Efficacy and Safety of "Treat-and-Extend" Regimen Versus "Pro Re Nata" of Conbercept in Age-related Macular Degeneration

NCT02802657 | Unknown Phase 4 DMC

• 1 other identifier: 15216713049
• Study Type: interventional
• Target: 141
• Locations: 1 country
• Sites: 5

Brief Summary

The study will evaluate the efficacy and safety of two different regimens of Conbercept (Treat-and-Extend (T\&E) Regimen vs. Pro Re Nata (PRN)) in patients with wet AMD. This study is to provide long-term safety data in the treatment of patients with wet Age-related Macular Degeneration (AMD).

Conditions

Age-related Macular Degeneration

Keywords

Age-related Macular Degeneration; Conbercept; Treat-and-Extend Regimen; Pro Re Nata

Outcome Measures

Primary Outcomes (1)

• Mean Snellen BCVA at every visit or treatment

  Compare of mean Snellen Best-Corrected-visual-acuity at every visit or treatment between the two groups to assess the efficacy of Treat-and-Extend regimen of Conbercept.

  24 months

Secondary Outcomes (3)

• Number of participants with treatment-related adverse events

  24 months

• Mean number of injections after the initial three loading dose monthly injections

  21 months

• mean central macular thickness at every visit or treatment by OCT

  24 months

Study Arms (2)

Conbercept 0.5mg Treat-and-Extend regimen

EXPERIMENTAL

Monthly intravitreal injections of Conbercept 0.5mg in the core treatment period and Treat-and-Extend Regimen of the same dose guided by BCVA stabilization and optical coherence tomography (OCT) in the extension treatment period. Intervention: Drug: Conbercept

Procedure: Treat-and-Extend regimen; Drug: Conbercept

Conbercept 0.5mg Pro Re Nata

ACTIVE COMPARATOR

Monthly intravitreal injections of Conbercept 0.5mg in the core treatment period and PRN intravitreal injections of the same dose guided by BCVA stabilization in the extension treatment period. Intervention: Drug: Conbercept

Procedure: Pro Re Nata; Drug: Conbercept

Interventions

Treat-and-Extend regimen PROCEDURE

For the T\&E regimen,investigators recorded patients' data after retreatment by 3 monthly intravitreal injections of Conbercept. Patients were examined 6 weeks after the third injection, with ETDRS visual acuity testing, fundus ophthalmoscopy and photography, and OCT, and treated on the same day. The interval between treatments was extended by 2-week (12-week was a maximum) provided that OCT and fundus examination did not show either exudative manifestations or new macular hemorrhage or active CNV or reduced by 2 weeks (4-week was minimum) in case of such manifestations or hemorrhage. The persistence of pigment epithelium detachment was not considered a condition that justified shortening the interval between injections.

Also known as: T&E

Conbercept 0.5mg Treat-and-Extend regimen

Pro Re Nata PROCEDURE

For the PRN group, investigators recorded patients'data after retreatment by 3 monthly intravitreal injections of Conbercept.Subsequent reinjections were given as needed according to the changes in patients'visual acuity and/or the exudation shown by OCT. Four to five weeks after the third and last injection, all patients in the PRN group underwent an examination, including ETDRS visual acuity, fundus photography,and OCT. In case of persistent subfoveal or perifoveal fluid, macular intraretinal edema, visual loss of \>5 letters, or the occurrence of a new hemorrhage, patients were retreated. The persistence of hemorrhage without evidence of fluid was not considered a criterion for retreatment. In the absence of retreatment criteria, no further injections were given and another examination was proposed usually 4 weeks later.

Also known as: PRN

Conbercept 0.5mg Pro Re Nata

Conbercept DRUG

Conbercept 0.5mg Pro Re Nata; Conbercept 0.5mg Treat-and-Extend regimen

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Written informed-consent before any evaluation
• Visual impairment due to active CNV,including predominantly classic CNV,minimally classic CNV,occult CNV with no classic component and PCV.
• years old and older
• Chinese
• For study eye: BCVA between 20/30 and 20/320 on electronic visual acuity texting at the time point of both screening and baseline.

