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    Summary
    EudraCT Number:2021-003226-71
    Sponsor's Protocol Code Number:MR42410
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-07-08
    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 ConcernedItaly - Italian Medicines Agency
    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)
    STUDIO DI FASE IIIB, MULTICENTRICO, RANDOMIZZATO, CON ESAMINATORE DI ACUITA’ VISIVA IN CIECO, SULL’EFFICACIA E LA SICUREZZA DI UN REGIME DI RICARICA OGNI 36 SETTIMANE PER PER L’IMPIANTO INTRAVITREALE DI SOMMINISTRAZIONE A RILASCIO GRADUALE (PDS) DI RANIBIZUMAB VS. AFLIBERCEPT TREAT AND EXTEND IN PAZIENTI AFFETTI DA DEGENERAZIONE MACULARE LEGATA ALL’ETÀ DI TIPO NEOVASCOLARE (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)
    STUDIO per valutare L’EFFICACIA E LA SICUREZZA DI UN REGIME DI RICARICA OGNI 36 SETTIMANE PER PER L’IMPIANTO INTRAVITREALE DI SOMMINISTRAZIONE A RILASCIO GRADUALE (PDS) DI RANIBIZUMAB VS. AFLIBERCEPT TREAT AND EXTEND IN PAZIENTI AFFETTI DA DEGENERAZIONE MACULARE LEGATA ALL’ETÀ DI TIPO NEOVASCOLARE (DIAGRID)
    A.3.2Name or abbreviated title of the trial where available
    MR42410
    MR42410
    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 SponsorF. 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 number0000000
    B.5.5Fax number0000000
    B.5.6E-mailglobal.rochegenentechtrials@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 Yes
    D.2.1.1.1Trade name Lucentis
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis
    D.2.1.2Country which granted the Marketing AuthorisationUnited States
    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 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 INNRANIBIZUMAB
    D.3.9.1CAS number 347396-82-1
    D.3.9.2Current sponsor codena
    D.3.9.4EV Substance CodeSUB22314
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number1
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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: 2
    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/infusion
    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.3.9.2Current sponsor codena
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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: 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 EU/1/12/797/001
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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: 4
    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 EU/1/17/1220/001
    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 cartridge
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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)
    Degenerazione maculare neovascolare correlata all'età (AMD)
    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.
    L'AMD umida, è una forma di AMD avanzata che causa la perdita della vista centrale e rimane una delle principali cause di disabilità visiva negli anziani.
    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
    L’obiettivo primario di questo studio è valutare l’efficacia di PDS Q36W rispetto ad aflibercept T&E sulla base degli endpoint co-primari:
    • Variazione rispetto al basale del punteggio BCVA (Best Corrected Visual Acuity, BCVA) calcolato come media sulle settimane 76 (o 78*) e 80, valutato utilizzando la tabella di acuità visiva ETDRS (Early Treatment Diabetic Retinopathy Study) a una distanza iniziale di 4 metri
    • Onere della terapia, valutato in base alla frequenza del trattamento fino alla Settimana 80.
    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
    Per valutare l'efficacia di PDS Q36W rispetto ad aflibercept T&E sulla base di (1) punteggio dell'acuità visiva (BCVA) con la migliore correzione alla fine dello studio o modifica del punteggio BCVA, (2) variazione dello spessore del punto centrale (CPT) e del sottocampo centrale spessore (CST)
    •Valutare la proporzione di soggetti nel gruppo PDS che non necessitano di un trattamento intravitreale supplementare
    •Per valutare la sicurezza di PDS Q36W e aflibercept T&E
    •Valutare la sicurezza relativa al dispositivo PDS e alle procedure 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
    Criteri di inclusione di carattere generale
    Per essere ammessi nello studio, i soggetti devono soddisfare i seguenti criteri generali di inclusione allo screening e alla randomizzazione:
    1. Firma del modulo di consenso informato
    2. Età = 50 anni al momento della firma del modulo di consenso informato
    3. Capacità e volontà di sottoporsi a tutte le visite e le valutazioni programmate
    4. Per le donne potenzialmente fertili: consenso a praticare l’astinenza sessuale oppure a utilizzare misure contraccettive, e nella fattispecie:
    Le donne devono praticare l’astinenza o utilizzare metodi contraccettivi caratterizzati da un tasso di insuccesso < 1% l’anno durante il periodo di trattamento e per almeno 3 mesi dopo l’ultima iniezione intravitreale di ranibizumab o aflibercept, o per 1 anno dopo l’ultimo reintegro dell’impianto di ranibizumab.
