Clinical trial NCT01579760: Intravitreal Aflibercept Injection for Radiation Retinopathy
Official title: Treatment of Radiation Retinopathy With Intravitreal Aflibercept Injection 2.0mg
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Radiation Retinopathy
Macular Edema
Keywords: radiation
retinopathy
macular edema
anti-VEGF
VEGF-Trap
aflibercept
Lead sponsor: Washington University School of Medicine
Sponsor class: OTHER
Collaborators: name: Regeneron Pharmaceuticals
First posted: 2012-04-18
Enrollment: 9
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to assess the safety of intravitreal aflibercept injection - in the treatment of macular edema associated with retinopathy secondary to previous radiation therapy.

Detailed description: Radiation retinopathy can cause decreased vision in patients who have received either external beam radiation or local plaque therapy to the eye. An early manifestation of radiation retinopathy is macular edema, which represents fluid within the retina that affects central vision. There is currently no approved treatment for this disease, although there have been anecdotal reports of benefit with laser photocoagulation, intravitreal anti-VEGF agents, or intravitreal steroid use. This is a phase 1 study to evaluate aflibercept for the treatment of macular edema associated with retinopathy secondary to previous radiation treatment.

Eligibility criteria: Inclusion Criteria:

* Retinopathy associated with previous I-125 brachytherapy for uveal melanoma (85 Gy over 96 hours) at least 6 months prior to enrollment
* Ability to provide written informed consent and comply with study assessments for the full duration of the study
* Age \> 18 years
* Center involved macular edema \> 300µm in thickness on SD-OCT
* Best corrected visual acuity of 20/40- 20/400
* Birth control therapy for females of child-bearing age

Exclusion Criteria:

* Pre-existing retinopathy due to other disorders
* Vision decrease is considered to be due to ischemic radiation retinopathy without macular edema or optic neuropathy
* Presence of metastasis
* Pregnancy (positive pregnancy test) or lactation
* Premenopausal women not using adequate contraception. The following are considered effective means of contraception: surgical sterilization or use of oral contraceptives, barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel, an IUD, or contraceptive hormone implant or patch.
* Prior enrollment in any study with intravitreal aflibercept injection
* Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated
* Uncontrolled glaucoma in the study eye (defined as IOP ≥ 30 mmHg despite treatment with anti-glaucoma medication)
* History of cerebral vascular accident, myocardial infarction, transient ischemic attacks within 4 months of study enrollment.
* Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye
* Any concurrent intraocular condition in the study eye (e.g., cataract or diabetic retinopathy) that, in the opinion of the investigator, could either require medical or surgical intervention during the study period to prevent or treat visual loss that might result from that condition, or if allowed to progress untreated, could likely contribute to loss of at least 2 Snellen equivalent lines of BCVA over the 6-month study period
* Presence of significant subfoveal fibrosis or atrophy
* Intraocular surgery (including cataract surgery) in the study eye within 2 months of enrollment
* Active intraocular inflammation (grade trace or above) in the study eye
* History of allergy to fluorescein, ICG or iodine, not amenable to treatment
* Prior/Concomitant Treatment:
* Panretinal photocoagulation treatment
* Previous intraocular steroids or PDT within 3 months
* Previous participation in any studies of investigational drugs within 30 days preceding Day 0 (excluding vitamins and minerals)
* Previous treatment with intravitreally (in either eye) or intravenously administered Avastin (bevacizumab) within 60 days or concomitant use in either eye outside the scope of this study
* Previous use of Eylea, Macugen or Lucentis in study eye within 60 days or concomitant use in either eye outside the scope of this study
* Prior submacular or vitreous surgery

Primary outcomes:
measure: Incidence of adverse events
timeFrame: 12 months
measure: Severity of adverse events
timeFrame: 12 months
Secondary outcomes:
measure: Mean change in best corrected visual acuity from baseline
timeFrame: 12 months
measure: Mean change in central foveal thickness by optical coherence tomography (OCT) from baseline
timeFrame: 12 months
measure: Mean visual acuity
timeFrame: 12 months
measure: Mean central foveal thickness
timeFrame: 12 months
measure: Proportion of patients gaining 3 lines of vision
timeFrame: 12 months
measure: Mean change in lesion characteristics (lesion size, leakage)
timeFrame: 12 months
measure: Proportion of patients with no fluid on OCT
timeFrame: 12 months
measure: Mean change in macular volume
timeFrame: 12 months
Other outcomes:
Locations:
city: Saint Louis
country: United States
facility: Washington University School of Medicine
state: Missouri
city: Houston
country: United States
facility: Retina Consultants of Houston
state: Texas
Study officials:
affiliation: Washington University School of Medicine
name: Prabakar K Rao, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Horgan N, Shields CL, Mashayekhi A, Teixeira LF, Materin MA, Shields JA. Early macular morphological changes following plaque radiotherapy for uveal melanoma. Retina. 2008 Feb;28(2):263-73. doi: 10.1097/IAE.0b013e31814b1b75.
citation: Finger PT, Chin K. Anti-vascular endothelial growth factor bevacizumab (avastin) for radiation retinopathy. Arch Ophthalmol. 2007 Jun;125(6):751-6. doi: 10.1001/archopht.125.6.751.
citation: Wen JC, McCannel TA. Treatment of radiation retinopathy following plaque brachytherapy for choroidal melanoma. Curr Opin Ophthalmol. 2009 May;20(3):200-4. doi: 10.1097/ICU.0b013e328329b62d.