Comparison of Safety, Effectiveness and Quality of Life Outcomes Between Labeled Versus Treat and Extend Regimen in Turkish Patients With Choroidal Neovascularisation Due to Age-related Macular Degeneration (AMD)

Study Overview
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Brief Summary
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The purpose of the study was to compare 2 treatment regimens for patients suffering from choroidal neovascularisation secondary to age-related macular degeneration (AMD). The first treatment regimen was the approved AMD treatment of 1 injection each month for 3 months and than re-treatment of patients who have a visual loss of more than 5 letters with monthly control (Treat and Observe). The second treatment regimen was 1 injection each month for 3 months and than extending the control period if the macula is dry during the monthly control (Treat and Extend). If the Treat and Extend regimen is found effective and safe, the number of ranibizumab injections, the number of patient visits, the risk of adverse events due to the intravitreal injections, and policlinic occupation number could all be reduced.

Official Title
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Comparison of Safety, Effectiveness, and Quality-of-life Outcomes Between Labeled Versus Treat and Extend Regimen in Turkish Patients With Choroidal Neovascularisation Due to AMD

Conditions
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Age-related Macular Degeneration

Intervention / Treatment
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* Drug: Ranibizumab 0.5 mg


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female patients over the age of 50. Patients with primary, secondary, or recurrent subfoveal choroidal neovascularization (CNV) to AMD with classic, minimal classic, or occult lesions. Patients with CNV area ≥ %50 of the total lesion. Total lesion area ≤ 12 disc areas for minimal classic/occult lesions and ≤ 9 disc areas for the classic lesions. Best-corrected visual acuity (BCVA) score between 73 and 34 letters in the study eye. Exclusion Criteria: BCVA < 34 letters. Patients using anti-angiogenic drugs (pegaptanib, ranibizumab, anecortave acetate, corticosteroids, or protein kinase C inhibitors, etc) or inclusion in another trial (for any eye). Verteporphin, external radiational therapy, subfoveal focal laser photocoagulation, vitrectomy, or transpupillary thermotherapy application to the eye before the study. Other protocol-defined inclusion/exclusion criteria may apply.

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treat and Extend<br>Patients received ranibizumab 0.5 mg intravitreally (ivt) once a month for 3 months. If the disease was inactive 4 weeks later, the next visit was postponed 2 weeks to 6 weeks later. If the disease was inactive during subsequent visits, the next visit was postponed an additional 2 weeks to 8 weeks later, the maximum interval between visits. If the disease became active at any visit, the patient received ranibizumab 0.5 mg ivt and the follow-up schedule started over. | Drug: Ranibizumab 0.5 mg<br>* Ranibizumab was supplied as a sterile solution in sealed glass vials.<br>* Other names: Lucentis;|
| Active Comparator: Treat and Observe<br>Patients received ranibizumab 0.5 mg intravitreally (ivt) once a month for 3 months. All subsequent visits occurred monthly. If the disease was active, the patient received ranibizumab 0.5 mg ivt. If the disease was inactive, no treatment was administered and the patient was instructed to return 1 month later. | Drug: Ranibizumab 0.5 mg<br>* Ranibizumab was supplied as a sterile solution in sealed glass vials.<br>* Other names: Lucentis;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Best-Corrected Visual Acuity (logMAR) From Baseline to Month 12 | Best corrected visual acuity (BCVA) was assessed in the study eye. BCVA measurements were made using the logarithm of the minimum angle of resolution (logMAR) visual acuity testing charts. Each letter on the chart has a score value of 0.02 log units. Since there are 5 letters per line, the total score for a line on the logMAR chart represents a change of 0.1 log units. The formula for calculating the logMAR BCVA score is: 0.1 + logMAR value of the best line read - 0.02 x number of letters read. A lower BCVA score indicates better vision. A negative change score indicates improvement. | Baseline to Month 12 | 
| Change in Letter Count From Baseline to Month 12 | Letter count was assessed in the study eye. Measurements were made using the logarithm of the minimum angle of resolution (logMAR) visual acuity testing charts. A higher letter count score indicates better vision. A negative change score indicates improvement. | Baseline to Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Letter Count From Baseline to Month 12 | Letter count was assessed in the study eye. Measurements were made using the logarithm of the minimum angle of resolution (logMAR) visual acuity testing charts. Results are reported in various categories of change in letter count. | Baseline to Month 12 | 
| Number of Visits |  | Baseline to Month 12 | 
| Follow-up Duration | Follow-up duration was defined as the number of days from Baseline to study discontinuation. | Baseline to Month 12 | 
| Change in Central Retinal Thickness From Baseline to Month 12 | Retinal thickness was measured using Optical Coherence Tomography (OCT). | Baseline to Month 12 | 
| Quality of Life | The National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) was used to measure a patient's subjective assessment of vision-related quality of life at Visits 2, 6, 9, 12, and 15. The 12 subscales in the VFQ-25 are general health, general vision, ocular pain, near activities, distance activities, social function, mental health, role difficulties, dependency, driving, color vision, and peripheral vision. The scores on the subscales were added together for a total score, which ranged from 0 to 100. A higher score indicated poorer function. | Visits 2, 6, 9, 12, and 15 (up to 12 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Macula degeneration, Ranibizumab, Choroidal neovascularisation, Treat and extend, Treat and observe