    Una donna è ritenuta potenzialmente fertile se ha avuto il menarca, non ha raggiunto uno stato di postmenopausa e non si è sottoposta a sterilizzazione permanente mediante chirurgia (asportazione di ovaie, tube di Falloppio e/o utero) o non è sterile per altra causa stabilita dallo sperimentatore (per es. agenesia mülleriana). Sulla base di questa definizione, una donna che ha ricevuto la legatura delle tube è considerata come in età fertile. La definizione di donna potenzialmente fertile potrebbe dover essere adeguata per allinearsi alle linee guida o alle normative locali.
    Esempi di metodi contraccettivi con tasso di fallimento < 1% l’anno sono legatura bilaterale delle tube, sterilizzazione maschile, contraccettivi ormonali che inibiscono l’ovulazione, dispositivi intrauterini a rilascio di ormoni e dispositivi intrauterini di rame.
    L’affidabilità dell’astinenza sessuale deve essere valutata in relazione alla durata della sperimentazione clinica e allo stile di vita preferito e abituale del soggetto. Astinenza periodica (per es. calcolo dei giorni fertili e dell’ovulazione, metodo sintotermico, metodo postovulazione) e coito interrotto non sono ritenuti metodi di contraccezione adeguati. Se richiesto dalle linee guida o dalle normative locali, nel modulo di consenso informato locale dovranno essere specificati i metodi contraccettivi ritenuti adeguati localmente e le informazioni sull’affidabilità dell’astinenza.

    Criteri di inclusione oculari
    Per essere ammessi nello studio, i soggetti devono soddisfare i seguenti criteri di inclusione oculari:
    5. Diagnosi iniziale di nAMD nei 9 mesi precedenti la visita di screening
    6. Precedente trattamento con almeno tre iniezioni intravitreali di anti-VEGF per nAMD secondo lo standard di cura nei 6 mesi precedenti la visita di screening
    7. Risposta dimostrata al precedente trattamento intravitreale anti-VEGF dalla diagnosi, attestata dai seguenti parametri:
    a) Diminuzione complessiva dell’attività della malattia nAMD rilevata alla SD-OCT, secondo la valutazione dello sperimentatore e la conferma dalla struttura di interpretazione centrale
    e
    b) BCVA stabile o migliorata alla randomizzazione
    8. Disponibilità di dati storici sull’acuità visiva ottenuti alla diagnosi di nAMD o successivamente e prima del primo trattamento anti-VEGF per nAMD
    9. Disponibilità di dati storici di imaging SD-OCT ottenuti alla diagnosi di nAMD o successivamente e prima del primo trattamento anti-VEGF per nAMD
    10. BCVA di 34 lettere o superiore , utilizzando la tabella ETDRS a una distanza iniziale di 4 metri alle visite di screening e di randomizzazione
    11. Presenza di lesioni dovute a un sottotipo di nAMD
    a. Le lesioni da nAMD essudativa al momento della diagnosi devono interessare la macula (diametro di 6 mm centrato sulla fovea)
    12. Sufficiente trasparenza dei mezzi oculari e dilatazione pupillare adeguata per consentire l’esame clinico e l’analisi e la classificazione da parte della struttura di interpretazione centrale della fotografia del fondo oculare , FA, immagini di autofluorescenza del fondo oculare e immagini di SD-OCT
    E.4Principal exclusion criteria
    Prior Ocular Treat Study Eye•History of vitrectomy surgery, submacular surgery, or other surgical intervention for AMD •Prior pars plana vitrectomy surgery•Prior treat with Visudyne, external-beam radiation therapy, or transpupillary thermotherapy• corticosteroid intravitreal injection•Previous intraocular device implantation•Previous intraocular surgery within 3 m of random•Previous laser used for AMD or diabetic retinopathy treat•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 quadrantEither Eye•History of a severe allergic reaction or anaphylactic reaction to a biologic agent or known hypersensitivity to any component of the ranib or afli injections, study-related procedure preparations, dilating drops, or any of the anesthetic and antimicrobial prep used by a subject•Any contraindication to afli•Prior participation in a clinical trial involving any anti-VEGF drugs •Prior treat with brolucizumab, external-beam radiation therapy or brachytherapyMacular neovascularization Lesion CharacteristicsStudy 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 lesionsConcurrent Ocular •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 •Rhegmatogenous retinal tears or peripheral retinal breaks on depressed fundus exam that are untreated •Aphakia or absence of the posterior capsule•Previous violation of the posterior capsule•Spherical equivalent of the refractive error•Preoperative refractive error that exceeds 8 diopters of myopia•Spherical equivalent of the refractive error•Preoperative refractive error that exceeds 5 diopters of hyperopia•Uncontrolled ocular hypertension or glaucoma•History or presence 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/paresisNon-Study Eye•BCVA of hand motion or worse•No physical presence of non-study eye•Legally blind in the subject’s relevant jurisdictionEither 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 diseaseConcurrent Systemic Conditions•Uncontrolled blood pressure•Active or history of autoimmune diseases•History of stroke within the last 3 prior to icf•Atrial fibrillation diagnosed or worsened within the last 3 prior to icf•History of myocardial infarction within the last 3 m prior to icf•History of other disease, metabolic dysfunction ,or lab finding•Confirmed active systemic infection•Use of any systemic anti-VEGF agents•use of oral corticoster.