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    Summary
    EudraCT Number:2021-003226-71
    Sponsor's Protocol Code Number:MR42410
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2021-12-01
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2021-003226-71
    A.3Full title of the trial
    A PHASE IIIB, MULTICENTER, RANDOMIZED, VISUAL ASSESSOR-MASKED STUDY OF THE EFFECTIVENESS AND SAFETY OF A 36-WEEK REFILL REGIMEN FOR THE PORT DELIVERY SYSTEM WITH RANIBIZUMAB VS AFLIBERCEPT TREAT & EXTEND IN SUBJECTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION (DIAGRID)
    ESTUDIO DE FASE IIIB, MULTICÉNTRICO, ALEATORIZADO, ENMASCARADO PARA EL EVALUADOR VISUAL, PARA EVALUAR LA EFICACIA Y SEGURIDAD DE RANIBIZUMAB ADMINISTRADO CON EL DISPOSITIVO PORT DELIVERY SYSTEM UTILIZANDO UNA PAUTA DE RECARGA CADA 36 SEMANAS, COMPARADO CON AFLIBERCEPT ADMINISTRADO DE ACUERDO CON UN RÉGIMEN DE TRATAR Y EXTENDER, EN SUJETOS CON DEGENERACION MACULAR ASOCIADA A LA
    EDAD NEOVASCULAR (DIAGRID)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study to Evaluate Effectiveness and Safety of A 36-Week Ranibizumab Refill Regimen for the Port Delivery System versus Aflibercept Intravitreal Injection Treat & Extend in Subjects with Neovascular Age-Related Macular Degeneration (DIAGRID)
    Estudio para evaluar la eficacia y seguridad de una pauta de recarga cada 36 semanas con el dispositivo Port Delivery System comparado con Aflivercept en injección intravítrea administrado de acuerdo con un régimen de tratar y extenfer en sujetos con degenaración macular asociada a la edad neovascular (DIAGRID)
    A.4.1Sponsor's protocol code numberMR42410
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorRoche Farma S. A. U. que realiza el ensayo en España y que actúa como representante F. Hoffmann-La Roche Ltd
    B.1.3.4CountrySwitzerland
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportF.Hoffman-La Roche Ltd
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationF. Hoffman-La Roche Ltd
    B.5.2Functional name of contact pointTrial Information Support Line-TISL
    B.5.3 Address:
    B.5.3.1Street AddressGrenzacherstrasse 124
    B.5.3.2Town/ cityBasel
    B.5.3.3Post code4070
    B.5.3.4CountrySwitzerland
    B.5.4Telephone number+34913257300
    B.5.5Fax number+34913248196
    B.5.6E-mailspain.start_up_unit@roche.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameRANIBIZUMAB
    D.3.2Product code RO4893594
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOcular use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRanibizumab
    D.3.9.1CAS number 347396-82-1
    D.3.9.4EV Substance CodeSUB22314
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Yes
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name EYLEA
    D.2.1.1.2Name of the Marketing Authorisation holderBayer AG
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAflibercept
    D.3.2Product code RO 717-1571
    D.3.4Pharmaceutical form Solution for injection in pre-filled syringe
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravitreal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAflibercept
    D.3.9.2Current sponsor codeRO 717-1571
    D.3.9.3Other descriptive nameEylea
    D.3.9.4EV Substance CodeSUB26987
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name EYLEA
    D.2.1.1.2Name of the Marketing Authorisation holderBayer AG
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameAflibercept
    D.3.2Product code RO 717-1571
    D.3.4Pharmaceutical form Solution for injection in vial
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravitreal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAflibercept
    D.3.9.2Current sponsor codeRO 717-1571
    D.3.9.3Other descriptive nameEylea
    D.3.9.4EV Substance CodeSUB26987
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Neovascular Age-Related Macular Degeneration (AMD)
    Degeneración macular asociada a la edad de tipo neovascular (DMAE).
    E.1.1.1Medical condition in easily understood language
    Wet AMD, is a form of advanced AMD that causes central visual loss, and remains a leading cause of visual impairment in the elderly.