You may not qualify if:

• Have Stroke and myocardial infarction within 3 months before screening
• Any active periocular and ocular infection and inflammation (including blepharitis, conjunctivitis, keratitis, scleritis, uveitis, intraocular inflammation) while screening and baseline.
• Uncontrolled glaucoma (under treatment \[IOP\] ≥ 30 mm Hg or depend on researchers) while screening and baseline
• Neovascularization of iris and neovascular glaucoma while screening and baseline
• Any causes led to choroidal neovascularization except Wet AMD (including ICNV,central serous chorioretinopathy,ocular histoplazmoza and pathologic myopia) while screening and baseline
• With structure injury (including vitreous macular traction,epiretinal membrane involving in central fovea,subretinal fibroplasia,laser scar and central fovea atrophy) within 0.5 optic disc diameter to the central of macula while screening and baseline, which may harm the improvement of vision by treatment according to researchers
• Any systemic anti-VEGF medication(as Avastin) use within 3 months before screening
• Any medication systemic use toxic to lens, retina and optic nerve,including iron amine, chloroquine/chloroquine (Plaquenil ®), tamoxifen, phenothiazine and ethambutol
• For study eye：Used to accept following treatments for wet AMD within 3 months or accept following treatments more than three times before baseline: a)Anti-angiogenesis drugs(pegaptanib （Macugen®），ranibizumab ,bevacizumab（Avastin®),VEGF-Trap，KH902；b）Anecortave acetate corticosteroids；c）Protein kinase C inhibitors，squalamine，siRNA; d)PDT （Visudyne®）treatment,external beam radiotherapy, local laser photocoagulation, vitrectomy, submacular surgery and transpupillary thermotherapy
• Any intraocular surgery(including YAG laser) within 3 months before baseline or predicated within 6 months after baseline
• Intraocular or periocular treatment of corticosteroids within 3 months before baseline
• For follow eye:Any anti-angiogenesis treatment(including anti-VEGF,like Lucentis,Avastin® and KH902 ) within 3 months before baseline

Sponsors & Collaborators

• Xiaodong Sun: lead
• Eye & ENT Hospital of Fudan University: collaborator
• Shanghai Zhongshan Hospital: collaborator
• Shanghai Tongji Hospital, Tongji University School of Medicine: collaborator
• The General Hospital of Central Theater Command: collaborator

Study Sites (5)

Central Theater Command General Hospital

Wuhan, Hubei, 430070, China

Location

Eye & Ent Hospital of Fudan University

Shanghai, 200080, China

Location

Shanghai First People's Hospital

Shanghai, 200080, China

Location

Shanghai Tongji Hospital, Tongji University School of Medicine

Shanghai, 200080, China

Location

Shanghai Zhongshan Hospital

Shanghai, 200080, China

Location

Related Publications (15)

• Rush RB, Simunovic MP, Vandiver L, Aragon AV 2nd, Ysasaga JE. Treat-and-extend bevacizumab for neovascular age-related macular degeneration: the importance of baseline characteristics. Retina. 2014 May;34(5):846-52. doi: 10.1097/IAE.0000000000000033.

  PMID: 24240560 BACKGROUND

• Chen YN, Powell AM, Mao A, Sheidow TG. RETROSPECTIVE REVIEW OF LUCENTIS "TREAT AND EXTEND" PATTERNS AND OUTCOMES IN AGE-RELATED MACULAR DEGENERATION. Retina. 2016 Feb;36(2):272-8. doi: 10.1097/IAE.0000000000000691.

  PMID: 26200511 BACKGROUND

• Wykoff CC, Croft DE, Brown DM, Wang R, Payne JF, Clark L, Abdelfattah NS, Sadda SR; TREX-AMD Study Group. Prospective Trial of Treat-and-Extend versus Monthly Dosing for Neovascular Age-Related Macular Degeneration: TREX-AMD 1-Year Results. Ophthalmology. 2015 Dec;122(12):2514-22. doi: 10.1016/j.ophtha.2015.08.009. Epub 2015 Sep 29.

  PMID: 26391465 BACKGROUND

• Spaide R. Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol. 2007 Apr;143(4):679-80. doi: 10.1016/j.ajo.2007.02.024. No abstract available.

  PMID: 17386275 BACKGROUND

• Mrejen S, Jung JJ, Chen C, Patel SN, Gallego-Pinazo R, Yannuzzi N, Xu L, Marsiglia M, Boddu S, Freund KB. Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration. J Clin Med. 2015 Jul 8;4(7):1380-402. doi: 10.3390/jcm4071380.

  PMID: 26239682 BACKGROUND

• Berg K, Hadzalic E, Gjertsen I, Forsaa V, Berger LH, Kinge B, Henschien H, Fossen K, Markovic S, Pedersen TR, Sandvik L, Bragadottir R. Ranibizumab or Bevacizumab for Neovascular Age-Related Macular Degeneration According to the Lucentis Compared to Avastin Study Treat-and-Extend Protocol: Two-Year Results. Ophthalmology. 2016 Jan;123(1):51-9. doi: 10.1016/j.ophtha.2015.09.018. Epub 2015 Oct 21.