•Active cancer within 12 of random•Previous participation in any non-ocular disease studies of investigational drugs within 1 prec icf•Use of antimitotic or antimetabolite therapy within 30 D or 5 elimination half-lives of the random visit•Requirement for continuous use of any medications or treat prohibited in the study•Pregnant or breastfeeding
    Tratt oftalmico prec Occhio in studio1An di vitrectomia, chir submaculare o interv per AMD2Prec interv di vitrectomia via pars plana 3Prec tratt con Visudyne,RT a fasci ext o termoterapia transpupill4Prec tratt con iniez intravitr corticosteroidi 5Prec impianto dispos intraoculare6interv nei 3 m prec la randomizz7Prec laser per il tratt di nAMD o retinopatia diabetica 8An di emorragia del vitreo9An di distacco retinico regmatogen10pat della congiuntiva,capsula di Tenone e/o sclera11An di interv chir di filtr del glaucoma, posiz di shunt o int microinvasivo per glaucoma12An di trapianto corneale13An di chir congiuntivale.Entrambi occhi14An di reazione allerg grave o reaz anafil o ipersensib a compon delle iniez o delle preparaz di studio15controindicaz ad aflibercept16partecipaz a studio clin con farmaci per nAMD prec a screen17Prec tratt con brolucizumab e ter genica per nAMD18Prec tratt con RT a fasci est o brachiterapia.Caratter lesioni MNV(CNV)Occhio in studio19Emorr sottoretinica coinvolge centro fovea20Fibrosi subfoveale o atrofia subfoveale Entrambi occhi21CNV per altre cause22Lesioni mascher da CNV Pat oculari concomitanti Occhio in studio23Distacco epitelio pigmentato retinico subfoveale e/o iuxtafoveale24Patol sclera nel quadrante supero-temporale25Patol congiuntivali nel quadrante supero-temporale26patologie intraocular che richied interv durante studio27Infiammaz intraoculare attiva28Distacchi retinici regmatogeni o rotture retiniche periferiche all’esame del fondo oculare depresso non tratt o tratt nei 3 m prec la visita di randomizz 29Afachia o assenza della capsula posteriore30Equiv sferico dell’errore refrattivo con più di 8 diottrie di miopia o miopia pato all’esame del fondo oculare depresso31Errore refrattivo preoperatorio che supera le 8 diottrie di miopia, per i sog sottoposti in prec a chir refrattiva o della cataratta nell’occhio in studio32Equiv sferico dell’errore refrattivo che attesta più di 5 diottrie di ipermetropia33Errore refrattivo preoperat che supera le 5 diottrie di ipermetropia, per sog sottoposti in prec a interventi di chirurgia refrattiva o della cataratta34Ipertens oculare nc o glaucoma e condizioni che potrebb richiedere interv di filtraggio del glaucoma35An o presenza di blefarite posteriore grave,calazio o orzaiolo ricorrente, sindrome dell’occhio secco grave o congiuntivite allergica grave36Ectropion,entropion,ciglia incarnite o altra compromiss funzionalità della palpebra37Trichiasi38Neuropatia corneale39Lagoftalmo o battito delle palpebre incompleto40An o presenza di paralisi/paresi del nervo facciale.Occhio non in studio 41non funzionante, così def : a)BCVA appena suffic a individuare il movim di una mano o peggiore b)Assenza dell’occhio non in studio.Entrambi gli occhi42An o presenza di uveite43An o presenza di cheratite, sclerite, endoftalmite o blefarite cronica44Congiuntiv infettiva oculare o perioculare o endoftalmite45An o presenza di sindrome di Sjögren o cheratocongiuntivite sicca46An o presenza di sindrome della palpebra flaccida47An o presenza di sfregamento oc cronico48Oftalmopatia tiroidea in atto49Incapacità di rispettare il progr o proc di studio50P arteriosa non controllata51An o presenza di malattie autoimmuni52Anamnesi di ictus nei 3 m prec il icf53Fibrillaz atriale diagnosticata o peggiorata nei 3 icf54An di infarto miocardico nei 3 m prec icf55An di altre patologie, disf metaboliche o riscontri di lab per cui uso di ranibizumab,aflibercept o il posiz dell’impianto è controind 56Infez sistemica attiva confermata 57Uso sistemico di anti-VEGF 58Uso cronico di corticosteroidi orali 59Neoplasia attiva nei 12 m prec la rando, eccetto K in situ della cervice, cutaneo non-melanoma e K prostatico con Gleason =6 e Ag prostatico specifico stabile da > 12 m 60Preced partecipaz a studi con IMP nel m prec il icf 61terapia con antimitotici o antimetaboliti nei 30 go 5 t1/2 prec la visita di random 62uso di medicinale o tratt proibito63Gravidanza o allatt, o pianif di grav