    DMAE húmeda, es una forma avanzada de DMAEn que que provoca pérdida de visión central, y sigue siendo una de las principales causas de discapacidad visual en las personas mayores.
    E.1.1.2Therapeutic area Diseases [C] - Eye Diseases [C11]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10071129
    E.1.2Term Neovascular age-related macular degeneration
    E.1.2System Organ Class 10015919 - Eye disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    •To evaluate the effectiveness of the Port Delivery System (PDS) refilled with ranibizumab every 36 weeks (PDS Q36W) compared with aflibercept intravitreal injections administered per a treat-and-extend strategy (aflibercept T&E) according to (1) change in visual acuity and (2) treatment burden
    evaluar la eficacia del dispositivo Port Delivery System (PDS) recargado con renibizumab cada 36 semanas (PDS c36s) en comparación con aflibercept intravítreo administrado de acuerdo con un régimen de tratar y extender (aflibercept T&E) según (1) variación en la puntuación de la mejor agudeza visual y (2)
    E.2.2Secondary objectives of the trial
    •To evaluate the effectiveness of PDS Q36W compared with aflibercept T&E based on (1) best-corrected visual acuity (BCVA) score at end of study or change to BCVA score, (2) change in center point thickness (CPT) and center subfield thickness (CST)
    •To evaluate the proportion of subjects in PDS group not needing supplemental intravitreal treatment
    •To evaluate the safety of PDS Q36W and aflibercept T&E
    •To evaluate the PDS device and PDS procedures-related safety
    • Evaluar la eficacia de PDS C36S en comparación con aflibercept T&E basándose en (1) agudeza visual corregida (MVAC) al final del estufio o cambio en la puntuación MVAC, (2) Variación en el grosor del punto central (GPC) y en el grosor del subcampo central (GSC)
    • Evaluar la proporcion de sujeton en el grupo de PDS que no necesitan tratamiento suplementario intravitreo
    • Evaluar la seguridad de PDS C36S en comparación con aflibercept T&E
    • Evaluar el dispositivo PDS y los procedimientos relacionados con la seguridad de PDS
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    General inclusion criteria
    •Age >=50 years, at time of signing Informed Consent Form
    •For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures during the treatment period and for at least 3 months after the final intravitreal injection of ranibizumab or aflibercept, or 1 year after the last implant refill of ranibizumab
    Ocular Inclusion Criteria
    •Initial diagnosis of nAMD within 9 months prior to the screening visit
    •Previous treatment with at least three anti- vascular endothelial growth factor (VEGF) intravitreal injections for nAMD per standard of care within 6 months prior to the screening visit
    •Demonstrated response to prior anti-VEGF intravitreal treatment since diagnosis, as evidenced by the following: a) Overall decrease in nAMD disease activity detected on SD-OCT, as assessed by the investigator and confirmed by the central reading center and b) Stable or improved BCVA at randomization
    •Availability of historical visual acuity data obtained at or after nAMD diagnosis and prior to the first anti-VEGF treatment for nAMD
    •Availability of historical spectral-domain optical coherence tomography (SD-OCT) image data obtained at or after nAMD diagnosis and prior to the first anti-VEGF treatment for nAMD
    •BCVA of 34 letters or better (20/200 or better approximate Snellen equivalent), using Early Treatment Diabetic Retinopathy Study (ETDRS) chart at a starting distance of 4 meters at screening and randomization visits
