A Study to Learn How Safe the Study Drug Intravitreal (Given by an Injection Into the Eye) Aflibercept is in Participants in India With Diabetic Macular Edema (VISION-AF)

A Phase IV Interventional Post Approval Trial to Assess the Safety of Intravitreal Aflibercept for the Treatment of Diabetic Macular Edema (DME) in Patients in India.

Researchers are looking for a better way to treat people who have diabetic macular edema (DME).

Diabetic macular edema (DME) is a complication of diabetes. Consistently high blood sugar due to poor glucose control over time can damage small blood vessels in the body, including the eye. Damaged blood vessels in the eye may lead to leakage of the fluid into the central part of the retina at the back of the eye (also called macula) where sharp, straight-ahead vision occurs. Fluid accumulation makes the macula swell and results in reduced vision. If not treated, DME can result in complete loss of central detailed vision.

The study treatment intravitreal aflibercept (also called BAY865321) works by blocking VEGFR-1 receptor activity. Intravitreal aflibercept is already approved in over 105 countries for doctors to prescribe to people with DME. In India, aflibercept is approved conditionally for people with DME. The reason for this is that the sponsor was asked to collect more safety data for intravitreal aflibercept in Indian people with DME.

The main purpose of this study is to collect more data to learn how safe intravitreal aflibercept is in Indian people with DME. To see how safe intravitreal aflibercept is, the researchers will collect the information/data on the medical problems the participants may have during the study, and which may or may not be related to the study treatment. These medical problems are also known as "adverse events" (AEs). AEs will be categorized according to relatedness, seriousness, discontinuation of therapy, action taken and outcome.

The study participants will receive aflibercept as an injection directly into the space in the back of the eye once every 4 weeks in the first 5 months, followed by one injection every 8 weeks for the rest of the study duration. Only one eye per participant to be treated with aflibercept will be considered for the study.

Each participant will be in the study for approximately 52 weeks. The treatment duration will be 48 weeks. For each participant 11 visits to the study site are planned. The study team will perform additional safety calls 16 to 36 hours after each visit starting at visit 2. Alternatively, an additional safety visit can be arranged/planned for the day after treatment.

During the study, the study team will:

• take blood and urine samples
• examine the participants' eyes
• do physical examinations
• examine heart health using ECG
• check vital signs
• ask the participants questions about how they are feeling and what adverse events they are having.
• in- administer the study drug

At the end of the study the participants will be switched to commercially available treatment if recommended by the study doctor/if the participant still benefits from the treatment.

Study Overview

• Status: Completed
• Conditions: Diabetic Macular Edema
• Intervention / Treatment: Drug: Aflibercept (Eylea, VEGF Trap-Eye, BAY86-5321)

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Phase 4

Contacts and Locations

Study Locations

• India
  • Chandigarh, India, 160012
    • Post Graduate Institute of Medical education and Research
  • Andhra Pradesh
    • Hyderabad, Andhra Pradesh, India, 500034
      • L.V. Prasad Eye Institute
  • Gujarat
    • Ahmedabad, Gujarat, India, 380016
      • M & J Western Regional Institute of Ophthalmology
    • Ahmedabad, Gujarat, India, 380052
      • Raghudeep Eye Hospital
  • Karnataka
    • Bengaluru, Karnataka, India, 560037
      • Sankara Eye Hospital
    • Bengaluru, Karnataka, India, 560010
      • Narayana Nethralaya
  • National Capital Territory of Delhi
    • New Delhi, National Capital Territory of Delhi, India, 110029
      • Dr. R.P. Centre for Ophthalmic Sciences, AIIMS
  • Tamil Nadu
    • Chennai, Tamil Nadu, India, 600006
      • Medical Research Foundation, Sankara Nethralaya
    • Coimbatore, Tamil Nadu, India, 641014
      • Lotus Eye Hospital and Institute
  • West Bengal
    • Kolkata, West Bengal, India, 700120
      • Disha Eye Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Female or male adult participant ≥18 years of age, with type 1 or 2 diabetes mellitus.
• Participant must have diabetic macular edema (DME) secondary to diabetes mellitus, involving the centre of the macula (defined as the area of the centre subfield of optical coherence tomography (OCT)) in the study eye.
• Decrease in vision, determined to be primarily the result of DME in the study eye.
• Retinal thickness of ≥300 µm in the study eye, as assessed by OCT.
• Best Corrected Visual Acuity (BCVA) Early Treatment Diabetic Retinopathy Study ( ETDRS) letter score of 73 to 24 (i.e., VA of 20/50 to 20/320) or equivalent in the study eye.
• Participant for whom the decision to initiate treatment with Intravitreal (IVT) aflibercept has been made by the treating Investigator/Physician.
• Willing and able to comply with clinic visits and study-related procedures.
• Provide a signed Informed Consent Form (ICF) prior to any study procedures.

