Pharmacogenomics of antiVEGF in Patients With Age-Associated Macular Degeneration (AMD) (AMD)

Multicentre, Randomised, Double-blind, Parallel-group, Phase III Study to Evaluate the Genetic Polymorphism Influence in the Response to Ranibizumab and Bevacizumab Treatment in Patients With Age-Associated Macular Degeneration.

This is a phase III, multicenter, randomized double-blinded clinical trial with two parallel groups (ranibizumab and bevacizumab) and an observational follow-up of patients who meet elegibility criteria and decline participation due to treatment randomization. It will be performed involving 630 eyes from patients with wet age-related macular degeneration (wAMD) diagnosis without another eye disease. This clinical trial compares the treatment response for 3 years, considering genetic variants already studied between the eyes treated with one of the first options of anti-VEGF used in patients with wAMD, (ranibizumab) and the most cost-effective anti-VEGF (bevacizumab; off-label use)

Study Overview

• Status: Recruiting
• Conditions: Wet Age-related Macular Degeneration
• Intervention / Treatment: Drug: Bevacizumab; Drug: Ranibizumab Ophthalmic

• Study Type: Interventional
• Enrollment (Estimated): 630
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Ana Aldea; Phone Number: +3431604900; Email: aaldea@imim.es
• Study Contact Backup: Name: Melina Rojas; Email: mrojas@researchmar.net

Study Locations

• Spain
  • Barcelona, Spain
    • Recruiting
    • Hospital De La Santa Creu I Sant Pau
    • Contact: Melina Rojas; Email: mrojas@researchmar.net
    • Contact: Jose Ignacio Vela
  • Barcelona, Spain
    • Recruiting
    • Hospital La Esperanza
    • Contact: Melina Rojas; Email: mrojas@researchmar.net
    • Contact: Alba Parrado
  • Madrid, Spain, 28046
    • Recruiting
    • Unidad Central de Investigación Clínica y Ensayos Clínicos (UCICEC La Paz)
    • Contact: Melina Rojas; Email: mrojas@researchmar.net
    • Contact: Alicia Marín Candón
  • Santa Cruz De Tenerife
    • San Cristóbal de La Laguna, Santa Cruz De Tenerife, Spain
      • Recruiting
      • Hospital Universitario de Canarias
      • Contact: Melina Rojas; Email: mrojas@researchmar.net
      • Contact: Hugo Tapia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients diagnosed with neovascular Age-related Macular Degeneration
• Age of 50 years or older.
• That at the discretion of the ophthalmologist has an indication of receiving treatment with an anti-VEGF agent as usual in clinical practice.
• Without previous treatment in the eye under study (no previous treatment for AMD).

Exclusion Criteria:

• Participate or have participated in another clinical trial with an experimental drug in the last 6 months.
• Patients with other eye diseases, p. eg, advanced glaucoma or visually significant cataracts, which are likely to require surgery during the follow-up period in the eye under study.
• Concomitant, ocular or systemic, administration of drugs up to 3 months before the treatment with another anti-VEGF in the contralateral eye.
• High cardiovascular risk: poorly controlled arterial hypertension, history or risk of arterial thromboembolic events, history of stroke or acute myocardial infarction, anticoagulant treatment, proteinuria or major elective surgery within 3 months.
• Ophthalmological risk with the intraocular injection (all intravitreal treatments): active or suspected ocular or periocular infection, severe blepharitis, history of endophthalmitis, history of retinal detachment, myopathy, glaucoma.
• Hypersensitivity to the active substance or to the excipients.
• Diabetic retinopathy documented.
• Pregnant or nursing (lactating) women.

Patients who meet elegibility criteria and decline participation due to treatment randomization, will participate in an observational follow-up, collecting saliva for the analysis of genetic polymorphisms and clinical data related to antiVEGF received out of the clinical trial and AV, OCT results and adverse events registered in medical records at 6m, 12m, 24m, 36m.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bevacizumab, BVZ (group A); A cycle of 3 intravitreal injections every 4-6 weeks of BVZ	Drug: Bevacizumab; The dosage for each intravitreal injection is 1.25mg of BVZ in 0.05ml; Other Names: Avastin; L01XC07
Active Comparator: Ranibizumab, RBZ (group B); A cycle of 3 intravitreal injections every 4-6 weeks of RBZ	Drug: Ranibizumab Ophthalmic; The dosage for each intravitreal injection contains 0.5mg of RBZ in 0.05ml; Other Names: Lucentis; S01LA04