  PMID: 26477842 BACKGROUND

• Oubraham H, Cohen SY, Samimi S, Marotte D, Bouzaher I, Bonicel P, Fajnkuchen F, Tadayoni R. Inject and extend dosing versus dosing as needed: a comparative retrospective study of ranibizumab in exudative age-related macular degeneration. Retina. 2011 Jan;31(1):26-30. doi: 10.1097/IAE.0b013e3181de5609.

  PMID: 20890246 BACKGROUND

• Chin-Yee D, Eck T, Fowler S, Hardi A, Apte RS. A systematic review of as needed versus treat and extend ranibizumab or bevacizumab treatment regimens for neovascular age-related macular degeneration. Br J Ophthalmol. 2016 Jul;100(7):914-917. doi: 10.1136/bjophthalmol-2015-306987. Epub 2015 Oct 29.

  PMID: 26516125 BACKGROUND

• Houston SK 3rd, Rayess N, Cohen MN, Ho AC, Regillo CD. INFLUENCE OF VITREOMACULAR INTERFACE ON ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY USING TREAT AND EXTEND TREATMENT PROTOCOL FOR AGE-RELATED MACULAR DEGENERATION (VINTREX). Retina. 2015 Sep;35(9):1757-64. doi: 10.1097/IAE.0000000000000663.

  PMID: 26110596 BACKGROUND

• Gupta OP, Shienbaum G, Patel AH, Fecarotta C, Kaiser RS, Regillo CD. A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration clinical and economic impact. Ophthalmology. 2010 Nov;117(11):2134-40. doi: 10.1016/j.ophtha.2010.02.032. Epub 2010 Jul 1.

  PMID: 20591490 BACKGROUND

• Abedi F, Wickremasinghe S, Islam AF, Inglis KM, Guymer RH. Anti-VEGF treatment in neovascular age-related macular degeneration: a treat-and-extend protocol over 2 years. Retina. 2014 Aug;34(8):1531-8. doi: 10.1097/IAE.0000000000000134.

  PMID: 24637667 BACKGROUND

• Homer N, Grewal DS, Mirza RG, Lyon AT, Gill MK. Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results. Eye (Lond). 2015 Sep;29(9):1152-5. doi: 10.1038/eye.2015.87. Epub 2015 May 29.

  PMID: 26021870 BACKGROUND

• Li X, Xu G, Wang Y, Xu X, Liu X, Tang S, Zhang F, Zhang J, Tang L, Wu Q, Luo D, Ke X; AURORA Study Group. Safety and efficacy of conbercept in neovascular age-related macular degeneration: results from a 12-month randomized phase 2 study: AURORA study. Ophthalmology. 2014 Sep;121(9):1740-7. doi: 10.1016/j.ophtha.2014.03.026. Epub 2014 May 1.

  PMID: 24793528 BACKGROUND

• Zhang M, Zhang J, Yan M, Luo D, Zhu W, Kaiser PK, Yu DC; KH902 Phase 1 Study Group. A phase 1 study of KH902, a vascular endothelial growth factor receptor decoy, for exudative age-related macular degeneration. Ophthalmology. 2011 Apr;118(4):672-8. doi: 10.1016/j.ophtha.2010.08.008. Epub 2010 Dec 13.

  PMID: 21146224 BACKGROUND

• Jia H, Lu B, Yuan Y, Yuan F, Li L, Song Y, Rong A, Zhou M, Wang F, Sun X. A Randomized, Controlled Trial of Treat-and-Extend vs. Pro Re Nata Regimen for Neovascular Age-Related Macular Degeneration. Front Med (Lausanne). 2022 Jun 20;9:852519. doi: 10.3389/fmed.2022.852519. eCollection 2022.

  PMID: 35795633 DERIVED

MeSH Terms

Conditions

Macular Degeneration

Interventions

KH902 fusion protein

Condition Hierarchy (Ancestors)

Retinal Degeneration; Retinal Diseases; Eye Diseases

Study Officials

• Xiaodong Sun

  Shanghai General Hospital, Shanghai Jiao Tong University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Professor and Executive Vicechair of Department of Ophthalmology

Study Record Dates

• First Submitted: June 5, 2016
• First Posted: June 16, 2016
• Study Start: September 1, 2016
• Primary Completion: September 1, 2020
• Study Completion: September 1, 2020
• Last Updated: May 19, 2020

Record last verified: 2020-05

Locations

CN (5)