Topical Infliximab for Sterile Corneal Melt

Topical Infliximab for the Treatment of Sterile Corneal Melt

Corneal melt is a complication that could affect very ill eyes and lead to the thinning of the cornea (the clear window covering of the eyes). This thinning can lead to severe consequences such as the leakage of the liquid inside the eye (ocular perforation), or even blindness. Corneal melt can be caused by certain infections or as a sterile process. This project only includes patients with a sterile corneal melt (without an infection) caused by diseases such as rosacea, Sjogren's syndrome, rheumatoid arthritis, Crohn's disease, Stevens Johnson syndrome, as well as toxic epidermal necrolysis or mucous membrane pemphigoid.

Infliximab is an antibody against tumour necrosis factor alpha and has been used to treat or prevent corneal melt in certain patients with inflammatory of auto-immune disease. In this situation, infliximab was used intravenous (using veins) in order to treat the whole body.

This study's hypothesis is that infliximab can safely be used as eye drops for the treatment of sterile corneal melt.

Study Overview

• Status: Recruiting
• Conditions: Sterile Corneal Melt
• Intervention / Treatment: Drug: Topical Infliximab

Detailed Description

This is an unmasked, prospective, single-center trial of twelve patients with sterile corneal melt and an underlying auto-immune or inflammatory disease, such as rosacea, Sjogren's syndrome, rheumatoid arthritis, Crohn's disease, Stevens Johnson syndrome, as well as toxic epidermal necrolysis or mucous membrane pemphigoid.

The aim of this phase I study is to evaluate the safety and tolerability of topical infliximab 10mg/ml eye drops for the treatment of corneal melt. As such, six (6) subjects will be recruited in the experimental treatment study and six (6) subjects will be enrolled in the parallel observational study. Indeed, candidates having all inclusion criteria but one exclusion criteria (which are contraindication to infliximab use), will be recruited in the observational study, will receive the standard treatment without infliximab.

During the treatment period, subjects in the therapeutic study will receive topical infliximab 10mg/ml four (4) times per day for four (4) weeks. In order to determine the safety profile, potential side effects as well as the course of the disease, subjects will be monitored while on the study medication as well as for 8 weeks following discontinuation of the drug. The ophthalmological follow-up will be identical in the two groups. However, only subjects enrolled in the experimental treatment study will receive additional laboratory tests. The total study duration for each patient will be 12 weeks.

In terms of statistical analysis, the investigators will focus on describing the outcome measured in the study. For instance, the investigators will describe the number and proportion of side effects, the number of patients with a quiescent corneal melt at 4 weeks and the patients who required a tectonic surgery at 12 weeks post-treatment. The investigators will report the average and standard of deviation of the OSDI score, the epithelial deficit surface as well as the minimal corneal thickness. Moreover, the investigators will perform exploratory statistical analysis in order to study the disease course of each subject and comparing the addition of infliximab to the standard.

• Study Type: Interventional
• Enrollment (Estimated): 12
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Marie-Claude Robert, MD; Phone Number: 11550 514 890-8000; Email: marie-claude.robert.2@umontreal.ca
• Study Contact Backup: Name: Marie-Catherine Tessier; Phone Number: 11550 514 890-8000; Email: marie-catherine.tessier.chum@ssss.gouv.qc.ca

Study Locations

• Canada
  • Quebec
    • Montreal, Quebec, Canada, H2X3E4
      • Recruiting
      • Centre Hospitalier de l'Universite de Montreal
      • Contact: Marie-Catherine Tessier; Phone Number: 11550 5148908000

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 78 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 to 80 years;
• Any degree of active sterile corneal melting , as documented by slit-lamp examination, showing an epithelial defect and stromal thinning;
• Negative work-up for local and systemic infectious causes
• Negative corneal cultures (may show growth of common contaminants)
• Capable of providing informed consent;
• Capable of administering eye drops either themselves or through a caregiver.

Exclusion Criteria:

• Any active ocular or systemic infection including active or latent tuberculosis, histoplasmosis, coccidiomycosis, cytomegalovirus, pneumocystosis, aspergillosis, or hepatitis B.
• History of neoplasia diagnosed within the last 5 years
• Demyelinating disease
• Diabetes
• Congestive heart failure
• Significant anomalies on complete blood count, creatinine or hepatic enzymes
• Pregnancy or breast feeding
• Allergy to infliximab or to the drug vehicle (Refresh liquigel)
• Past or present use of anti-TNF-α medications or human interleukin-1 receptor antagonist (anakinra, IL-1Ra)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Topical Infliximab; Additionally to standard treatment, patients with all inclusive criteria and none exclusive criteria will be included in the therapeutic group and will receive topical infliximab QID for 4 weeks.	Drug: Topical Infliximab; Aside from the standard treatment, patients will receive topical infliximab ( 10mg/ml) four (4) time per day for four (4) weeks.; Other Names: Remicade
No Intervention: Observational group; Patients with all inclusive criteria and one exclusive criteria will receive the standard treatment, without topical infliximab.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse Events	Number and type of adverse events	12 weeks
Percentage of patients finishing 4 weeks of infliximab use	Percentage of patients finishing 4 weeks of infliximab use	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Acuity	Visual Acuity is measured using a Snellen chart	4 and 12 weeks
Ocular surface symptoms as assessed by ocular disease index score	Ocular surface symptoms as assessed by ocular disease index score	4 and 12 weeks
Conjunctival hyperemia using a slit-lamp photographs	Conjunctival hyperemia using a slit-lamp photographs	4 and 12 weeks
Corneal thickness as measured by anterior segment optical coherence tomography	Corneal thickness as measured by anterior segment optical coherence tomography	4 weeks
Surface area of the corneal melt using a slit-lamp photographs	Surface area of the corneal melt using a slit-lamp photographs	4 weeks
Quiescent corneal state	Percentage of eyes presenting a quiescent corneal state at 4 weeks	4 weeks
Eyes requiring tectonic surgery	Percentage of eyes requiring tectonic surgery at 12 weeks	12 weeks

Collaborators and Investigators

• Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)
• Collaborators: Fonds de recherche en ophtalmologie de l'Université de Montréal
• Investigators: Principal Investigator: Marie-Claude Robert, MD, Centre Hospitalier de l'Universite de Montreal (CHUM)

Study record dates

Study Major Dates

• Study Start (Actual): September 6, 2017
• Primary Completion (Estimated): December 31, 2025
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: October 26, 2016
• First Submitted That Met QC Criteria: December 7, 2016
• First Posted (Estimated): December 9, 2016

Study Record Updates

• Last Update Posted (Actual): February 12, 2024
• Last Update Submitted That Met QC Criteria: February 9, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Cornea; Keratolysis; Topical Infliximab
• Additional Relevant MeSH Terms: Infections; Eye Diseases; Keratitis; Corneal Diseases; Eye Infections; Urogenital Diseases; Genital Diseases; Infertility; Corneal Ulcer; Anti-Inflammatory Agents; Antirheumatic Agents; Gastrointestinal Agents; Dermatologic Agents; Tumor Necrosis Factor Inhibitors; Infliximab
• Other Study ID Numbers: CE16.221

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No