    •With any subtype of nAMD lesions (i.e., type I, type II, type III, or mixed forms per OCT classification, including polypoidal choroidal vasculopathy and retinal angiomatous proliferation). Exudative nAMD lesions at the time of diagnosis must involve the macula (6-mm diameter centered at the fovea)
    •Sufficiently clear ocular media and adequate pupillary dilation to allow for clinical examination and analysis and grading by the central reading center of fundus photography (FP), fluorescein angiography (FA), fundus autofluorescence (FAF) image, and SD-OCT images
    General inclusion criteria
    • >=50 años en el momento de firmar el formulario de consentimiento informado
    •Las mujeres potencialmente fértiles deben comprometerse a practicar la abstinencia sexual (abstenerse de mantener relaciones heterosexuales) o a usar métodos anticonceptivos, durante el período de tratamiento y como mínimo hasta 3 meses después de la última inyección intravítrea de ranibizumab o aflibercept, o hasta 1 año después de la última recarga del implante de ranibizumab

    Criterios de inclusión oculares
    •DMAEn diagnosticada inicialmente en los 9 meses previos a la visita de selección
    •Tratamiento previo con un mínimo de tres inyecciones intravítreas de un agente anti-VEGF para la DMAEn, de acuerdo con la práctica clínica estándar, en los 6 meses anteriores a la visita de selección
    •Respuesta demostrada a un tratamiento intravítreo anti-VEGF previo desde el diagnóstico, evidenciada por lo siguiente: a) Disminución general de la actividad de la enfermedad de la DMAEn detectada en SD-OCT, determinada por el investigador y confirmada por el centro de investigación central y b) MAVC estable o mejorada en el momento de la aleatorización
    •Disponibilidad de datos previos sobre la agudeza visual obtenidos en el momento del diagnóstico de la DMAEn o después del mismo y antes de administrar el primer tratamiento anti-VEGF para la DMAEn
    •Disponibilidad de datos previos de imágenes de optical coherence tomography (SD-OCT) en el momento del diagnóstico de la DMAEn o después del mismo y antes de administrar el primer tratamiento anti-VEGF para la DMAEn
    •MAVC de 34 letras o mejor (aproximadamente 20/200 o mejor en equivalentes de Snellen), evaluada en una cartilla de Early Treatment Diabetic Retinopathy Study (ETDRS) a una distancia inicial de 4 metros (para obtener información adicional, consúltese el manual de MAVC) en las visitas de selección y aleatorización
    •Cualquier subtipo de lesión de DMAEn (es decir, tipo I, II o III o formas mixtas de acuerdo con la clasificación OCT, incluyendo vasculopatía coroidea polipoidal y proliferación angiomatosa retiniana) Las lesiones exudativas de la DMAEn en el momento del diagnóstico deben afectar a la mácula (6 mm de diámetro en el centro de la fóvea)
    •Medio ocular suficientemente claro y dilatación pupilar adecuada que permita el examen clínico y el análisis y la clasificación de las imágenes de las fotografías de fondo de ojo (FFO), angiografía con fluoresceína (AF), autofluorescencia del fondo de ojo (AFFO) y SD-OCT por el centro de interpretación central
    E.4Principal exclusion criteria
    Prior Ocular Treatment
    Study Eye
    •History of vitrectomy surgery, submacular surgery, or other surgical intervention for AMD
    •Prior pars plana vitrectomy surgery
    •Prior treatment with Visudyne®, external-beam radiation therapy, or transpupillary thermotherapy
    • corticosteroid intravitreal injection
    •Previous intraocular device implantation
    •Previous intraocular surgery within 3 mths of randomization
    •Previous laser used for AMD or diabetic retinopathy treatment
    •History of vitreous hemorrhage, rhegmatogenous retinal detachment
    •Concurrent conjunctival, Tenon's capsule, and/or scleral condition in the supero-temporal quadrant of the eye
    •History of glaucoma-filtering surgery, tube shunts, or microinvasive glaucoma surgery, corneal transplant, conjunctival surgery in the superotemporal quadrant
