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The purpose of this study is to look at the safety and effectiveness of CNTF implants on vision in persons with retinitis pigmentosa, Usher type II & III, and Choroideremia. This research is being done because there are no effective therapies for people with these retinal degenerations. They are genetic disorders that affect our ability to see at night, and later cause tunnel vision and loss of central vision. Retinal degenerations affect the retina, a light sensitive layer of cells in the back of the eye. Slowly over time, these cells die and cause permanent loss of vision.
The implant is a small capsule that contains human retinal pigment epithelium cells. These cells have been given the ability to make CNTF and release it through the capsule membrane into the surrounding fluid. This study will look at the effect of the implant on vision loss by retinitis pigmentosa, Usher type II & III, and Choroideremia. In this study, two different CNTF dose levels will be used: a high dose and a low dose in one eye, as well as a sham (or placebo) surgery in the other eye.
This study will involve about 16 visits over 1½ years for specific tests of the participant's vision and health. These visits may include visual exams, blood draw for laboratory testing, brief medical history and exam, and occasionally a questionnaire (survey), in addition to the visit for the surgical procedures. The primary effectiveness outcome for this study will be a visual acuity score one year after the implant surgery. There will be about 13 centers participating in this study, and up to 60 people enrolled across the US. Each participant joining the study who has completed initial screening will then be scheduled to have a brief surgical procedure performed on each eye, one of which will include a very small cell-filled implant. Follow-up visits for repeat assessments will be required regularly to determine if the implant being tested is safe and effective for use to treat RP.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low Dose NT-501 | Experimental | NT-501 Low Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina Sham Implant in Fellow Eye |
|
| High Dose NT-501 | Experimental | NT-501 High Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina Sham Implant in Fellow Eye |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Low Dose NT-501 | Combination Product | Low Dose NT-501 Implanted in study eye and fellow eye received sham surgery |
|
| Measure | Description | Time Frame |
|---|---|---|
| The Primary Outcome is the Change in Best-corrected Visual Acuity (BCVA) Using the Electronic Visual Acuity (EVA) Technology at Month 12. | The primary efficacy endpoint was the proportion of patients demonstrating an improvement in best-corrected visual acuity (BCVA), defined as an increase of 10 letters or more at the 1-Year post-implant visit (pre-explant, if explant is completed). No response is defined as an improvement of <10 letters. | 12 months post-implant |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With and Without Best Corrected Visual Acuity Response Over the 18-month Follow-up Period (Months 1, 3, 6, 12 and 18) | The key visits for efficacy assessments were Months 1, 3, 6, 12 and 18. At these time points, BCVA was measured 3 times and the mean outcome reported. The assessments were conducted by masked technicians. The change from baseline for BCVA was summarized by time. Response is defined as an improvement in visual acuity by an increase of 10 letters or more whereas no response is <10 letters. |
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Inclusion Criteria:
Participant was older than 18, but less than 68 years of age.
Participant understood and signed the informed consent. If the participant's vision was impaired to the point where he/she could not read the informed consent document, the document would be read to the participant in its entirety.
Females of childbearing potential (women with last menses <1 year prior to screening) agreed to use an effective form of birth control from study onset until they completed the 18-month study visit.
Participant was medically able to undergo ophthalmic surgery for the NT-501 device.
Participant's clinical diagnosis was consistent with retinal degeneration in the set of retinitis pigmentosa (RP) dystrophies characterized by the following features:
Each eye had a visual acuity score of at least 24 (20/320) and no more than 63 (20/63) letters.
Each eye had an ERG amplitude reduced below the 95% limit of normal (CI) per site by Full Field 28-32 Hz flicker.
Exclusion Criteria:
Participant was medically unable to comply with study procedures or follow-up visits.
Participant had glaucoma (defined as independent optic atrophy causing vision loss), irrespective of whether it was currently treated or untreated.
Participant had classic syndromic RP.
Participant had optic nerve atrophy beyond modest pallor, primary cone-rod dystrophy, unilateral bulls-eye maculopathy, cystoid maculopathy as judged by OCT reading center, or other retinal dystrophy.
Participant who had any of the following lens opacities: cortical opacity > standard 3, posterior subcapsular opacity > standard 3, or a nuclear opacity > standard 3 as measured on the AREDS clinical lens grading system.
Participant had chronic requirement (e.g., > or =4 weeks at a time) for ocular medications or has disease(s) that in the judgment of the examining physician were vision threatening, toxic to the lens, retina, or optic nerve or might affect the primary outcome.
Participant had a requirement of acyclovir and/or related products during study duration.
To be eligible for this study, the participant must have discontinued use of these products prior to enrollment and must not continue with the products until after they had completed the study.
Participant had evidence of corneal opacification or lack of optical clarity.
Participant had undergone lens removal in the last 3 months, with or without intra-ocular lens implantation, or had undergone intra-ocular lens replacement within 6 months prior to enrollment.
Participant was receiving systemic steroids or other immunosuppressive medications.
