Study of DS-7080a for the Treatment of Macular Degeneration

Study Overview
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Brief Summary
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The purpose of this study is to test DS-7080a, a monoclonal antibody, as a new treatment for neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME). The hypothesis of the study is that DS-7080a is safe and shows preliminary efficacy in patients with these conditions either alone or in combination with ranibizumab. This study is organized into 3 Parts: Part 1 Dose Escalation in AMD participants, Part 2 Dose Expansion in AMD participants, and Part 3 Dose Expansion in DME participants. In Part 1, participants will be enrolled into 3 sequential, ascending dose-level cohorts in non-randomized uncontrolled manner with the main purpose to determine the recommended dose. In Part 2, participants will be randomized to 1 of 3 arms of either monotherapy with DS-7080a or monotherapy with ranibizumab, which is an active control, or combination therapy of DS-7080a plus ranibizumab (ranibizumab will be administered 30 minutes prior to DS-7080a). In Part 3, subjects with DME will be assigned to 1 of 2 arms of either monotherapy with DS-7080a or monotherapy with ranibizumab. DS-7080a or ranibizumab will be administered 3 times: on Baseline/Day 1, Day 29, and Day 57. Both Parts 2 and 3 will consist of 8 visits including a 14-day screening phase, an 84-day treatment period, and a 28-day follow-up period.

Official Title
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Phase I Dose Escalation and Expansion Study of DS-7080a in Subjects With Neovascular Age-related Macular Degeneration or Diabetic Macular Edema

Conditions
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Neovascular Age-Related Macular Degeneration, Diabetic Macular Edema

Intervention / Treatment
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* Drug: DS-7080a
* Drug: Ranibizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For parts 1 and 2: ≥ 50 years of age Has active primary subfoveal choroid neovascularization (CNV) lesions secondary to age-related macular degeneration (AMD) CNV ≥ 50% of total lesion size in study eye Central sub-field thickness > 315 µm on spectral domain optical coherence tomography (SD-OCT) in the study eye Has BCVA letter score required at screening visit: For Part 1, ≤ 49 (approximately 20/100 or worse) in the study eye and ≥ 49 (approximately 20/100 or better) in the fellow eye For Part 2, 78 to 25 (approximately 20/32 to 20/320) in the study eye For Part 3: Is ≥ 18 years of age with retinal thickening due to diabetic macular edema (DME) Has central sub-field thickness (CST) > 335 μm in the study eye Has BCVA letter score at screening visit 78 to 25 letters (approximately 20/32 to 20/320) in the study eye Exclusion Criteria: For Parts 1 and 2: Has used any long acting steroids, either systemically or intraocularly, within 6 months of Baseline Visit Has total lesion size > 12 disc areas (30.5 mm2) in the study eye Has presence of retinal pigment epithelial tears or rips involving the macula in the study eye Has history of any vitreous hemorrhage within 4 weeks prior to Screening Visit in the study eye Has presence of causes of CNV other than AMD Had prior vitrectomy in the study eye Has history of retinal detachment or treatment or surgery for retinal detachment in the study eye Has any history of a full thickness macular hole in the study eye Had any intraocular or periocular surgery within 3 months of Baseline Visit on the study eye, except lid surgery Has uncontrolled glaucoma in the study eye Has active intraocular inflammation or periocular infection in either eye Has any history of uveitis in either eye of scleromalacia in either eye Has aphakia or pseudophakia in the study eye Had previous therapeutic radiation in the region of the study eye Has history of corneal transplant or corneal dystrophy in the study eye Has significant media opacities in the study eye (e.g. cataract) that could require either medical or surgical intervention during the study period Is a women who is pregnant, breastfeeding, or of childbearing potential and unwilling to practice two measures of adequate contraception throughout the study For Part 1 only: Had any ocular (in the study eye) or systemic treatment or surgery for neovascular AMD within 4 weeks of Baseline Visit, except dietary supplements or vitamins Has a subretinal hemorrhage that is ≥ 50% of the total lesion area in the study eye Has scarring or fibrosis, making up >50% of total lesion or involving the center of the fovea in the study eye For Part 2 only: Had any prior therapy in the study eye within 3 months of Baseline Visit, except dietary supplements or vitamins For Part 3: Has used any steroids, either systemically or ocular in the study eye (other than fluocinolone), within 6 months of Baseline Visit Has macular edema in the study eye considered to be due to a cause other than DME Has high-risk proliferative diabetic retinopathy (PDR) in the study eye Has decrease in BCVA in the study eye due to causes other than DME Has significant macular ischemia in the study Has choroidal neovascularization (CNV) secondary to any etiology Has retinal pigment epithelial tears or rips involving the macula in the study eye Had any vitreous hemorrhage within 4 weeks prior to Screening/Visit 1 in the study eye Had prior vitrectomy in the study eye Has history of retinal detachment or treatment or surgery for retinal detachment in the study eye Has history of a full thickness macular hole in the study eye Had any intraocular or periocular surgery within 3 months of Baseline Visit Has uncontrolled glaucoma in the study eye Had prior trabeculectomy or other filtration surgery in the study eye Has active intraocular inflammation or periocular infection in either eye Has current or history of scleromalacia in either eye Has aphakia or pseudophakia with absence of posterior capsule Has previous therapeutic radiation in the region of the study eye Has history of corneal transplant or corneal dystrophy in the study eye Has concurrent ocular condition in the study eye which, in the opinion of the investigator, could either increase the risk to the subject beyond what is to be expected from standard procedures of intraocular injection, or which otherwise may interfere with the injection procedure or with evaluation of safety, tolerability, or efficacy Has systolic blood pressure ≥160 mmHg and/or a diastolic blood pressure ≥95 mmHg at Screening Has an estimated Glomerular Filtration Rate (eGFR) of < 15 mL/min/1.73 m^2 as per the creatinine equation (CKD-EPI) at Screening Has any history of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect interpretation of the results of the study or render the subject at high risk for treatment complications Is a women who is pregnant, breastfeeding, or of childbearing potential and unwilling to practice two measures of adequate contraception throughout the study

