Gevokizumab for Active Scleritis

Phase 1

Completed

Conditions: Scleritis

Interventions: Device: Gevokizumab

Registration Number: NCT01835132

Lead Sponsor: National Eye Institute (NEI)

Brief Summary: Background:

- Scleritis is the inflammation of the white outer coating of the eye, known as the sclera. In severe cases, it can cause blindness. It is commonly associated with autoimmune disorders such as rheumatoid arthritis. Mild scleritis can be treated with drugs such as ibuprofen. More severe scleritis may need oral steroids or immunosuppressive treatments; however, these treatments can cause side effects in the whole body. Gevokizumab is a newer anti-inflammatory drug that is under investigation to treat other inflammatory diseases. It may not have as severe side effects as some other drugs. However, it has not yet been used to treat scleritis. Researchers want to see if it can be given as a safe and effective treatment for scleritis.

Objectives:

- To see if gevokizumab is a safe and effective treatment for scleritis.

Eligibility:

- Individuals at least 18 years of age who have active scleritis.

Design:

* There is an initial phase and a two-part extension phase in this study. The extension phase is optional. The initial phase of the study requires seven visits to the National Eye Institute (NEI).

* Participants will be screened with a physical exam and eye exam, and medical history will be obtained. Blood and urine samples will be collected.

* Eligible participants will receive an injection of 60 mg of gevokizumab at the first study visit and at Weeks 4, 8, and 12. They will be given under the skin by the stomach, or in the upper arm or thigh.

* Participants will have additional visits after the first study visit at Weeks 2, 16, and 28. No injection will be given at these visits. Eye exams will be done, and blood and tear samples will be collected.

* If the scleritis improves by Week 16, participants may choose to continue the study in the extension phase. In the 1st extension, they will have a visit every 4 weeks until Week 36 and then two additional monitoring visits at Weeks 40 and 52 for a total of 13 study visits.

* Participants who are eligible at Week 52 may continue in the "as needed" (PRN) extension phase (2nd extension) and receive gevokizumab injections (60 mg) at Weeks 52, 54, 58 and 62.

Detailed Description: Objective: Scleritis is a chronic, painful and potentially blinding inflammatory disease characterized by edema of the episcleral and sclera tissues and is commonly associated with systemic autoimmune disorders. Gevokizumab is an interleukin-1β (IL-1β) inhibitor, thus possibly preventing the IL-1β that may be responsible for scleral breakdown in patients with anterior scleritis. The study objective is to evaluate the safety and potential efficacy of gevokizumab as a possible treatment of non-infectious, active, anterior scleritis.

Study Population: Ten participants with non-infectious, active, anterior scleritis with a scleral inflammatory grade of ≥ +1 in at least one eye were to be initially enrolled. However, only eight participants were enrolled. Participants may be on ≤ 20 mg/day of prednisone or the equivalent at the time of enrollment but all other immunosuppressive drugs will be stopped with the initiation of study drug.

Design: This is a Phase 1/2, open label, non-randomized, prospective, single-arm, pilot trial to evaluate the safety and potential efficacy of gevokizumab in non-infectious, active, anterior scleritis. The study consists of an initial phase followed by a two-part extension phase. For the initial phase, all participants will receive one subcutaneous injection of 60 mg gevokizumab at Baseline and Weeks 4, 8 and 12. At Week 16 of the initial phase, participants will be assessed for eligibility in the first extension phase of the study. Participants from the initial phase, who do not continue in the first extension phase of the study will discontinue the study drug and may receive salvage therapy using standard-of-care treatment at the investigator's discretion. Participants from the initial phase who do not continue in the first extension phase will return for a final safety visit at Week 28. Participants from the initial phase who are determined eligible for the first extension phase may continue in the first extension phase and receive one gevokizumab injection (60 mg) every four weeks until the Week 36 visit. Participants entering the first extension phase will have follow-up safety visits at Weeks 40 and 52. At Week 52 follow-up of the first extension phase, participants will be assessed for eligibility in the 2nd extension phase, which is a PRN extension phase of the study. Participants who are eligible may continue in the PRN extension phase (2nd extension) and receive gevokizumab injections (60 mg) at Weeks 52, 54, 58, and 62. Subjects that have already completed the week 52 visit will be eligible to return and be assessed for entry into this 2nd extension phase. If they have already completed the Week 52 exit visit from the protocol and are returning to enroll in the PRN extension phase (2nd extension), the visits will be labeled as Weeks 52 (PRN-week0), 54 (PRN-week2), 58 (PRN-week6), and 62 (PRN-week10). Participants in the PRN extension phase (2nd extension) will have a final safety visit at least 16 weeks following their last injection in the PRN extension phase (2nd extension).