Participant had undergone LASIK surgery or other refractive surgery for either eye in less than 6 months prior to screening.
Participant was currently participating in or had participated in any other clinical trial of a drug by ocular or systemic administration within the last 6 months.
Participant had previous exposure to an intra-ocular device or implant into the eye (excluding intra-ocular lens).
Participant had uveitis or other retinal inflammatory disease.
Participant was receiving oral or other insulin treatment for diabetes.
Participant who had a history of myocardial infarction within the last 12 months.
Participant was pregnant or lactating.
Participant was considered immunodeficient or had a known history of HIV. A laboratory test for HIV was performed, and a positive result was also an exclusion criterion.
Participant with a history of ocular herpes zoster.
Participant was on chemotherapy.
Participant had a history of malignancy, except study participants having cancer treated successfully ≥5 years prior to inclusion in the trial.
Participant with severe hearing disabilities in both ears.
Participant with diabetic retinopathy in either eye.
Participant had history of retinal detachment in either eye.
Participant had been diagnosed and treated for amblyopia as an infant.
Participant with a history of Pars Plana Vitrectomy.
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| Name | Affiliation | Role |
|---|---|---|
| David Birch, MD | Retina Foundation of the Southwest | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Retina-Vitreous Associates Medical Group | Beverly Hills | California | 90211 | United States | ||
| University of Califoria, Davis |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23668681 | Derived | Birch DG, Weleber RG, Duncan JL, Jaffe GJ, Tao W; Ciliary Neurotrophic Factor Retinitis Pigmentosa Study Groups. Randomized trial of ciliary neurotrophic factor delivered by encapsulated cell intraocular implants for retinitis pigmentosa. Am J Ophthalmol. 2013 Aug;156(2):283-292.e1. doi: 10.1016/j.ajo.2013.03.021. Epub 2013 May 10. | |
| 23049090 |
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The total number of participant in the low dose group was 22 and the high dose group was 45 since each patient consented to treatment in one eye and sham treatment in the other eye.
| ID | Title | Description |
|---|---|---|
| FG000 | Low Dose Arm - Implant | NT-501 Low Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina |
| FG001 | Low Dose Arm - Sham | Sham Implant in Fellow Eye (Low Dose Arm) |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| High Dose NT-501 | Combination Product | High Dose NT-501 Implanted in study eye and fellow eye received sham surgery |
|
|
| From initial implant to 18 months post-implant |
| Sacramento |
| California |
| 95817 |
| United States |
| University of California, San Francisco | San Francisco | California | 94143-0730 | United States |
| Retina Group of Florida | Hollywood | Florida | 33021-6746 | United States |
| University of Florida | Jacksonville | Florida | 32216-1480 | United States |
| Kellogg Eye Center | Ann Arbor | Michigan | 48105 | United States |
| University of Minnesota | Minneapolis | Minnesota | 55455-0501 | United States |
| NY University Medical Center | New York | New York | 10016 | United States |
| Casey Eye Institue | Portland | Oregon | 97239-4197 | United States |
| The Hamilton Eye Institute | Memphis | Tennessee | 38163 | United States |
| Retina Foundation of Southwest | Dallas | Texas | 75231 | United States |
| Kauper K, McGovern C, Sherman S, Heatherton P, Rapoza R, Stabila P, Dean B, Lee A, Borges S, Bouchard B, Tao W. Two-year intraocular delivery of ciliary neurotrophic factor by encapsulated cell technology implants in patients with chronic retinal degenerative diseases. Invest Ophthalmol Vis Sci. 2012 Nov 1;53(12):7484-91. doi: 10.1167/iovs.12-9970. |
| FG002 | High Dose Arm - Implant | NT-501 High Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina |
| FG003 | High Dose Arm - Sham | Sham Implant in Fellow Eye (High Dose Arm) |
| COMPLETED |
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| NOT COMPLETED |
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Total number of participants in the trial was 67, with 22 participants in the Low Dose Arm and 45 participants in the High Dose Arm. Note, the participants also received a sham surgery in fellow eye on both study arms, which was used as reference therapy. No capsule was implanted in fellow eye. Baseline reports include sham as a separate column for each arm.