    Either Eye
    •History of a severe allergic reaction or anaphylactic reaction to a biologic agent or known hypersensitivity to any component of the ranibizumab or aflibercept injections, study-related procedure preparations, dilating drops, or any of the anesthetic and antimicrobial preparations used by a subject
    •Any contraindication to aflibercept
    •Prior participation in a clinical trial involving any anti-VEGF drugs within 6 mths prior to the randomization visit
    •Prior treatment with brolucizumab, external-beam radiation therapy or brachytherapy
    Macular neovascularization (MNV) (choroidal neovascularization [CNV]) Lesion Characteristics
    Study Eye
    •Subretinal hemorrhage that involves the center of the fovea
    •Subfoveal fibrosis or subfoveal atrophy
    Either Eye
    •CNV due to other causes, such as ocular histoplasmosis, trauma, central serous chorio-retinopathy, or pathologic myopia
    •CNV masquerading lesions
    Concurrent Ocular Conditions
    Study Eye
    •Subfoveal and/or juxtafoveal retinal pigment epithelial tear
    •Scleral pathology in the superotemporal quadrant
    •Conjunctival pathologies in the superotemporal quadrant
    •Any concurrent intraocular condition
    •Active intraocular inflammation (grade trace or above)
    •Rhegmatogenous retinal tears or peripheral retinal breaks on depressed fundus exam that are untreated, or treated within 3 mths prior to the randomization visit
    •Aphakia or absence of the posterior capsule
    •Previous violation of the posterior capsule
    •Spherical equivalent of the refractive error demonstrating more than 8 diopters of myopia or evidence of pathologic myopia on depressed fundus exam
    •Preoperative refractive error that exceeds 8 diopters of myopia
    •Spherical equivalent of the refractive error demonstrating more than 5 diopters of hyperopia
    •Preoperative refractive error that exceeds 5 diopters of hyperopia
    •Uncontrolled ocular hypertension or glaucoma and any such condition the investigator determines may require a glaucoma-filtering surgery during a subject's participation in the study
    •History or presence of severe posterior blepharitis, recurrent chalazia or hordeolum, severe dry eye syndrome, or severe allergic conjunctivitis
    •Ectropion, entropion, in growing lashes, or other impairment of the upper or lower eyelid impacting lid functionality needed to protect the ocular surface from exposure
    •Trichiasis, Corneal neuropathy, Lagophthalmos or incomplete blink, Active or history of facial nerve palsy/paresis
    Non-Study (Fellow) Eye
    •BCVA of hand motion or worse
    •No physical presence of non-study eye
    •Legally blind in the subject’s relevant jurisdiction
    Either Eye
    •Any active or history of uveitis
    •Active or history of keratitis, scleritis, endophthalmitis, or chronic blepharitis
    •for active ocular or periocular infectious conjunctivitis or endophthalmitis
    •Active or history of Sjogrens syndrome or keratoconjunctivitis sicca, floppy eyelid syndrome, chronic eye rubbing
    •Active thyroid eye disease
    Concurrent Systemic Conditions
    •Uncontrolled blood pressure
    •Active or history of autoimmune diseases
    •History of stroke within the last 3 mths prior to informed consent
    •Atrial fibrillation diagnosed or worsened within the last 3 mths prior to informed consent
    •History of myocardial infarction within the last 3 mths prior to informed consent
    •History of other disease, metabolic dysfunction (including uncontrolled diabetes), or clinical laboratory finding
    •Confirmed active systemic infection
    •Use of any systemic anti-VEGF agents
    •use of oral corticoster.
    •Active cancer within 12 mths of randomiz.