Ages Eligible for Study
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Minimum Age: 18 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
Interventional Model Description: Sequential Assignment with 3 cohorts in Part 1, Parallel Assignment with 3 arms in Part 2, and Parallel Assignment with 2 arms in Part 3
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Part 1 DS-7080a dose escalation<br>3 sequential ascending dose levels (1.0, 2.0, 4.0 mg), every 4 weeks for 12 weeks | Drug: DS-7080a<br>* 1.0, 2.0, or 4.0 mg administered by a 50 μL intravitreal (IVT) injection of solution<br>* Other names: Investigational product;|
| Experimental: Part 2 DS-7080a<br>Specific dose (either the maximum tolerated dose or 4.0 mg) of DS-7080a determined in Part 1, every 4 weeks for 12 weeks | Drug: DS-7080a<br>* 1.0, 2.0, or 4.0 mg administered by a 50 μL intravitreal (IVT) injection of solution<br>* Other names: Investigational product;|
| Active Comparator: Part 2 ranibizumab<br>Ranibizumab 0.5 mg, every 4 weeks for 12 weeks | Drug: Ranibizumab<br>* 0.3 mg or 0.5 mg administered by a 50 μL IVT injection of solution<br>* Other names: Lucentis;|
| Experimental: Part 2 DS-7080a and ranibizumab<br>Specific dose of DS-7080a determined in Part 1 and ranibizumab 0.5 mg, every 4 weeks for 12 weeks | Drug: DS-7080a<br>* 1.0, 2.0, or 4.0 mg administered by a 50 μL intravitreal (IVT) injection of solution<br>* Other names: Investigational product;Drug: Ranibizumab<br>* 0.3 mg or 0.5 mg administered by a 50 μL IVT injection of solution<br>* Other names: Lucentis;|
| Experimental: Part 3 DS-7080a<br>Specific dose of DS-7080a determined in Part 1, every 4 weeks for 12 weeks | Drug: DS-7080a<br>* 1.0, 2.0, or 4.0 mg administered by a 50 μL intravitreal (IVT) injection of solution<br>* Other names: Investigational product;|
| Experimental: Part 3 ranibizumab<br>Ranibizumab 0.3 mg, every 4 weeks for 12 weeks | Drug: Ranibizumab<br>* 0.3 mg or 0.5 mg administered by a 50 μL IVT injection of solution<br>* Other names: Lucentis;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants experiencing any treatment-emergent adverse event (TEAE) | Treatment-emergent AEs (TEAEs) are defined as those adverse events (AEs) that were new or got worse between the start of study treatment and the end of the follow-up period. | 16 weeks | 
| Best Corrected Visual Acuity (BCVA) score | Visual acuity of both eyes will be assessed at all study visits using the Early Treatment Diabetic Retinopathy Study (ETDRS) letter score. The patient starts are the top of the chart and begins to read down the chart. The patient reads down the chart until he or she reaches a row where a minimum of three letters on a line cannot be read. The patient is scored by how many letters could be correctly identified. Added to the score for the last row where the participant could read all five letters correctly are scores for each additional letter that could be read correctly in the next row. This is the BCVA score. A higher score means better visual acuity (sharpness of vision). | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in retinal thickness and volume | Retinal thickness and volume are assessed by spectral domain optical coherence tomography (SD-OCT) | 12 weeks | 
| Change from baseline in retinal leakage | Retinal leakage is assessed by fluorescein angiography (FA) | 12 weeks | 
| Plasma concentrations | Concentration of study drug in blood plasma | 12 weeks | 
| Part 3 only: Change from baseline in vessel flow density, foveal avascular zone (FAZ) area, and FAZ shape | Vessel flow density, foveal avascular zone (FAZ) area, and FAZ shape are assessed by OCT angiography (OCT-A) | 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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DS-7080a Monoclonal Antibody