Faricimab for Chronic Central Serous Chorioretinopathy: A Randomized Sham-Controlled Trial
A Randomized, Double-Masked, Sham-Controlled Clinical Trial of Intravitreal Faricimab for Chronic Central Serous Chorioretinopathy With or Without Secondary Macular Neovascularization: Study Protocol for a Randomised, Double-Masked Trial
Dysregulation of the Angiopoietin-2 (Ang-2)/Tyrosine kinase with Immunoglobulin-like and EGF-like domains 2 (Tie-2) signaling pathway has been implicated in choroidal vascular instability and RPE dysfunction in Central serous chorioretinopathy (CSCR) and pachychoroid-associated neovascularization.
This study prospectively evaluates the efficacy and safety of faricimab compared to sham in CSCR with and without secondary neovascularization, using standardized anatomical and functional endpoints. The results of this trial may help define the role of dual pathway inhibition in CSCR and inform future treatment strategies for this challenging and vision threatening condition.
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
Current understanding of central serous chorioretinopathy (CSCR) pathophysiology has evolved from a localized retinal disorder to a disease driven primarily by choroidal venous congestion, vascular hyperpermeability, and hemodynamic dysfunction. The current treatment of choice is photodynamic therapy (PDT). However, there is a global shortage of the photosensitive dye (Verteporfin) which is required for PDT. In addition, special laser and angiography equipment are required to deliver PDT, further limiting the access to this treatment.
Persistent subretinal fluid and neovascular complications represent unmet clinical challenges in the management of CSCR and pachychoroid-associated disease. Emerging evidence from genetic studies suggests that the Angiopoietin-2 (Ang-2) pathway plays a direct role in retinal pigment epithelium (RPE) dysfunction and choroidal vascular instability, along with Tie2 receptor. These mechanisms are also believed to contribute to the choroidal congestion and subretinal fluid accumulation seen in CSCR.
The dual inhibition of Vascular Endothelial Growth Factor (VEGF)-A and Ang-2 offered by faricimab provides a mechanistic rationale for evaluating its efficacy in eyes with CSCR. To-date, only small observational studies and case series have reported macular fluid reduction following intravitreal faricimab. However, these studies are limited by small sample sizes and the absence of comparator groups, hence the need for more robust clinical evidence.
Specific aim: To evaluate the efficacy and safety of intravitreal faricimab in achieving anatomical improvements compared with sham treatment in patients with retinal fluid secondary to CSCR with/ without neovascularization.
Hypothesis: Intravitreal faricimab, through its dual inhibition of VEGF-A and Ang -2, will result in superior drying effect compared with sham treatment.
Tipo de estudo
Inscrição (Estimado)
Estágio
- Fase 2
Contactos e Locais
Contato de estudo
- Nome: Gemmy Cheung Professor
- Número de telefone: +6563224500
- E-mail: gemmy.cheung.c.m@singhealth.com.sg
Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion Criteria:
- Age ≥21 years at the time of consent.
- Best corrected visual acuity between 24 and 73 ETDRS letters (approximately Snellen equivalent 20/32 to 20/300) in the study eye.
- Diagnosis of chronic CSCR, defined as the presence of persistent SRF for ≥3 months, with or without secondary MNV.
- Presence of pachychoroid features, including pachyvessels on ultra-widefield imaging in at least one quadrant and SFCT ≥300 µm.
- Presence of intraretinal fluid and/or subretinal fluid involving the fovea, as confirmed by OCT.
Disease duration criteria:
- CSCR without secondary MNV: persistent subretinal fluid for ≥3 months despite observation, or
- CSCR with secondary MNV: presence of exudative fluid of any duration, with neovascularization confirmed on OCTA.
- Ability and willingness to provide written informed consent.
- Women of childbearing potential must have a negative pregnancy test prior to enrollment and agree to use a reliable form of contraception for the duration of the study.
Exclusion Criteria:
- Presence of ocular inflammation or primary choroidal disorders.
- Presence of polypoidal choroidal vasculopathy (PCV).
- Any ocular condition that, in the opinion of the investigator, could affect intra- or subretinal fluid or significantly alter visual acuity during the study (e.g., diabetic macular edema, retinal vein occlusion, uveitis, neovascular glaucoma).
- Clinically significant cataract likely to reduce visual acuity by more than three ETDRS lines (i.e., worse than approximately 20/40 if the eye were otherwise normal).
- Any intraocular surgery within 3 months prior to enrollment.
