A Study to Understand Effectiveness and Safety of ABP 938 Compared to Aflibercept (Eylea®) in Patients Suffering With Neovascular Age-related Macular Degeneration [Neovascular (Wet) AMD]
Condition: Neovascular (Wet) Age-related Macular Degeneration (AMD)
MeSH terms: Macular Degeneration
Intervention: ABP 938; Aflibercept
Intervention description: Subject will receive ABP 938 2 mg (0.05 mL) IVT injection every 4 weeks for the first 3 doses, followed by once every 8 weeks; Subject will receive aflibercept 2 mg (0.05 mL) IVT injection every 4 weeks for the first 3 doses, followed by once every 8 weeks
Intervention MeSH terms: Aflibercept
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Masking description: The study is double-masked; therefore, the investigators, study personnel, and the study subjects will remain masked to treatment allocation. Unmasking is only allowed in the case of an emergency, when knowledge of the investigational product is essential for the clinical management of the subject.
Enrollment: 576.0
Sex: All
Minimum age: 50 Years
Healthy volunteers: No

Summary:

      The purpose of this study is to compare the efficacy and safety of ABP 938 versus Aflibercept
      (Eylea®) in the treatment of neovascular age-related macular degeneration. Subjects will be
      randomized in a masked 1:1 ratio to receive 2 mg (0.05 mL) of either ABP 938 (Treatment Group
      A) or aflibercept (Treatment Group B) administered by intravitreal (IVT) injection.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Subjects or their legally authorized representative must sign an Institutional Review
             Board/Independent Ethics Committee approved informed consent form before any
             study-specific procedures

          -  Men or women ≥ 50 years old

          -  Subjects must be diagnosed with neovascular (wet) AMD in the study eye

          -  Active treatment naïve subfoveal CNV lesions secondary to neovascular (wet) AMD
             including juxtafoveal lesions that affect the fovea as confirmed with SD OCT, FA
             and/or Fundus Photography (FP) in the study eye

          -  BCVA between 73 and 34 letters, inclusive, in the study eye using ETDRS testing

          -  Presence of intra and/or subretinal fluid as identified by SD-OCT attributable to
             active CNV in the study eye

          -  Central retinal thickness of > 270µm in the study eye as measured by the machine,
             calculated average thickness in the central 1 mm subfield (CST) by SD-OCT at screening

        Exclusion Criteria:

        Subjects are excluded if they meet any of the following criteria in the study eye:

          -  Total lesion size > 12 disc areas (30.5 mm^2, including blood, scars, and
             neovascularization) in the study eye

          -  Active CNV area (classic plus occult components) that is < 50% of the total lesion
             area in the study eye

          -  Scar, fibrosis, or atrophy involving the center of the fovea in the study eye

          -  Presence of retinal pigment epithelium tears or rips involving the macula in the study
             eye

          -  History of any vitreous hemorrhage within 4 weeks before randomization in the study
             eye

          -  Presence of other causes of CNV, including pathologic myopia (spherical equivalent of
             8 diopters or more negative or axial length of 25 mm or more), ocular histoplasmosis
             syndrome, angioid streaks, choroidal rupture, or multifocal choroiditis in the study
             eye

          -  Prior vitrectomy or laser surgery of the macula (including photodynamic therapy or
             focal laser photocoagulation) in the study eye

          -  History of retinal detachment in the study eye

          -  Any history of macular hole of stage 2 and above in the study eye

          -  Any macular pathology that might limit vision i.e., Vitreomacular traction or
             significant epiretinal membrane in the study eye

          -  Any intraocular or periocular surgery within 3 months before randomization on the
             study eye, except lid surgery, which may not have taken place within 4 weeks before
             randomization, as long as it is unlikely to interfere with the injection

          -  Prior trabeculectomy or other filtration surgery in the study eye

          -  Uncontrolled glaucoma (defined as intraocular pressure ≥ 25 mmHg despite treatment
             with antiglaucoma medication) in the study eye

          -  Aphakia or pseudophakia with complete absence of posterior capsule (unless it occurred
             as a result of a yttrium aluminum garnet [YAG] posterior capsulotomy) in the study eye