    •Previous participation in any non-ocular disease studies of investigational drugs within 1 mth preceding the informed consent
    •Use of antimitotic or antimetabolite therapy within 30 D or 5 elimination half-lives of the randomization visit
    •Requirement for continuous use of any medications or treatments prohibited in the study
    •Pregnant or breastfeeding, or intending to become pregnant during the treatment period and for at least 3 mths after the final intravitreal injection of ranibizumab or aflibercept, or 1 Y after the last implant refill-exchange procedure
    Tratamiento ocular previo
    Ojo en estudio
    •Vitrectomía,cirugía submacular u otras intervenciones quirúrgicas previas para la DMAE •Vitrectomía pars plana previa•Tratamiento(tto)previo con Visudyne®,radioterapia de haz externo o termoterapia transpupilar•Inyecciones(iny)intravítreas de corticoides•Dispositivo intraocular implantado prevo•Cirugía intraocular en los 3meses(m)previos a aleatorización(aleat)•Tto previo con láser para DMAE o retinopatía diabética•Antecedentes(anteced) de hemorragia vítrea,desprendimiento de retina regmatógeno•Trastornos concurrentes conjuntivales,de la cápsula de Tenon y/o esclerales en el cuadrante(cuadr)superotemporal del ojo•Anteced de cirugía filtrante para glaucoma, shunts tubulares o cirugía microinvasiva para glaucoma,trasplante de córnea,cirugía conjuntival en el cuadr superotemporal
    Cualquier ojo
    •Anteced de reacciones alérgicas graves/anafilácticas a ag biológico/hipersensibilidad conocida a cualquier componente de las iny de ranibizumab o aflibercept,prep utilizadas en proced relacionados con el estudio,colirios dilatadores o cualquiera de las preparaciones anestésicas y antimicrobianas utilizadas por un sujeto durante el estudio•Contraindicación a aflibercept•Participación previa en ensayo clínico que(q)incluyese ag anti-VEGF los 6 m previos a la visita de aleat•Tto previo con brolucizumab, radioterapia de haz externo o braquiterapia
    Características de lesión de neovascularización macular o coroidea(NVM/NVC)
    Ojo en estudio
    •Hemorragia subretiniana q afecte al centro de la fóvea•Fibrosis/atrofia subfoveal
    Cualquier ojo
    •NVC debida a otras causas,como histoplasmosis ocular,traumatismos,coriorretinopatía serosa central o miopía patológica•Lesiones q enmascaren la NVC
    Afecciones oculares concurrentes
    Ojo en studio
    •Desgarro del epitelio pigmentario retiniano subfoveal y/o yuxtafoveal•Trastornos de la esclerótica en el cuadr superotemporal•Trastornos de la conjuntiva(p.ej,pterigión,cicatrices,adelgazamiento,fibrosis)en cuadr superotemporal•Cualquier afección intraocular concurrente•Inflamación intraocular activa(trazas/grado superior)•Desprendimiento de retina regmatógeno/rotura de retina periférica en examen de fondo de ojo con depresión escleral,no tratados o tratados en los 3m previos a visita de aleat•Afaquia/ausencia de cápsula posterior•Traumatismo previo en cápsula posterior•Equivalente(equiv)esférico del error refractivo q demuestre miopía de +de 8dioptrías o evidencia de miopía patológica en examen de fondo de ojo con depresión escleral•Error refractivo preoperatorio q demuestre miopía de +de 8dioptrías•Equiv esférico del error refractivo q demuestre hipermetropía de+de 5 dioptrías•Error refractivo preoperatorio q demuestre hipermetropía de+ de 5dioptrías•Hipertensión ocular no controlada o glaucoma y cualquier afección de este tipo q el investigador considere q pueda requerir cirugía filtrante para glaucoma durante participación del sujeto•Anteced/presencia de blefaritis posterior grave,chalazión u orzuelo recurrente,síndrome de ojo seco grave o conjuntivitis alérgica grave•Ectropión,entropión,triquiasis u otras alteraciones del párpado sup. e inf. q afecten a funcionalidad de párpado necesaria para proteger la sup ocular de la exposición•Triquiasis,neuropatía corneal,lagoftalmos o parpadeo incompleto,parálisis facial/paresia activa/previa
    Ojo no en estudio(contralateral)
    •MAVC de movimiento de mano o peor•Ausencia física del ojo no en estudio•Ceguera legal conforme a la jurisprudencia del país del sujeto
    Cualquier ojo
    •Cualquier tipo uveítis activa/previa•Queratitis,escleritis,endoftalmitis o blefaritis crónica activas/previas•Conjuntivitis o endoftalmitis infecciosa ocular o periocular,presuntiva/ activa•Síndrome de Sjögren o queratoconjuntivitis seca,síndrome de párpado flácido frotamiento ocular crónico activos/ previos•Oftalmopatía tiroidea activa
    Afecciones sistémicas concurrentes
