretinal or sub-RPE hemorrhage, blocked fluorescence, macular edema, or subretinal sub-RPE or intraretinal fluid) must involve the center of the fovea.
• The total area of fibrosis must comprise less than 50% of the total lesion.
• No previous treatment for CNV in the study eye
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A. Män och kvinnor > 50 år som kommer till kliniken med kliniskt signifikanta maculaödem samt kärlnybildningar verifierat med kontrastundersökning (fluoresceinangiografi) på sedvanligt sätt kommer tillfrågas om de vill ingå i studien.
• Patienter med alla slag av våt AMD (minimal classic, predominantly classic, okult membran) och ej tidigare behandlade samt visus ≥ 0.1 kommer inkluderas.
Beslut om att behandla med Aflibercept ska ha tagits innan inklusion i studien övervägs.
Patienten kommer informeras nogsamt, få möjlighet till att ställa frågor och sedan signera informed consent.
Enbart ett öga kommer att erbjudas behandling.
Om båda ögonen har liknande problem kommer det ögat, som har de mest aktuella symptomen att behandlas
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E.4 | Principal exclusion criteria |
Ocular concomitant / previous conditions / diseases
• Concomitant conditions in the study eye which could, in the opinion of the investigator, prevent the improvement of visual acuity on study treatment
• Active intraocular inflammation (grade trace or above) in either eye
• Any active infection (e.g. conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) in either eye
• History of uveitis in either eye
• Structural damage within 0.5 disc diameter of the center of the macula in the study eye likely to preclude improvement in visual acuity following the resolution of macular edema, including atrophy of the retinal pigment epithelium, subretinal fibrosis, laser scar(s), epiretinal membrane involving fovea or organized hard exudate plaques
• Ocular disorders in the study eye that may confound interpretation of study results, compromise visual acuity or require medical or surgical intervention during the 24-month study period, including cataract, retinal vascular occlusion, retinal detachment, macular hole, or choroidal neovascularization of any cause (e.g., AMD, ocular histoplasmosis, or pathologic myopia)
• Uncontrolled glaucoma in either eye (IOP > 24 mmHg on medication or according to investigator’s judgment)
• Neovascularization of the iris in either eye
• Evidence of vitreomacular traction in either eye
• Active proliferative diabetic retinopathy in the study eye
• Patients who are monocular or have a BCVA score in the non-study eye (fellow eye) 24 letters (approximate Snellen equivalent of 20/320) at Visit 1
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B. Exklusionkriterier
B1. Allmänna exklusionkriterier
• Gravida och ammande kvinnor.
• Kvinnor i fertil ålder skall ha adekvat antikonception
B2. Specifika exklusionskriterier
• Patienter med aktiva eller misstänkta infektioner i eller runt ögat.
• Patienter med aktiv svår intraokulär inflammation
• Patienter med okontrollerat IOP (intraokulärt tryck) (>25 mm Hg trots behandling)
• Genomgången intraokulär kirurgi de senaste 3 månaderna (risk för försämrad sårläkning)
• Tidigare behandling för näthinnesjukdom såsom trombos eller diabetesretinopati
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E.5 End points |
E.5.1 | Primary end point(s) |
Efficacy
• Mean change in VA at 18 months (non-inferiority limit of 5 letters)
• Change in retinal thickness on OCT
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medel förändring i synskärpa efter 18 mån
Förändring i OCT (näthinnetjocklek) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
After 18 months follow up |
Eftre 18 månader |
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E.5.2 | Secondary end point(s) |
Secondary:
• ERG
• Quality of Life questioner, VFQ 25
• Reading speed, eye movement,(central visual field?) |
ERG (elektroretinogram
Livskvalitetsfrågor VFQ 25
Läshastighet
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
After 18 months follow-up |
Efter 18 månader |
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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) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
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 | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |