Phase 1 Trial of Bevacizumab Treatment for Severe Retinopathy of Prematurity
- Registration Number
- NCT02390531
- Lead Sponsor
- Jaeb Center for Health Research
- Brief Summary
The purpose of this study is to find a dose of intravitreal bevacizumab that is lower than currently used for severe retinopathy of prematurity (ROP), is effective in this study, and can be tested in future larger studies.
- Detailed Description
Despite promising initial results using empirical doses of bevacizumab based on half the adult dose for treatment of acute severe ROP, little is known about lower doses of bevacizumab for ROP. An increasing number of ophthalmologists are treating premature infants with severe ROP using bevacizumab. Given the potential systemic and ocular adverse effects of intravitreal bevacizumab injections, determining a lower effective dose of bevacizumab is an important next step. The proposed study will test progressively lower doses to find a dose to take forward to a future larger study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 120
-
Type 1 ROP; defined as:
- Zone I, any stage ROP with plus disease, or
- Zone I, stage 3 ROP without plus disease, or
- Zone II, stage 2 or 3 ROP with plus disease
-
No previous treatment for ROP in the study eye; no previous bevacizumab treatment in the non-study eye
The following exclusions apply to the study eye:
- Nasolacrimal duct obstruction
- Major ocular anomalies (e.g., cataract, coloboma)
- Any opacity that precludes an adequate view of the retina
If purulent ocular discharge is present in either eye, then the infant is ineligible.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Bevacizumab 0.125 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.250 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.063 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.031 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.016 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.008 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.004 mg Bevacizumab Dosage of injected Bevacizumab to be studied Bevacizumab 0.002 mg Bevacizumab Dosage of injected Bevacizumab to be studied
- Primary Outcome Measures
Name Time Method Number of Participants With Successful Treatment of ROP 4 weeks post-injection Success is defined as improvement\* by the 4-day exam and no recurrence of type 1 ROP or severe neovascularization requiring additional treatment within 4 weeks of injection.
\* For infants with plus disease, improvement by the 4-day post-injection exam is defined as plus disease no longer being present. For infants with type 1 ROP without plus disease (i.e., zone I, stage 3), improvement by the 4-day post-injection exam is defined as: (1) a significant reduction in severity and/or extent of extraretinal neovascularization, and, (2) if pre-plus was present pre-injection, reduction in the degree of abnormal vascular dilation and/or tortuosity.
A dose will be considered effective if it successfully treats at least 80% of subjects.
- Secondary Outcome Measures
Name Time Method Visual Fixation Status at 12 Months 12-month corrected age 12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 months
Distribution of VEGF Levels 4 weeks post-injection The parents of each infant enrolled in the study will be given the option to participate in a study to measure levels of VEGF and Avastin in the plasma. Participants in this optional study will have blood collected for analysis The distribution of VEGF and Avastin levels (median, range, and quartiles) will be described before injection, and at 2 weeks and 4 weeks post-injection. For each dosage level, at 2, and 4-weeks post-injection, the change from pre-injection will be calculated.
Number of Study Eyes Requiring Additional Treatment/s for ROP 12-month corrected age 12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 months
Any Adverse Events or Complications Since the 4-week Exam 12-month corrected age 12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 months
Distribution of Avastin Levels 4 weeks post-injection The parents of each infant enrolled in the study will be given the option to participate in a study to measure levels of VEGF and Avastin in the plasma. Participants in this optional study will have blood collected for analysis The distribution of VEGF and Avastin levels (median, range, and quartiles) will be described before injection, and at 2 weeks and 4 weeks post-injection. For each dosage level, at 2, and 4-weeks post-injection, the change from pre-injection will be calculated, and a 95% confidence interval calculated for the change.
Proportion of Infants for Whom at Least One Event Was Reported Enrollment to 12-month corrected age Adverse events reported at any time during the study will be tabulated for all enrolled infants and coded using the MedRA system. For each dosage level, an estimate and 95% confidence interval of the proportions will be obtained using the exact binomial method
12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 monthsProportion of Infants With an Adverse Event Thought by Investigator to be Related to Study Drug Enrollment to 12-month corrected age Adverse events reported at any time during the study will be tabulated for all enrolled infants and coded using the MedRA system. For each dosage level, an estimate and 95% confidence interval of the proportions will be obtained using the exact binomial method
12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 monthsCount of Infants for Whom at Least One Serious Adverse Event Was Reported Enrollment to 12-month corrected age Adverse events reported at any time during the study will be tabulated for all enrolled infants and coded using the MedRA system. For each dosage level, an estimate and 95% confidence interval of the proportions will be obtained using the exact binomial method.
Number of Infant Deaths Enrollment to 12-month corrected age Adverse events reported at any time during the study will be tabulated for all enrolled infants and coded using the MedRA system.
12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 monthsNumber of Infants With 24-Month Extended Follow Up Exam 24-month corrected age A subset of infants enrolled in ROP1 will have extended follow up consisting of one additional office exam with developmental testing.
This testing will provide a cross-sectional evaluation of visual acuity, refractive error, and development at the adjusted age 24-month visit.
24-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 24 months.Number of Fellow Eyes Requiring Additional Treatment/s for ROP 12-month corrected age 12-month corrected age calculated as the estimated date of confinement (EDC), or due date, plus 12 months
Trial Locations
- Locations (11)
Wilmer Institute
🇺🇸Baltimore, Maryland, United States
Pediatric Ophthalmology Associates, Inc.
🇺🇸Columbus, Ohio, United States
Texas Children's Hospital - Dept. Of Ophthalmology
🇺🇸Houston, Texas, United States
Riley Hospital for Children
🇺🇸Indianapolis, Indiana, United States
University of Utah Moran Eye Center
🇺🇸Salt Lake City, Utah, United States
Virginia Pediatric Eye Center
🇺🇸Norfolk, Virginia, United States
The Emory Eye Center
🇺🇸Atlanta, Georgia, United States
Boston Children's Hospital
🇺🇸Boston, Massachusetts, United States
Duke University Eye Center
🇺🇸Durham, North Carolina, United States
Cincinnati Children's Hospital
🇺🇸Cincinnati, Ohio, United States
Dean A. McGee Eye Institute, University of Oklahoma
🇺🇸Oklahoma City, Oklahoma, United States