Ranibizumab DosE Comparison and the Role of LAser in REtinal Vein Occlusions

Phase 1

Completed

Conditions: Retinal Vein Occlusion

Interventions: Drug: Ranibizumab 2.0mg (monthly)
Drug: Ranibizumab 0.5mg (monthly)
Drug: Pro re nata (prn) ranibizumab
Procedure: Pro re nata (prn) Laser photocoagulation

Registration Number: NCT01003106

Lead Sponsor: Peter A Campochiaro, MD

Brief Summary: The primary Objective of this study is to evaluate the safety and tolerability of intraocular injections of 0.5mg or 2.0mg of ranibizumab in patients with macular edema due to retinal vein occlusion.

Detailed Description: The secondary objectives are to assess the efficacy of 0.5mg versus 2.0mg of monthly ranibizumab injections in patients with macular edema due to retinal vein occlusion between baseline and month 6. At week 24, patients will be re-randomized to receive pro re nata (prn) ranibizumab+laser photocoagulation versus ranibizumab alone and the efficacy of both treatment options will be compared. Treatment efficacy will be assessed by comparing changes in best corrected visual acuity (BCVA) and central subfiled thickness (CST) between the treatment groups.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 81

Inclusion Criteria

Signed informed consent and authorization of use and disclosure of protected health information
Age equal to or greater than 18 years
Diagnosis of macular edema due to central or branch retinal vein occlusion
Foveal thickness of equal to or greater than 250 mm, as assessed by OCT
Best corrected visual acuity score in the study eye of 20/40 to 20/400 inclusive (Snellen equivalents using the ETDRS protocol at a distance of 4 meters). Only one eye will be treated in the study. If both eyes are eligible, the investigator will select the eye to be enrolled.
In the opinion of the investigator, decreased vision in the study eye is due to foveal thickening from vein occlusion and not from other obvious causes of decreased vision

Exclusion Criteria

Scatter laser photocoagulation or macular photocoagulation within 3 months of study entry in the study eye
Intraocular surgery in the study eye within 3 months of study entry
Use of intraocular or periocular injection of steroids in the study eye (e.g., triamcinolone) within 4 months of study entry
Previous use of an anti-VEGF drug within 3 months of study entry
Cataract surgery in the study eye within 3 months of study entry; Yttrium-Aluminum-Garnet (YAG) laser capsulotomy within 1 month of study entry; or any other intraocular surgery within 3 months preceding Day 0.
History of vitreoretinal surgery in the study eye within 3 months of study entry
Uncontrolled glaucoma (defined as intraocular pressure ³30 mm Hg despite treatment with anti-glaucoma medications)
History of cerebral vascular accident, myocardial infarction, transient ischemic attacks within 3 months of study enrollment.
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.
Have the presence of active malignancy, including lymphoproliferative disorders. Subjects with a history of fully resolved basal or squamous cell skin cancer may be enrolled.
Any condition that the investigator believes would pose a significant hazard to the subject if investigational therapy were initiated.
History of allergy to humanized antibodies or any component of the ranibizumab formulation
Inability to comply with study or followup procedures
Participation in another simultaneous medical investigation or trial

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
BRVO- Ranibizumab 2.0mg alone	Ranibizumab 2.0mg (monthly)	Branch retinal vein occlusion patients randomized to this group will receive 2.0mg of ranibizumab alone as per protocol without laser photocoagulation.
BRVO- Ranibizumab 0.5mg alone	Ranibizumab 0.5mg (monthly)	Branch retinal vein occlusion patients randomized to this group will receive 0.5mg of ranibizumab alone as per protocol without laser photocoagulation.
CRVO- Ranibizumab 0.5mg alone	Ranibizumab 0.5mg (monthly)	Central retinal vein occlusion patients randomized to this group will receive 0.5mg of ranibizumab alone as per protocol without laser photocoagulation
BRVO- Pro re nata (prn) ranibizumab with laser	Pro re nata (prn) ranibizumab	Branch retinal vein occlusion patients randomized to this group will receive 0.5mg/2.0mg of ranibizumab as per protocol, and additional laser photocoagulation if required.
BRVO- Pro re nata (prn) ranibizumab with laser	Pro re nata (prn) Laser photocoagulation	Branch retinal vein occlusion patients randomized to this group will receive 0.5mg/2.0mg of ranibizumab as per protocol, and additional laser photocoagulation if required.
BRVO- Pro re nata (prn) ranibizumab	Pro re nata (prn) ranibizumab	Branch retinal vein occlusion patients randomized to this group will receive 0.5mg/2.0mg of ranibizumab as per protocol, without additional laser photocoagulation.
CRVO- Pro re nata (prn) ranibizumab with laser	Pro re nata (prn) ranibizumab	Central retinal vein occlusion patients randomized to this group will receive 0.5mg/2.0mg of ranibizumab as per protocol, and additional laser photocoagulation if required.
CRVO- Pro re nata (prn) ranibizumab	Pro re nata (prn) ranibizumab	Central retinal vein occlusion patients randomized to this group will receive 0.5mg/2.0mg of ranibizumab as per protocol, without additional laser photocoagulation.
CRVO- Pro re nata (prn) ranibizumab with laser	Pro re nata (prn) Laser photocoagulation	Central retinal vein occlusion patients randomized to this group will receive 0.5mg/2.0mg of ranibizumab as per protocol, and additional laser photocoagulation if required.
CRVO- Ranibizumab 2.0mg alone	Ranibizumab 2.0mg (monthly)	Central retinal vein occlusion patients randomized to this group will receive 2.0mg of ranibizumab alone as per protocol without laser photocoagulation.

Primary Outcome Measures

Name	Time	Method
Incidence and Severity of Ocular and Non-ocular Adverse Events.	36 months

Secondary Outcome Measures

Name	Time	Method
Mean Change From Baseline to Month 6 in Best Corrected Visual Acuity in Patients Treated With 0.5mg Versus 2.0mg of Ranibizumab	Baseline to month 6
Mean Change From Month 6 to Month 36 in Best Corrected Visual Acuity in Patients Treated With Prn Ranibizumab+Laser Photocoagulation Versus Prn Ranibizumab Alone.	Month 6- Month 36
Mean Change From Baseline to Month 6 in Central Subfield Thickness in Patients Treated With 0.5mg Versus 2.0mg of Ranibizumab	Baseline to month 6
Mean Change From Month 6 to Month 36 in Central Subfield Thickness in Patients Treated With Prn Ranibizumab+Laser Photocoagulation Versus Prn Ranibizumab Alone.	Month 6- Month 36