Diabetic Macular Edema Asian Response (DEAR) Study: Biomarkers for Response to Aflibercept in Asian Patients With Center Involving DME

Study Overview
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Brief Summary
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To investigate whether ocular imaging and proteomic biomarkers; and systemic biochemical, metabolomic, and genetic biomarkers predict treatment response to intravitreal aflibercept in a cohort of patients with DME.

Detailed Description
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This is a prospective observational clinical trial with only the use of a standard care of drug, aflibercept. All study eyes will receive intravitreal aflibercept at the initial injection and x 4 monthly injections including at month 3.

Official Title
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Identifying Ocular and Systemic Biomarkers for Response to Aflibercept in Asian Patients With Centre Involving Diabetic Macular Edema: A Prospective Clinical Trial

Conditions
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Diabetic Macular Edema

Intervention / Treatment
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* Drug: Aflibercept Injection [Eylea]


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant Age >=21 years Diagnosis of Diabetes Mellitus (Type 1 or type 2) Current regular use of insulin or oral hypoglycemic agents for treatment of diabetes Documented diabetes by ADA and/or WHO criteria. Able and willing to provide informed consent. Study Eye Best corrected ETDRS visual acuity score <= 78 (ie 20/32 or worse) On Clinical Examination, definite retinal thickening due to diabetic macular edema involving the center of the macula. Diabetic macular edema present on OCT (central subfield thickness on OCT >=300um with spectralis (Heidelberg) Media clarity, pupillary dilation and individual cooperation sufficient for study procedure including fundus photography. Exclusion Criteria: Participant End stage renal failure requiring hemodialysis or peritoneal dialysis. Medical condition that, in the opinion of the investigator, would preclude participation in the study (e.g., unstable medical status including blood pressure, cardiovascular disease, and glycemic control). Participation in an investigational trial within 30 days of enrolment which involves treatment with unapproved investigational drug Known allergy to any component of the study drug. Blood pressure > 180/110 (systolic above 180 OR diastolic above 110 on repeated measurements). If blood pressure is brought below 180/110 by anti-hypertensive treatment, individual can become eligible. Myocardial infarction, other acute cardiac event requiring hospitalization, stroke, transient ischemic attack, or treatment for acute congestive heart failure within 4 months prior to randomization. Systemic anti-VEGF or pro-VEGF treatment within three months prior to randomization or anticipated use during the study. For women of child-bearing potential: pregnant or lactating or intending to become pregnant within the next 24 months. Women who are potential study participants should be questioned about the potential for pregnancy. Patient with non study eye VA: counting finger or worse (i.e. only one seeing eye) will be excluded. Study Eye Macular edema is considered to be due to a cause other than diabetic macular edema. An eye should not be considered eligible if: (1) the macular edema is considered to be related to ocular surgery such as cataract extraction or (2) clinical exam and/or OCT suggest that vitreoretinal interface abnormalities (e.g., a taut posterior hyaloid or epiretinal membrane) are the primary cause of the macular edema. An ocular condition is present such that, in the opinion of the investigator, visual acuity loss would not improve from resolution of macular edema (e.g., foveal atrophy, pigment abnormalities, dense subfoveal hard exudates, nonretinal condition). An ocular condition is present (other than diabetes) that, in the opinion of the investigator, might affect macular edema or alter visual acuity during the course of the study (e.g., vein occlusion, uveitis or other ocular inflammatory disease, neovascular glaucoma, etc.) Substantial cataract that, in the opinion of the investigator, is likely to be decreasing visual acuity by more than three lines (i.e., cataract would be reducing acuity to worse than 20/40 if eye was otherwise normal). History of an anti-VEGF treatment for DME in the past 3 months or history of any other treatment for DME at any time in the past 3 months (such as focal/grid macular photocoagulation, intravitreal or peribulbar corticosteroids). History of pan-retinal photocoagulation within 3 months prior to randomization or anticipated need for immediate pan-retinal photocoagulation. (eg. Proliferative diabetic retinopathy. Cases with severe non-proliferative diabetic retinopathy will still be eligible) History of ocular anti-VEGF treatment for a disease other than DME in the past 3 months History of major ocular surgery (including vitrectomy, cataract extraction, scleral buckle, any intraocular surgery, etc.) within prior four months or anticipated within the next six months following randomization. History of YAG capsulotomy performed within two months prior to randomization. Aphakia. Exam evidence of external ocular infection, including conjunctivitis, chalazion, or significant blepharitis. History of intravitreal steroids within the last 6 months.

Ages Eligible for Study
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Minimum Age: 21 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
Intervention Model: Single Group Assignment
Interventional Model Description: This is a prospective observational clinical trial with only the use of a standard care of drug, aflibercept. All study eyes will receive intravitreal aflibercept at the initial injection and x 4 monthly injections including at month 3.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: DME treatment group<br>All patients will received 4 intravitreal injections of aflibercept. Based on the OCT outcome they will be classified into 2 groups for assessment of biomarkers: Less than 20% reduction in CRT on OCT or <5 letter improvement of VA (if VA<6/6 and CRT>=340) Rapid (Mac Dry at M4) Delayed: Persistent fluid at M4, but more than 20% reduction in CRT on OCT | Drug: Aflibercept Injection [Eylea]<br>* All subjects will receive 4 monthly intravitreal injections of aflibercept<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CRT | Mean change in Central Retinal Thickness | 12 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| BCVA | Mean change in Best Corrected Visual Acuity | 12 Months | 
| Change in vascular density by OCTA | Change in vascular density by OCTA in different layer | Baseline, Month 12 | 
| Percentage of patients with a BCVA improvement of 15 letters or more | Percentage of patients with a BCVA improvement of 15 letters or more | Baseline, Month 12 | 
| Percentage of patients with a BCVA improvement of 10 letters or more | Percentage of patients with a BCVA improvement of 10 letters or more | Baseline, Month 12 | 
| Mean BCVA at each injection number | Mean BCVA at each injection number | 12 Months | 
| Mean change in BCVA across all the study injection numbers | Mean change in BCVA across all the study injection numbers | Baseline, Month 12 | 
| Percentage of patients with BCVA improvement | Percentage of patients with BCVA improvement | Baseline, Month 12 | 
| Percentage of BCVA losers | Percentage of BCVA losers | Baseline, Month 12 | 
| Percentage of patients improving to 20/40 or better | Percentage of patients improving to 20/40 or better | Baseline, Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anti-Vascular Endothelial Growth Factor, Aflibercept, Intravitreal injection, Diabetic Macular Edema