    •Presión arterial no controlada•Enfermedades autoinmunes activas/previas•Anteced de ictus en los3m previos al consentimiento informado(CI)•Fibrilación auricular diagnosticada o agravada 3m previos al CI•Infarto de miocardio 3m previos al CI•Anteced de otras enfermedades,alteraciones metabólicas(incluida diabetes no controlada)o hallazgos de lab clínico•Inf.sistémica activa confirmada•Uso de ag anti-VEGF sistémico•Uso crónico de corticoides orales•Cáncer activo previos a la aleat•Participación previa en estudio de enfermedades no oculares con fármacos(F) en investigación el mes previo al CI•Uso de antimitóticos/antimetabolitos30días previos a la visita de aleat o durante el equiv a 5semividas de eliminación del F•Necesidad de utilizar de forma continua de medicaciones o ttos no permitidos•Mujeres embarazadas,en período de lactancia o q tengan intención de quedarse embarazadas durante el período de tto y hasta 3m después de la última inyección intravítrea de ranibizumab o aflibercept o en el año siguiente al procedimiento final de recarga-intercambio del implante
    E.5 End points
    E.5.1Primary end point(s)
    1.Change from baseline in BCVA score averaged over Weeks 76 (or 78*) and 80, as assessed using the ETDRS visual acuity chart at a starting distance of 4 meters
    2.Treatment burden as assessed by the treatment frequency up to Week 80
    1.Variación en la puntuación de MVAC desde la situación basal hasta el promedio registrado entre las semanas 76 (o 78*) y 80, evaluada utilizando la cartilla de agudeza visual del ETDRS a una distancia inicial de 4 metros
    2.Carga del tratamiento, evaluada basándose en la frecuencia del tratamiento hasta la semana 80
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Baseline, Week 76 and Week 80
    2. Up to Week 80
    1. Basal, semana 76 y semana 80
    2. Hasta la semana 80
    E.5.2Secondary end point(s)
    1.Proportion of subjects with BCVA score of 69 letters (approximate 20/40 Snellen equivalent) or better averaged over Week 76 (Week 78 for some subjects) and Week 80
    2.Proportion of subjects with BCVA score of 38 letters (approximate 20/200 Snellen equivalent) or worse averaged over Weeks 76 (or 78) and 80
    3.Proportion of subjects who lose <15, < 10, or < 5 letters in BCVA score from baseline averaged over Weeks 76 (or 78) and 80
    4.Change from baseline in CPT, defined as the retinal thickness in the center point of the fovea measured between the internal limiting membrane and the inner third of the retinal pigment epithelium layer, on SD-OCT at Week 80
    5.Change from baseline in CST, defined as the average thickness of the central 1 mm circle of the ETDRS grid centered on the fovea measured between the internal limiting membrane and the Bruch’s membrane, on SD-OCT at Week 80
    6.Proportion of subjects randomized to PDS Q36W who do not undergo supplemental treatment with intravitreal ranibizumab 0.5 mg before each refill-exchange procedure
    7.Incidence and severity of ocular and systemic (non-ocular) adverse events
    8.Incidence, severity, and duration of adverse events of special interest, including ocular adverse events of special interest
    9.Incidence, severity, and duration of ocular adverse events of special interest during the postoperative period (≤ 37 days of initial implantation) and follow-up period (> 37 days after implantation surgery)
    10.Incidence and severity of adverse device effects with PDS Q36W
    11.Incidence, causality, severity, and duration of anticipated serious adverse device effects with PDS Q36W
    1. Porcentaje de sujetos que alcanzan una puntuación de MAVC e 69 letras (aproximadamente 20/40 en equivalentes de Snellen) o mejor, hasta el promedio registrado entre las semanas 76 (o 78 para algunos sujetos)y 80
    2. Porcentaje de sujetos que alcanzan una puntuación de MAVC de 38 letras (aproximadamente 20/200 en equivalentes de Snellen) o peor, hasta el promedio registrado entre las semanas 76 (o 78) y 80
    3. Porcentaje de sujetos con pérdida de < 15, < 10 o < 5 letras en la puntuación de MAVC desde la situación basal hasta el promedio registrado entre las semanas 76 (o 78) y 80
    4. Variación respecto al estado basal en el GPC, definido como el espesor de la retina en el punto central de la fóvea medido entre la membrana limitante interna y el tercio interno de la capa del epitelio pigmentario de la retina, en SD-OCT en la semana 80
    5. Variación respecto al estado basal en el GSC, definido como el espesor medio del círculo central de 1 mm de la cuadrícula ETDRS centrada en la fóvea, medido entre la membrana limitante interna y la membrana de Bruch, en SDOCT en la semana 80