Outcome Measures: The primary outcome is the number of participants with at least a 2-step reduction or reduction to grade 0 in scleral inflammation in the study eye (or eyes, if both eyes meet study eye criteria), according to a standardized photographic scleritis grading system developed at NEI, on or before the Week 16 visit as compared to Baseline. Secondary outcomes include changes in visual acuity, changes in intraocular pressure and changes in scleral grading. Safety outcomes include the number and severity of systemic and ocular toxicities and adverse events (AEs), and the proportion of participants with loss of ≥ 15 ETDRS letters at any follow-up visit.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 8

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Gevokizumab	Gevokizumab	Subcutaneous injection of 60 mg gevokizumab

Primary Outcome Measures

Name	Time	Method
Number of Participants With at Least a 2-step Reduction or Reduction to Grade 0 in Scleral Inflammation in the Study Eye (or Eyes), According to the National Eye Institute (NEI) Photographic Scleritis Grading System, on or Before the Week 16 Visit.	Baseline and Week 16	Scleral inflammation was graded following 10% Phenylephrine application with an ordinal scale of 0 (no scleral inflammation with complete blanching of vessels), 0.5+ (minimal/trace inflammation with localized pink appearance of the sclera around minimally dilated deep episcleral vessels), 1+ (mild inflammation with diffuse pink appearance of the sclera around mildly dilated deep episcleral vessels), 2+ (moderate inflammation with purplish pink appearance of the sclera with tortuous and engorged deep episcleral vessels), 3+ (severe inflammation with diffuse significant redness of sclera, the details of superficial and deep episcleral vessels can't be observed), and 4+ (necrotizing inflammation with diffuse redness of the sclera with scleral thinning and uveal show).

Secondary Outcome Measures

Name	Time	Method
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 40 Compared to Baseline	Baseline and Week 40	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 12 Compared to Baseline	Baseline and Week 12	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 4 Compared to Baseline	Baseline and Week 4	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 8 Compared to Baseline	Baseline and Week 8	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 16 Compared to Baseline	Baseline and Week 16	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 24 Compared to Baseline	Baseline and Week 24	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 52 Compared to Baseline	Baseline and Week 52	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 8 Compared to Baseline	Baseline and Week 8	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 12 Compared to Baseline	Baseline and Week 12	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 40 Compared to Baseline	Baseline and Week 40	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 52 Compared to Baseline	Baseline and Week 52	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 2 Compared to Baseline	Baseline and Week 2	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 20 Compared to Baseline	Baseline and Week 20	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 32 Compared to Baseline	Baseline and Week 32	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 36 Compared to Baseline	Baseline and Week 36	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 52A Compared to Baseline	Baseline and Week 52A	This visit represents the beginning of the as-needed 2nd Extension Phase at Week 52. If eligible, participants continued with injections at Wks 52, 54, 58 and 62. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 58 Compared to Baseline	Baseline and Week 58	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 20 Compared to Baseline	Baseline and Week 20	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 28 Compared to Baseline	Baseline and Week 28	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 54 Compared to Baseline	Baseline and Week 54	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Final Safety Visit Compared to Baseline	Baseline and Final Visit	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Visual Acuity in the Study Eye (or Eyes) at Week 62 Compared to Baseline	Baseline and Week 62	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 16 Compared to Baseline	Baseline and Week 16	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 54 Compared to Baseline	Baseline and Week 54	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 28 Compared to Baseline	Baseline and Week 28	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 32 Compared to Baseline	Baseline and Week 32	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Changes in Scleral Grading From Baseline to Week 52	Baseline and Week 52	Scleral inflammation was summarized on an ordinal scale as either none, minimal/trace, mild, moderate, severe or necrotizing inflammation in the four quadrants of the study eye (superonasal \[SN\], superotemporal \[ST\], inferotemporal \[IT\], and inferonasal \[IN\]) for each participant at each visit. The exact change from Baseline to Week 52 for each participant (such as from mild to severe) cannot be quantified; therefore, we chose not to report due to the difficulty of reporting a quantitative change in each quadrant for each participant within the limited parameters allowed by PRS.
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 2 Compared to Baseline	Baseline and Week 2	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 4 Compared to Baseline	Baseline and Week 4	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 24 Compared to Baseline	Baseline and Week 24	Mean Change in Intraocular pressure (IOP) is measured and reported as change in IOP between baseline and 24 weeks in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 52A Compared to Baseline	Baseline and Week 52A	This visit represents the beginning of the as-needed 2nd Extension Phase at Week 52. If eligible, participants continued with injections at Wks 52, 54, 58 and 62. Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 58 Compared to Baseline	Baseline and Week 58	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 36 Compared to Baseline	Baseline and Week 36	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Week 62 Compared to Baseline	Baseline and Week 62	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Mean Change in Intraocular Pressure in the Study Eye (or Eyes) at Final Safety Visit Compared to Baseline	Baseline and Final Visit	Intraocular pressure (IOP) is measured in millimeters of mercury (mmHg).
Number of Participants With Loss of ≥ 15 Early Treatment Diabetic Retinopathy Study (ETDRS) Letters	Post-injection through study completion, up to 78 weeks per participant	Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Acuity is measured as letters read on an ETDRS eye chart and the letters read equate to Snellen measurements. For example, if a participant reads between 84 and 88 letters, the equivalent Snellen measurement is 20/20.