- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04444492
Combination of Ranibizumab and Targeted Laser Photocoagulation (CoRaLaII)
Long-term Need of Ranibizumab Injections With or Without Early Targeted Peripheral Laser Photocoagulation for Treatment of Macular Edema Due to Central Retinal Vein Occlusion
Study Overview
Status
Intervention / Treatment
Detailed Description
Retinal vein occlusion (RVO) is the second most common retinal vascular disease leading to visual impairment. Main cause for visual impairment in CRVO (Central Retinal Vein Occlusion) is macular edema (ME) while neovascularization of the retina and/or the anterior segment is the most serious complication leading to vitreous hemorrhage, retinal detachment and neovascular glaucoma. In serious cases loss of vision is imminent. To date, no causal treatment has been proven to be effective in large trials. Intravitreal injections of drugs that inhibit the vascular endothelial growth factor (VEGF) and other inflammatory factors are the current treatments of choice for ME due to CRVO. Two different anti-VEGF drugs (ranibizumab and aflibercept), and a biodegradable dexamethasone implant are approved by the EMA (European Medicines Agency). Based on data from confirmatory studies anti-VEGF-drugs are recommended as a treatment of first choice in patients with RVO. All intravitreal drugs provide only a temporary effect with need for re-treatment for recurrences of ME. Mean number of ranibizumab application needed in CRVO patients was found to be 7.4 to 10.2 injections in 12 months. A significant number of CRVO patients require treatment over several years. Need for repetitive treatments and ophthalmic controls are a major burden for patients (and their relatives who are required for driving the patients to ophthalmologists) despite of only few adverse events and generally well-tolerated injections. Endophthalmitis is the most severe ocular complication which can be eye-sight-threatening. The more injections are administered, the higher is the cumulative risk of complications. Due to high costs (>1000 € per injection) treatment with repeated injections over years is of significant socio-economic importance, too. Therefore, treatments concepts which would lead to permanent reduction of ME and/or significantly reduce the number of re-injections over long-term periods are the major currently unmet need in patients with RVO.
Until now, several studies evaluated the impact of the additional pan-retinal laser photocoagulation in patients undergoing the anti-VEGF-treatment for the ME due to retinal vein occlusions. However, most of the studies are limited by retrospective design, small number of evaluated patients or lack of the randomization. None of the available prospective randomized studies had sufficient power to finally clarify the benefit of the additional laser treatment. Therefore, there is an unmet need for a large randomized, prospective, multicentric trials.
The proposed study will be the first sufficiently powered trial evaluating the long-term effect of targeted laser photocoagulation performed selectively (targeted) in peripheral areas of non-perfusion in combination with standard anti-VEGF treatment (ranibizumab injections) on the duration of the required intravitreal treatment over time period of 2 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Matus Rehak, Professor
- Phone Number: 0049 641 985 438 01
- Email: matus.rehak@uk-gm.de
Study Contact Backup
- Name: Yasmine Breitenstein
- Phone Number: 0049 341 97 16 247
- Email: yasmine.breitenstein@zks.uni-leipzig.de
Study Locations
-
-
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Dresden, Germany, 01307
- Not yet recruiting
- Universitätsklinikum Carl Gustav Carus Dresden Klinik und Polyklinik für Augenheilkunde
-
Contact:
- Dirk Sandner, Dr.
-
Düsseldorf, Germany
- Recruiting
- Internationale Innovative Ophthalmochirurgie GbR, Klinik für Augenchirurgie
-
Contact:
- Hakan Kaymak, Dr.
-
Freiburg, Germany, 79106
- Recruiting
- Universitätsklinikum Klinik für Augenheilkunde Freiburg
-
Contact:
- Hansjürgen Agostini, Prof.
-
Gießen, Germany
- Recruiting
- Universitätsklinikum Gießen, Klinik und Poliklinik für Augenheilkunde
-
Contact:
- Matus Rehak, Prof. MUDr.
-
Hannover, Germany, 30625
- Recruiting
- Hannover MHH Universitätsklinik für Augenheilkunde
-
Contact:
- Amelie Pielen, PD. Dr.
-
Leipzig, Germany, 04103
- Recruiting
- University Hospital of Leipzig Department of Ophthalmology
-
Contact:
- Focke Ziemssen, Prof. Dr.
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Ludwigshafen, Germany, 67063
- Recruiting
- Klinikum der Stadt Ludwigshafen Augenklinik
-
Contact:
- Lars-Olof Hattenbach, Prof.
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Marburg, Germany, 35043
- Recruiting
- Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg Klinik für Augenheilkunde
-
Contact:
- Walter Sekundo, Prof.
-
München, Germany
- Recruiting
- Ludwig-Maximilians-Universität München, Augenklinik
-
Contact:
- Siegfried Prieglinger, Prof. Dr.
-
Münster, Germany, 48145
- Recruiting
- Augenzentrum am St. Franziskus-Hospital Münster
-
Contact:
- Georg Spital, Dr.
-
Münster, Germany, 48149
- Withdrawn
- Universitätsklinikum Klinik für Augenheilkunde
-
Tübingen, Germany
- Recruiting
- Universitätsklinikum Tübingen, Department für Augenheilkunde
-
Contact:
- Alexandra Schweig, Dr.
-
Ulm, Germany
- Recruiting
- Universitätsklinikum Ulm, Klinik für Augenheilkunde
-
Contact:
- Armin Hilmar Wolf, Prof. Dr.