    6. Porcentaje de sujetos aleatorizados a PDS C36S que no reciben tratamiento complementario con inyecciones intravítreas de 0,5 mg de ranibizumab antes de cada procedimiento de recarga-intercambio del implante
    7. Incidencia e intensidad de los acontecimientos adversos oculares y sistémicos (no oculares)
    8. Incidencia, intensidad y duración de los acontecimientos adversos de especial interés, incluidos los oculares
    9. Incidencia, intensidad y duración de los acontecimientos adversos oculares de especial interés durante el período postoperatorio (≤ 37 días del implante inicial) y el de seguimiento (> 37 días después de la cirugía del implante)
    10. Incidencia e intensidad de los efectos adversos del dispositivo con el PDS C36S
    11. Incidencia, causalidad, intensidad y duración de los efectos adversos graves previstos del dispositivo con el PDS C36S
    E.5.2.1Timepoint(s) of evaluation of this end point
    1-3. At Weeks 78 and 80
    4-5. Baseline and Week 80
    6. Up to approximately 40 months
    7-8. Up to approximately 40 months
    9. During the postoperative period (≤ 37 days of initial implantation) and follow-up period (> 37 days after implantation surgery)
    10-11. Up to approximately 40 months
    1-3. En las semanas 78 y 80
    4-5. En el momento basal y la semana80
    6. Hasta aproximadamente 40 meses
    7-8. Hasta aproximadamente 40 meses
    9. Durante el período postoperatorio (≤ 37 días del implante inicial) y el de seguimiento (> 37 días después de la cirugía del implante)
    10-11. Hasta aproximadamente 40 meses
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    multicentrizo, randomizado, dos brazos, ensayo con evaluador visual enmascarado
    multicenter, randomized, two-arm, visual assessor-masked trial
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    aflibercept T&E
    aflibercept T&E
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA108
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Yes
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Chile
    Hong Kong
    Singapore
    Thailand
    United Arab Emirates
    Argentina
    Austria
    Brazil
    Canada
    Czechia
    Denmark
    Finland
    Germany
    Greece
    Hungary
    Ireland
    Israel
    Italy
    Netherlands
    Norway
    Poland
    Portugal
    Spain
    Switzerland
    United Kingdom
    France
    E.8.7Trial has a data monitoring committee Yes
    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
    The end of this study is defined as the date when the last patient, last
    visit (LPLV) occurs or safety follow-up is received from the last patient
    whichever occurs later.
    El final de este estudio se define como la fecha en la que se produce la última visita del visita (UVUP) o cuando se reciba el seguimiento de seguridad del último paciente lo que ocurra más tarde.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months3
    E.8.9.1In the Member State concerned days10
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months3
    E.8.9.2In all countries concerned by the trial days10
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 56
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 90
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception Yes
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state30
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 447
    F.4.2.2In the whole clinical trial 560
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    The sponsor will terminate the trial once Ranibizumab becomes
    commercially available. Currently, the Sponsor does not have any plans
    to provide Ranibizumab to patients who have completed the study. The
    Sponsor may evaluate whether to continue providing Ranibizumab in
    accordance with the Roche Global Policy on Continued Access to
    Investigational Medicinal Product is available at the following website:
    http://www.roche.com/policy_continued_access_to_investigational_
    medicines.pdf
    El promotor terminará el ensayo una vez que Ranibizumab esté comercialmente disponible. Actualmente, el promotor no tiene previsto proporcionar Ranibizumab a los pacientes que han completado el estudio. El promotor puede evaluar si continúa proporcionando Ranibizumab de acuerdo con la Política Global de Roche sobre el Acceso Continuado que está disponible en el siguiente sitio web: http://www.roche.com/policy_continued_access_to_investigational_medicines.pdf
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-01-31
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-01-25
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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