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of Genetic Polymorphism in VEGFA Associated With Anti-VEGF Treatment Response in AMD Patients	Proportion of patients carrying the VEGFA genetic polymorphism (VEGFA, CFH, CTFG, ARMS2, HTRA1, OR52B4, LOC387715, LOC100287225, LEPR, SERPINF1), as determined by genotyping of DNA extracted from saliva samples. This measure will be correlated with response to anti-VEGF therapy (ranibizumab or aflibercept). Unit of Measure: % of participants with polymorphism. Measurement Tool: Genotyping assay on saliva-derived DNA (e.g., TaqMan PCR-based method).	From baseline, first dose, up to 3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Visual Acuity Over Time in Patients With AMD Receiving Anti-VEGF Therapy	Visual acuity (VA), measured in number of letters read on the ETDRS chart, at baseline and at months 6, 12, 24, and 36. The change from baseline will be analyzed to assess treatment response over time. Unit of Measure: Number of letters (ETDRS scale). Measurement Tool: ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart.	Baseline, 6 months, 12 months, 24 months, 36 months
Change in Retinal Fluid and Foveal Thickness Over Time as Measured by OCT in Patients With AMD Treated With Anti-VEGF Therapy	Retinal anatomical changes assessed by OCT, including presence and amount of intraretinal and/or subretinal fluid, and central foveal thickness (in microns), measured at baseline and at months 6, 12, 24, and 36. Differences between treatment arms (ranibizumab vs. bevacizumab) will be evaluated over time. Unit of Measure: Microns for foveal thickness; qualitative presence/absence or categorical grading of retinal fluid Measurement Tool: Spectral-domain Optical Coherence Tomography (SD-OCT)	Baseline, 6 months, 12 months, 24 months, 36 months
Distribution of Sex Among Patients With AMD Receiving Anti-VEGF Therapy	Proportion of male and female participants in the study population, analyzed in relation to treatment response to anti-VEGF drugs. Unit of Measure: % of participants by sex. Measurement Tool: Demographic data collected via clinical records.	At baseline
Distribution of Age at Diagnosis in Patients With AMD Receiving Anti-VEGF Therapy	Age in years at time of AMD diagnosis for each participant. Age will be analyzed as a continuous variable in relation to treatment response. Unit of Measure: Years. Measurement Tool: patient-reported age or medical record.	At baseline
Proportion of Smokers Among Patients With AMD Receiving Anti-VEGF Therapy	Proportion of participants with a history of tobacco use at baseline, categorized as current, former, or never smokers. Unit of Measure: % of participants by smoking status. Measurement Tool: Patient-reported history via questionnaire or clinical interview.	At baseline
Prevalence of Obesity in Patients With AMD Receiving Anti-VEGF Therapy	Proportion of participants with obesity, defined as BMI ≥ 30 kg/m² at baseline. Unit of Measure: % of participants with BMI ≥ 30 kg/m². Measurement Tool: Body Mass Index (BMI) calculated from measured height and weight.	At baseline
Prevalence of Hypertension in Patients With AMD Receiving Anti-VEGF Therapy	Proportion of participants with a diagnosis of hypertension at baseline. Unit of Measure: % of participants with hypertension. Measurement Tool: Clinical diagnosis from patient medical records or blood pressure measurement (≥140/90 mmHg).	At baseline
Number of Participants With Ocular and Systemic Adverse Events Associated With Intravitreal Anti-VEGF Therapy	Total number of participants experiencing ocular or systemic adverse events, including cardiovascular events (e.g., myocardial infarction, stroke), following intravitreal injection of ranibizumab or bevacizumab. Events will be assessed cumulatively from the third intravitreal injection through the 3-year follow-up. Unit of Measure: Number of participants with at least one adverse event. Measurement Tool: Clinical assessment and adverse event reporting as per standard pharmacovigilance procedures.	From intravitreal injection, up to 3 years
Total Direct Healthcare Cost per Patient for Anti-VEGF Therapy Over One Year From the Health System Perspective	Total direct healthcare cost per patient treated with ranibizumab or bevacizumab over a 1-year period, based on a cost minimization analysis assuming similar clinical efficacy. Costs will be calculated from the perspective of the Spanish National Health System (SNS) and will include drug acquisition (considering container cost and fractionation), number of intravitreal injections, pharmacogenomic testing, and clinical monitoring. The NEI VFQ-25 composite score will be used to contextualize quality-of-life outcomes within the economic evaluation. Unit of Measure: Euros per patient. Measurement Tool: Cost minimization analysis based on administrative and billing records; NEI VFQ-25 (National Eye Institute Visual Function Questionnaire) for quality-of-life scoring.	From baseline up to 1 year
Weight of Patients With AMD Receiving Anti-VEGF Therapy	Mean weight of participants measured at baseline. Weight will be used both as a descriptive baseline characteristic and as part of the BMI calculation. Unit of Measure: Kilograms (kg) Measurement Tool: Calibrated digital scale	At baseline
Height of Patients With AMD Receiving Anti-VEGF Therapy	Mean height of participants measured at baseline. Height will be used both as a descriptive baseline characteristic and as part of the BMI calculation. Unit of Measure: Meters (m) Measurement Tool: Stadiometer	At baseline

Collaborators and Investigators

• Sponsor: Parc de Salut Mar
• Collaborators: Instituto de Salud Carlos III

Study record dates

Study Major Dates

• Study Start (Actual): November 18, 2022
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: October 28, 2024
• First Submitted That Met QC Criteria: April 23, 2025
• First Posted (Actual): April 30, 2025

Study Record Updates

• Last Update Posted (Actual): November 20, 2025
• Last Update Submitted That Met QC Criteria: November 19, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: AMD; pharmacogenomics; wAMD; antiVEGF; BVZ; RBZ
• Additional Relevant MeSH Terms: Eye Diseases; Retinal Diseases; Retinal Degeneration; Macular Degeneration; Amino Acids, Peptides, and Proteins; Proteins; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Serum Globulins; Globulins; Ranibizumab; Bevacizumab
• Other Study ID Numbers: ICI21/00025; 2019-003204-12 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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