    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.Variazione rispetto al basale del punteggio BCVA mediato nelle settimane 76 (o 78*) e 80, come valutato utilizzando il grafico dell'acuità visiva ETDRS a una distanza iniziale di 4 metri
    2. Carico del trattamento valutato dalla frequenza del trattamento fino alla settimana 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. Baseline, settimana 76 e settimana 80
    2. Fino alla settimana 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. Percentuale di soggetti con punteggio BCVA di 69 lettere (circa 20/40 Snellen equivalente) o una media migliore della settimana 76 (settimana 78 per alcuni soggetti) e della settimana 80
    2. Percentuale di soggetti con punteggio BCVA di 38 lettere (circa 20/200 equivalenti Snellen) o peggiore mediato nelle Settimane 76 (o 78) e 80
    3. Percentuale di soggetti che perdono <15, < 10 o < 5 lettere nel punteggio BCVA dal basale mediato nelle settimane 76 (o 78) e 80
    4.Variazione rispetto al basale in CPT, definito come lo spessore retinico nel punto centrale della fovea misurato tra la membrana limitante interna e il terzo interno dello strato di epitelio pigmentato retinico, su SD-OCT alla settimana 80
    5.Variazione rispetto al basale in CST, definita come lo spessore medio del cerchio centrale di 1 mm della griglia ETDRS centrata sulla fovea misurata tra la membrana limitante interna e la membrana di Bruch, su SD-OCT alla settimana 80
    6. Percentuale di soggetti randomizzati a PDS Q36W che non si sottopongono a trattamento supplementare con ranibizumab intravitreale 0,5 mg prima di ciascuna procedura di sostituzione delle ricariche
    7.Incidenza e gravità degli eventi avversi oculari e sistemici (non oculari).
    8.Incidenza, gravità e durata degli eventi avversi di particolare interesse, compresi gli eventi avversi oculari di particolare interesse
    9. Incidenza, gravità e durata degli eventi avversi oculari di particolare interesse durante il periodo postoperatorio (= 37 giorni dall'impianto iniziale) e il periodo di follow-up (> 37 giorni dopo l'intervento chirurgico di impianto)
    10.Incidenza e gravità degli effetti avversi del dispositivo con PDS Q36W
    11.Incidenza, causalità, gravità e durata degli effetti avversi gravi previsti dal dispositivo con PDS Q36W
    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. Alle settimane 78 e 80
    4-5. Baseline e settimana 80
    6. Fino a circa 40 mesi
    7-8. Fino a circa 40 mesi
    9. Durante il periodo postoperatorio (= 37 giorni dall'impianto iniziale) e il periodo di follow-up (> 37 giorni dopo l'intervento di impianto)
    10-11. Fino a circa 40 mesi
    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 Yes
    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
    studio multicentrico, randomizzato, a due bracci, con maschera per il valutatore visivo
    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 concerned10
    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 Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Brazil
    Canada
    Chile
    Hong Kong
    Israel
    Singapore
    Thailand
    United Arab Emirates
    Austria
    Finland
    France
    Poland
    Netherlands
    Spain
    Switzerland
    Czechia
    Germany
    Greece
    Italy
    Denmark
    Hungary
    Ireland
    Norway
    Portugal
    United Kingdom
    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.
    La fine di questo studio è definita come la data in cui l'ultimo paziente, ultimo
    si verifica la visita (LPLV) o si riceve un follow-up di sicurezza dall'ultimo paziente
    qualunque cosa accada dopo.
    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: 504
    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 No
    F.3.3.2Women of child-bearing potential using contraception Yes
    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 state37
    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
    Lo sponsor interromperà il processo una volta diventato Ranibizumab disponibili commercialmente. Attualmente, lo Sponsor non ha piani
    fornire Ranibizumab ai pazienti che hanno completato lo studio. Il Lo sponsor può valutare se continuare a somministrare Ranibizumab
    in conformità con la politica globale di Roche sull'accesso continuo a Il medicinale sperimentale è disponibile al seguente sito web:
    http://www.roche.com/policy_continued_access_to_investigational_farmaci.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 Decision2022-09-20
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-28
    P. End of Trial
    P.End of Trial StatusOngoing
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