          -  Previous therapeutic radiation in the region of the study eye

          -  History of corneal transplant or corneal dystrophy in the study eye

          -  Significant media opacities, including cataract, which might interfere with visual
             acuity or assessment of safety, in the study eye

          -  Any concurrent intraocular condition other than neovascular (wet) AMD in the study eye
             that, in the opinion of the investigator, requires planned medical or surgical
             intervention during the study or increases the risk to the subject beyond what is
             expected from standard procedures of intraocular injection, or which otherwise may
             interfere with the injection procedure or with evaluation of efficacy or safety

        Subjects are excluded if they meet any of the following criteria in either eye:

          -  History or clinical evidence of uveitis, diabetic retinopathy, diabetic macular edema,
             or any other vascular disease affecting the retina, other than neovascular (wet) AMD

          -  Active intraocular inflammation or active or suspected ocular or periocular infection,
             within 2 weeks before randomization

          -  Active scleritis or episcleritis or presence of scleromalacia

        Other Medical Conditions

        • Active extraocular infection or history of extraocular infections as follows: A. any
        active infection for which systemic anti-infectives were used within 4 weeks before
        randomization B. recurrent or chronic infections or other active infection that, in the
        opinion of the investigator, might cause this study to be detrimental to the subject

          -  Acute coronary event or stroke within 3 months before randomization

          -  Uncontrolled, clinically significant systemic disease such as diabetes mellitus,
             hypertension, cardiovascular disease including moderate to severe heart failure (New
             York Heart Association class III/IV), renal disease, or liver disease

          -  Malignancy within 5 years EXCEPT treated and considered cured cutaneous squamous or
             basal cell carcinoma, in situ cervical cancer, OR in situ breast ductal carcinoma

        Washouts and Nonpermitted Treatments

          -  Any prior ocular or systemic treatment, including another investigational product or
             surgery for neovascular (wet) AMD (including anti vascular endothelial growth factor
             [VEGF] therapy) in the study eye, except dietary supplements or vitamins

          -  Any ocular or systemic treatment including another investigational product or surgery
             for neovascular (wet) AMD (including anti VEGF therapy) in the fellow eye, within 30
             days before randomization, except dietary supplements or vitamins

          -  Prior systemic anti-VEGF treatment as follows:

          -  Investigational or approved anti-VEGF therapy systemically within 3 months before
             randomization

          -  Aflibercept, ziv-aflibercept, or a biosimilar of aflibercept/ziv-aflibercept
             systemically at any time

          -  Any IVT therapy, including adrenocorticotropic hormone, in the study or fellow eye, or
             intramuscular or intravenous corticosteroids within 4 weeks before randomization. The
             use of long-acting steroids, either systemically or intraocularly, in the 3 months
             before randomization

          -  Currently receiving treatment with another investigational device or study drug, or
             less than 30 days or 5 half-lives (whichever is longer) since ending treatment on
             another investigational device or drug study(ies). Other investigational procedures
             while participating in this study are excluded

        General

          -  For women: pregnant or breast feeding, or planning to become pregnant while enrolled
             in the study and for 3 months after the last dose of investigational product

          -  Sexually active subjects and their partners who are of childbearing potential (ie,
             neither surgically sterile nor postmenopausal) and not agreeing to use adequate
             contraception (eg, true abstinence, sterilization, birth control pills, Depo Provera
             injections, contraceptive implants, or other effective methods) while on study and for
             3 months after the last dose of study drug. Male subjects must agree not to donate
             sperm during study and for 3 months following treatment with test article or until the
             scheduled end of the study (whichever is longer)

          -  Allergy or hypersensitivity to investigational product, to any of the excipients of
             ABP 938 or aflibercept, or to other study-related procedures/medications (eg,
             anesthesia, antiseptic, fluorescein dye)

          -  History or evidence of any other clinically significant disorder, condition, or
             disease (with the exception of those outlined above) that, in the opinion of the
             investigator or Amgen physician, if consulted, would pose a risk to subject safety or
             interfere with the study evaluation, procedures, or completion

          -  Subject likely to not be available to complete all protocol-required study visits or
             procedures, and/or to comply with all required study procedures (eg, Clinical Outcome
             Assessments) to the best of the subject and investigator's knowledge