| ID | Title | Description |
|---|---|---|
| BG000 | Low Dose Arm - Implant | NT-501 Low Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina |
| BG001 | Low Dose Arm - Sham | Sham Implant in Fellow Eye (Low Dose Arm) |
| BG002 | High Dose | NT-501 High Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina |
| BG003 | High Dose Arm - Sham | Sham Implant in Fellow Eye (High Dose Arm) |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Eyes |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | Years | Participants |
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| Sex: Female, Male | Count of Participants | Participants | Participants |
| |||||||||||||||||||
| Ethnicity (NIH/OMB) | Count of Participants | Participants | Participants |
| |||||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants | Participants |
| |||||||||||||||||||
| Ocular History - Years Since RP Diagnosis | Mean | Standard Deviation | Years | Participants |
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| Type of Ocular History | Count of Units | Eyes | Eyes |
| |||||||||||||||||||
| BCVA Letter Score | BCVA = best corrected visual acuity; For BCVA, baseline=average of values at Baseline Visits 2 and 3 | Two patients, both in the high dose were randomized but did not receive the implant and did not take part in the study. One of these participants ended study participation prior to completion of Visit 3 baseline visit. The other patient is included in the BCVA baseline data set; however, did not proceed with surgery. | Mean | Standard Deviation | Letters | Eyes |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | The Primary Outcome is the Change in Best-corrected Visual Acuity (BCVA) Using the Electronic Visual Acuity (EVA) Technology at Month 12. | The primary efficacy endpoint was the proportion of patients demonstrating an improvement in best-corrected visual acuity (BCVA), defined as an increase of 10 letters or more at the 1-Year post-implant visit (pre-explant, if explant is completed). No response is defined as an improvement of <10 letters. | Results are based on participants who completed the 1-yr post implant visit/assessment. | Posted | Number | participants | 12 months post-implant | Eyes | Eyes |
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| Secondary | Number of Participants With and Without Best Corrected Visual Acuity Response Over the 18-month Follow-up Period (Months 1, 3, 6, 12 and 18) | The key visits for efficacy assessments were Months 1, 3, 6, 12 and 18. At these time points, BCVA was measured 3 times and the mean outcome reported. The assessments were conducted by masked technicians. The change from baseline for BCVA was summarized by time. Response is defined as an improvement in visual acuity by an increase of 10 letters or more whereas no response is <10 letters. | Data set provides details for each timepoint based on number of patients who completed BCVA procedure at the each applicable visit. | Posted | Count of Participants | Participants | From initial implant to 18 months post-implant |
|
Adverse Events were collected from time of the consent through 18 months post-implant.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Low Dose | NT-501 Low Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina Sham Implant in Fellow Eye | 0 | 22 | 1 | 22 | 22 | 22 |
| EG001 | High Dose | NT-501 High Dose Implant: encapsulated cell therapy that delivers ciliary neurotrophic factor to the retina Sham Implant in Fellow Eye | 0 | 43 | 0 | 22 | 42 | 43 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Pelvic Fracture | Injury, poisoning and procedural complications | MedDRA (9.0) | Non-systematic Assessment |
| |
| Upper limb fracture | Injury, poisoning and procedural complications | MedDRA (9.0) | Non-systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abnormal sensation in eye | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Anterior chamber cell | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Anterior chamber flare | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Cataract | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Conjunctival cyst | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Conjunctival Haemorrhage | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Conjunctival Hyperaemia | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Conjunctival Oedema | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Eye inflammation | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Eye irritation | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Eye pain | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Eye pruritis | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Foreign body sensation in eyes | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Macular Oedema | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Maculopathy | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Miosis | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Pupils unequal | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Vision blurred | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Visual acuity reduced | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Vitreous detachment | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Vitreous disorder | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Vitreous opacities | Eye disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Dyspepsia | Gastrointestinal disorders | MedDRA (9.0) | Non-systematic Assessment |
| |
| Bronchitis | Infections and infestations | MedDRA (9.0) | Non-systematic Assessment |
| |
| Nasopharyngitis | Infections and infestations | MedDRA (9.0) | Non-systematic Assessment |
| |
| Pneumonia | Infections and infestations | MedDRA (9.0) | Non-systematic Assessment |
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| Sinusitis | Infections and infestations | MedDRA (9.0) | Non-systematic Assessment |
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| Post procedural complication | Injury, poisoning and procedural complications | MedDRA (9.0) | Non-systematic Assessment |
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| Post procedural haemorrhage | Injury, poisoning and procedural complications | MedDRA (9.0) | Non-systematic Assessment |
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| Procedural pain | Injury, poisoning and procedural complications | MedDRA (9.0) | Non-systematic Assessment |
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| Suture related complication | Injury, poisoning and procedural complications | MedDRA (9.0) | Non-systematic Assessment |
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| Headache | Nervous system disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Pharyngolaryngeal Pain | Respiratory, thoracic and mediastinal disorders | MedDRA (9.0) | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| CMO | Neurotech Pharmaceuticals, LLC | 401-333-3880 | neurotech@neurotechusa.com |
| ID | Term |
|---|---|
| D012174 | Retinitis Pigmentosa |
| D005128 | Eye Diseases |
| D012164 | Retinal Diseases |
| ID | Term |
|---|---|
| D015785 | Eye Diseases, Hereditary |
| D058499 | Retinal Dystrophies |
| D012162 | Retinal Degeneration |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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| ID | Term |
|---|---|
| D020934 | Ciliary Neurotrophic Factor |
| ID | Term |
|---|---|
| D009414 | Nerve Growth Factors |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D011506 | Proteins |
| D009419 | Nerve Tissue Proteins |
| D001685 | Biological Factors |
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| No Response |
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| OG003 |
| High Dose Arm - Sham |
Sham Implant in Fellow Eye (High Dose Arm) |
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