comparison of treatment regimens using ranibizumab: intensive (resolution of intra- and sub-retinal fluid) vs relaxed (resolution of intra-retinal fluid and/or sub-retinal fluid >200µm at the foveal centre)

Conditions: Subfoveal Choroidal Neovascularization CNV Secondary to Wet Age-related Macular Degeneration AMD

Summary: to evaluate and compare two individualised ranibizumab treatment regimens, differentiated by the definition of disease activity, which determines the treatment interval until the next injection. the results will be used to generate recommendations about ranibizumab treatment when using an 'inject and extend' approach to maximise patient outcomes, while reducing the need for potentially unnecessary intravitreal injections. this study will also investigate if genotypic expression influences response to intravitreal injections of ranibizumab between the two treatment arms. the study hypothesis is that intravitreal ranibizumab when administered to resolve irf (and/or srf \>200 μm at the foveal centre) results in visual acuity benefit that is not clinically worse than intravitreal ranibizumab when administered to completely resolve both irf and srf in patients with wet amd


Eligibility criteria:
inclusion criteria: 1. diagnosis of subfoveal cnv secondary to wet amd without restriction of lesion size, with visual impairment being exclusively due to an active wet amd lesion. active lesions will be characterised by any of the following: abnormal retinal thickness, with evidence of intraretinal, subretinal or sub-pigment epithelial fluid accumulation, confirmed by oct; presence of intraretinal or subretinal haemorrhage; new leakage shown on a fa; cnv enlargement on fa unless solely due to dry, fibrotic staining; visual acuity deterioration considered likely to represent cnv. 2. bcva score at both screening and baseline must be 23 letters or more as measured by the early treatment diabetic retinopathy study (etdrs) logmar charts (a snellen visual acuity or equivalent of 20/320 or more may be used as an alternative at screening). exclusion criteria: 1. any active periocular or ocular infection or inflammation (e.g., blepharitis, conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) at the time of screening or baseline. 2. uncontrolled glaucoma (intraocular pressure \[iop\] ≥30 mm hg on medication) at the time of screening or baseline. 3. neovascularisation of the iris or neovascular glaucoma at the time of screening or baseline. 4. visually significant cataract, aphakia, severe vitreous haemorrhage, rhegmatogenous retinal detachment, proliferative diabetic retinopathy or cnv of any cause other than wet amd at the time of screening and baseline. 5. structural damage within 0.5 disc diameter of the centre of the macula (e.g., vitreomacular traction, epiretinal membrane, scar, laser burn, foveal atrophy) at the time of screening that in the investigator's opinion could preclude visual function improvement with treatment. 6. treatment with any anti-angiogenic drugs (including any anti-vegf agents) prior to baseline in study eye (allowed in fellow eye). 7. any intraocular procedure (including ytrium-aluminium- garnet capsulotomy) within 2 months prior to baseline or anticipated within the next 6 months following baseline in th study eye (allowed in fellow eye). other protocol-defined inclusion/exclusion criteria may apply.

Keywords: subfoveal choroidal neovascularization (cnv) wet age-related macular degeneration(amd) inject and extend retinal fluid