-
Zschopau, Germany
- Recruiting
- Augen-OP-Zentrum Zschopau, Praxis für Augenheilkunde
-
Contact:
- Simo Murovski, Dr.
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Diagnosis of macular edema due to central retinal vein occlusion foveal thickness > 250 μm (measured by OCT)
- Age > 18 years
- Written informed consent of the patient
- BCVA score in the study eye between 24 letters (20/320) and 78 letters (20/25) measured in ETDRS chart
- History of CRVO no longer than 6 months
- Presence of capillary non-perfusion in peripheral retina larger than 5 disc areas documented in ultra wide-field fluorescein angiography
- Ability and willingness to attend all scheduled visits and assessments
Exclusion Criteria:
- CRVO with ischemic maculopathy defined as diameter of the foveolar avascular zone larger than 2 optic disc diameters
- Macular edema due to another etiology than retinal vein occlusion (e.g. diabetic maculopathy, uveitis, age related macular degeneration, Irvine-Gass syndrome)
- History of idiopathic central serous chorioretinopathy
- Presence of vitreoretinal interface disease (e.g. vitreomacular traction, epiretinal membrane), either on clinical examination or in OCT
- An eye that, in the investigator's opinion, would not benefit from resolution of macular edema, such as eyes with foveal atrophy, dense pigmentary changes, or dense subfoveal hard exudates
- Aphakia in the study eye
- Scatter laser photocoagulation or macular photocoagulation in the study eye prior to study entry
- Intraocular or periocular injection of steroids in the study eye prior to study entry
- Previous use of an anti-VEGF drug in the study eye
- Cataract surgery or any other intraocular surgery in the study eye within 3 months prior to study entry
- Uncontrolled glaucoma (defined as intraocular pressure ≥ 30 mm Hg despite treatment with maximal anti-glaucoma medications)
- History of stroke, myocardial infarction, transient ischemic attacks within 3 months prior to the study
- Pregnancy (positive urine pregnancy test) or lactation
- The presence of active malignancy, including lymphoproliferative disorders.
- History of allergy to fluorescein or any component of the ranibizumab formulation
- Active intraocular infection
- Participation in another simultaneous interventional medical investigation or trial
- Women with child bearing potency without effective contraception (i. e. implants, injectables, combined oral contraceptives, some IUDs or vasectomised partner) during the conduct of the trial.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ranibizumab+Laser-arm
Ranibizumab injections and additional targeted laser
|
initial three injections of Ranibizumab - afterwards pro re nata monthly
Other Names:
Areas of capillary non-perfusion will be treated with photocoagulation upto 4 times
|
Active Comparator: Ranibizumab-arm
Only Ranibizumab injections
|
initial three injections of Ranibizumab - afterwards pro re nata monthly
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy endpoint is the time to treatment success
Time Frame: up-to 29 months
|
Time from randomisation until the date of last criteria-based intravitreal injection in case that thereafter a treatment-free period for (at least) 6 months was observed.
|
up-to 29 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Best corrected visual acuity (BCVA)
Time Frame: Month 29
|
Best corrected visual acuity (BCVA) in number of ETDRS letters (Early Treatment of Diabetes Retinopathy Study) per visit
|
Month 29
|
Central subfield thickness (CST)
Time Frame: Month 29
|
Central subfield thickness (CST) measured by OCT per visit
|
Month 29
|
Number of ranibizumab injections
Time Frame: Month 29
|
Number of ranibizumab injections required until treatment success and up to the end of Observation.
|
Month 29
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Development of neovascularization(s)
Time Frame: Month 24
|
Proportion of subjects developing neovascularization(s) of retina, optic disc, and/or in anterior segment over the total period of observation.
|
Month 24
|
The area of non-perfusion
Time Frame: Month 24
|
The area of non-perfusion (assessed by FA) will be quantified as sum of all areas identified
|
Month 24
|
Vessel density
Time Frame: Month 24
|
Assessed by OCT-angiography, will be quantified by a metric measure with the range [0;1]
|
Month 24
|
Potential visual field loss
Time Frame: Month 4 and Month 24
|
The change between the two timepoints (Months 4 and 24) per arm will be used to characterize the both groups and be compared between treatment arms.
|
Month 4 and Month 24
|
The number of laser treatments and the laser spots given in the experimental group (RL-arm).
Time Frame: Month 24
|
The number of visits with applied laser treatment and the laser spots applied in the experimental group (RL-arm) will be counted for descriptive reasons and be compared between treatment arms.
|
Month 24
|
Health-related quality of life (QoL): Visual Function Questionnaire VFQ25
Time Frame: Baseline, Month 12 and Month 24
|
Measured by the Visual Function Questionnaire VFQ25
|
Baseline, Month 12 and Month 24
|
Areal of foveal avascular zone
Time Frame: Month 24
|
Area of the foveal avascular zone (FAZ, assessed by OCT-angiography, will be quantified in [mmm²])
|
Month 24
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Matus Rehak, Professor, Department of Ophthalmology Justus-Liebig-Universität Giessen
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Eye Diseases
- Retinal Degeneration
- Retinal Diseases
- Embolism and Thrombosis
- Venous Thrombosis
- Thrombosis
- Macular Degeneration
- Macular Edema
- Retinal Vein Occlusion
- Physiological Effects of Drugs
- Antineoplastic Agents
- Angiogenesis Inhibitors
- Angiogenesis Modulating Agents
- Growth Substances
- Growth Inhibitors
- Ranibizumab
Other Study ID Numbers
- CoRaLaII
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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