Prior treatment in the study eye with:
- Intravitreal corticosteroids (any time),
- Anti-VEGF therapy within 6 months, or
- Photodynamic therapy (any time).
- History of retinal detachment or surgery for retinal detachment, prior vitrectomy, or presence of a full-thickness macular hole.
- Evidence of vitreomacular traction that may preclude resolution of macular edema.
- Extensive intra- or subretinal hemorrhage exceeding 4 disc areas.
- Aphakia in the study eye.
- Pregnancy or breastfeeding.
- Any medical, psychiatric, or systemic condition that, in the opinion of the investigator, would make study participation unsafe or interfere with study assessments.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Triplo
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Comparador Ativo: Intravitreal injection (IVT) arm
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Intravitreal faricimab 6 mg at baseline, month 1, and month 2, followed by protocol-defined Pro Re Nata (PRN) dosing at monthly visits through Month 6.
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Comparador Falso: Sham arm
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Sham injections at baseline, month 1, and month 2. After assessment of the primary endpoint at Month 3, participants randomized to the sham arm who demonstrate persistent intraretinal and/or subretinal fluid will switch to intravitreal faricimab treatment by protocol-defined PRN dosing at monthly visits through Month 6.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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The efficacy of 3 loading doses of IVT faricimab compared with sham treatment in achieving anatomical improvement in eyes with chronic CSCR with presence of foveal sub-retinal fluid (SRF), with or without secondary macular neoascularization (MNV).
Prazo: 3 months.
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Assessed by the proportion of eyes achieving achieving complete resolution of SRF on optical coherence tomography (OCT) at Month 3.
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3 months.
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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The proportion of eyes achieving a ≥20% reduction in central retinal thickness (CRT) from baseline at month 3 and month 6.
Prazo: 6 months.
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6 months.
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The proportion of eyes achieving complete resolution of intraretinal and/or SRF from month 1 through month 6.
Prazo: 6 months.
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6 months.
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The time to first resolution of intraretinal and/or SRF.
Prazo: 6 months.
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6 months.
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The mean change in best corrected visual acuity (BCVA) from baseline to months 3 and 6.
Prazo: 6 months.
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6 months.
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The mean change in CRT from baseline to months 3 and 6.
Prazo: 6 months.
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6 months.
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The number of intravitreal faricimab injections administered from baseline through month 6.
Prazo: 6 months.
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6 months.
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Changes in subfoveal choroidal thickness (SFCT) measured by Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) from baseline to months 3 and 6.
Prazo: Measurements will be obtained at baseline, Month 3, and Month 6, from the central foveal B-scan.
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SFCT will be assessed using EDI-OCT.
SFCT is defined as the vertical distance (in micrometers) between the outer border of the retinal pigment epithelium (RPE)/Bruch's membrane complex and the choroid-scleral interface at the foveal center.
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Measurements will be obtained at baseline, Month 3, and Month 6, from the central foveal B-scan.
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The proportion of eyes demonstrating reduction in height or resolution of pigment epithelial detachment (PED).
Prazo: 6 months.
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6 months.
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Exploratory Analysis of Baseline Qualitative OCT Structural Features as Predictors of Treatment Response.
Prazo: Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Baseline qualitative OCT structural features will be evaluated as predictors of treatment response. The following features will be assessed from spectral-domain OCT images and recorded as binary variables (present/absent):
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Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Exploratory Analysis of Baseline Choroidal Vascularity Index (CVI) as a Predictor of Treatment Response.
Prazo: Baseline imaging with outcome assessed at Month 3 and at Month 6.
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CVI, defined as the ratio of luminal to total choroidal area, will be measured on swept-source OCT (DREAM OCT, Intalight) using the device's built-in analysis tool.
Values will be recorded as a proportion and reviewed by masked graders.
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Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Exploratory Analysis of Baseline Presence of Macular Neovascularization (MNV) on OCT Angiography as a Predictor of Treatment Response.
Prazo: Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Baseline presence of macular neovascularization (MNV) will be assessed on OCT angiography (OCT-A) images and recorded as a binary variable (present/absent).
Its association with treatment response will be evaluated.
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Baseline imaging with outcome assessed at Month 3 and at Month 6.
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The correlation between baseline MNV lesion area measured on OCT angiography and treatment response will be evaluated.
Prazo: Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Baseline imaging with outcome assessed at Month 3 and at Month 6.
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The correlation between baseline vessel density measured on OCT angiography and treatment response will be evaluated.
Prazo: Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Baseline imaging with outcome assessed at Month 3 and at Month 6.
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Colaboradores e Investigadores
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