Exclusion Criteria:

• Having any contraindications to the use of IVT aflibercept as listed in the local prescribing information (i.e., ocular or periocular infection, active severe intraocular inflammation, and known hypersensitivity to aflibercept or to any of the excipients).
• History of vitreoretinal surgery and/or scleral buckling in the study eye.
• Ocular conditions with a poorer prognosis in the fellow eye than in the study eye.

• Received previous/ prior treatment as mentioned below:

  • Received anti-Vascular Endothelial Growth Factor (VEGF) drugs in the study eye (pegaptanib sodium, bevacizumab, ranibizumab, etc., including aflibercept) within the last 3 months of Day 1.
  • Received IVT dexamethasone or triamcinolone in the study eye within the last 3 months of Day 1.
  • Received intraocular or periocular corticosteroids in the study eye within the last 4 months of Day 1.
  • Had fluocinolone implant in the study eye within the last 3 years of Day 1.
  • Had dexamethasone implant in the study eye within the last 6 months of Day 1.
  • systemic anti-angiogenic agents within 6 months of Day 1.
• Uncontrolled glaucoma in the study eye (patient who has had filtration surgery in the past, or likely to need filtration surgery in the future).
• Only 1 functional eye even if that eye is otherwise eligible for the study.
• Participated in an investigational study within 30 days prior to screening visit that involved treatment with any drug (excluding vitamins and minerals) or device.
• Pregnant or breast-feeding women.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Aflibercept; Participants will receive one aflibercept injection per month (every four weeks) for five consecutive doses, followed by one injection every alternate month (every 8 weeks) for rest of the duration	Drug: Aflibercept (Eylea, VEGF Trap-Eye, BAY86-5321); Injection, 2mg (equivalent to 50 µL solution for injection)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Frequency (Number) of Ocular and Non-ocular Treatment Emergent Adverse Events (TEAE).	An AE arising or worsening after the start of study treatment administration until 30 days after the last administration of study treatment, up to 52 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Change in BCVA From Baseline to Week 52, as Assessed Using the Early Treatment Diabetic Retinopathy Study (ETDRS) Chart or Equivalent.	Proportion of eyes that lose ≥ 5, 10 and 15 ETDRS letters from baseline to Week 52, Overall	From baseline to week 52
Change in Central Retinal Thickness (CRT) From Baseline to Week 52 as Measured by Optical Coherence Tomography (OCT), FA		From baseline to week 52
Proportion of Eyes That Gained ≥ 5, 10 and 15 Early Treatment Diabetic Retinopathy Study (ETDRS) Letters From Baseline to Week 52	Only 1 eye per patient was enrolled in the study. Therefore, number of participants equals to number of eyes.	From baseline to Week 52
Proportion of Eyes With a ≥2 Step Improvement in the ETDRS Diabetic Retinopathy Severity Scale (DRSS) Score	Only 1 eye per patient was enrolled in the study. Therefore, number of participants equals to number of eyes. The Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale (DRSS) is a standardized tool used to measure the severity of diabetic retinopathy. The scale assesses the level of retinal damage and provides a score based on the presence of specific lesions and the extent of retinal involvement. Scale Range: Minimum score: 10 (indicating no retinopathy); Maximum score: 85 (indicating severe retinopathy) Interpretation of Scores: Higher scores indicate worse outcomes, reflecting more severe diabetic retinopathy	From baseline to Week 52

Collaborators and Investigators

• Sponsor: Bayer

Publications and helpful links

Helpful Links

• Click here to find further information and, after study completion, the study results according to Bayer's transparency standards

Study record dates

Study Major Dates

• Study Start (Actual): August 26, 2022
• Primary Completion (Actual): April 16, 2024
• Study Completion (Actual): April 16, 2024

Study Registration Dates

• First Submitted: August 19, 2022
• First Submitted That Met QC Criteria: August 19, 2022
• First Posted (Actual): August 22, 2022

Study Record Updates

• Last Update Posted (Estimated): September 4, 2025
• Last Update Submitted That Met QC Criteria: September 2, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Eye Diseases; Retinal Diseases; Retinal Degeneration; Macular Degeneration; Edema; Macular Edema; Antineoplastic Agents; Physiological Effects of Drugs; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; aflibercept
• Other Study ID Numbers: 21974

Plan for Individual participant data (IPD)

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

IPD Plan Description

Availability of this study's data will later be determined according to Bayer's commitment to the EFPIA/PhRMA "Principles for responsible clinical trial data sharing". This pertains to scope, timepoint and process of data access. As such, Bayer commits to sharing upon request from qualified researchers patient-level clinical trial data, study-level clinical trial data, and protocols from clinical trials in patients for medicines and indications approved in the US and EU as necessary for conducting legitimate research. This applies to data on new medicines and indications that have been approved by the EU and US regulatory agencies on or after January 01, 2014.

Interested researchers can use www.vivli.org to request access to anonymized patient-level data and supporting documents from clinical studies to conduct research. Information on the Bayer criteria for listing studies and other relevant information is provided in the member section of the portal.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes