METforMIN: Metformin Administration for the Minimization of Geographic Atrophy Progression in Patients With Age-related Macular Degeneration
Overview
- Phase
- Phase 2
- Intervention
- Metformin
- Conditions
- Age-Related Macular Degeneration
- Sponsor
- University of California, San Francisco
- Enrollment
- 66
- Locations
- 12
- Primary Endpoint
- Fundus Autofluorescence Imaging to Measure the Rate of Change in Area of Geographic Atrophy
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The purpose of this study is to determine whether metformin, an FDA-approved drug for the treatment of type II diabetes, is a safe and effective treatment to decrease the progression of geographic atrophy in non-diabetic patients with Age-related Macular Degeneration (AMD).
Detailed Description
This is a phase II, single-blind, randomized, evaluation of the safety and efficacy of metformin use to decrease geographic atrophy (GA) progression in non-diabetic patients with dry Age-related Macular Degeneration (AMD). Approximately 186 study subjects throughout four separate study sites will be randomized in a 1:1 ratio to the treatment group and the observation group. The treatment group will be assigned to the study intervention (oral Metformin) for 18 months while the observation group will receive no intervention for 18 months, instead continuing with standard of care ophthalmic exams and close monitoring of their disease. There will be one additional follow up visit at 24 months. Throughout the 24 month study period, the progression of subjects' GA or drusen growth will be measured via ocular imaging taken at standard of care follow-up examinations, including fundus autofluorescence imaging, optical coherence tomography (OCT), and fundus photography.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Subject must be \>/= 55 years of age
- •Subject must have evidence of advanced dry AMD, defined by the characteristic presence of drusen and/or pigmentary changes as well as geographic atrophy
- •Subject must have clear ocular media and adequate pupillary dilation
- •Subject must be able to swallow capsules
- •Study eye must have best corrected visual acuity (BCVA) of 20/20-20/400
- •Subject must be willing and able to pay for monthly prescription of Metformin HCl for 18 months in the event that their insurance carrier will not cover the cost of the drug
Exclusion Criteria
- •Subjects with insufficient baseline size of geographic atrophy, less than 1.25 mm2 (0.5 Macular Photocoagulation Study Disc Areas). GA is defined as one or more well-defined and often circular patches of partial or complete depigmentation of the RPE, typically with exposure of underlying choroidal blood vessels. Even if much of the RPE appears to be preserved and large choroidal vessels are not visible, a round patch of RPE partial depigmentation may be classified as early GA. The GA in the study eye must be able to be photographed in its entirety, and it must not be contiguous with any areas of peripapillary atrophy, which can complicate area measurements.
- •Subjects who are already taking metformin for another purpose
- •Subjects with type 1 or 2 diabetes
- •Subjects with compromised kidney function:
- •Serum creatinine ≥1.5 mg/dL for males and ≥1.4 mg/dL for females
- •Subjects with moderate to severe heart failure (Class III or IV, New York Heart Association Functional Classifications)
- •Subjects with Child's class C cirrhosis
- •Evidence of retinal atrophy due to causes other than atrophic AMD.
- •Subjects who have had anti-VEGF injections or active choroidal neovascularization in the study eye during the last 12 months
- •Current evidence or history of ocular disorders in the study eye that in the opinion of the investigator confounds study outcome measures, including (but not limited to):
Arms & Interventions
Metformin
This arm will be receiving the study drug, Metformin, for the duration of the 24 month study. They will begin this drug on a low dose of Metformin, increasing the dosage in a step-wise fashion to avoid unwanted gastrointestinal discomfort, a common side effect when patients begin taking Metformin. During the 24 month study, subjects assigned to this arm will have 4 follow-up exams after the initial enrollment exam, at 6 month intervals.
Intervention: Metformin
Outcomes
Primary Outcomes
Fundus Autofluorescence Imaging to Measure the Rate of Change in Area of Geographic Atrophy
Time Frame: 0 months, 18 months
The primary efficacy endpoint was the annualized growth rate of the square root of geographic atrophy (GA) area in mm/year in the study eye as imaged by fundus autofluorescence (FAF) imaging. Change = (Month 18 GA Area - Baseline GA Area).
Secondary Outcomes
- Systemic Safety as Measured by Presence of Side Effects Listed on Metformin Drug Label as "Severe"(0 months, 6 months, 12 months, 18 months, 24 months)
- Change in Low-luminance Visual Acuity (LLVA)(0 months, 18 months)
- Ocular Safety as Measured by the Presence of Novel Intraocular Inflammation Judged by the Investigator to be Due to the Study Drug Metformin(0 months, 6 months, 12 months, 18 months, 24 months)
- Change in Best Corrected Visual Acuity (BCVA)(0 months, 18 months)