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The purpose of the study was to compare the effect of intravitreal injections of ranibizumab and aflibercept on systemic VEGF protein levels in treatment naïve wet neovascular Age-related Macular Degeneration (wAMD) patients in a detailed time course.
A planned study visit schedule was established at the time of baseline visit (day 1) for all patients. Study assessments for patients were performed at screening visit, baseline (day 1), day 2, day 8 (± 1 day to allow for flexibility in scheduling) and as of day 15 through to day 169 at biweekly visits.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Experimental | 6 monthly intravitreal injections of 0.5 mg ranibizumab |
|
| Group 2 | Experimental | 3 monthly intravitreal injections of 2 mg aflibercept followed by 3 monthly intravitreal injections of 0.5 mg ranibizumab |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ranibizumab 0.5 mg | Drug | Administered as an intravitreal injection |
|
| Measure | Description | Time Frame |
|---|---|---|
| Standardized Area Under the Curve (AUC) for VEGF A Levels by SIMOA (Quanterix's Single Molecule Array) Method for the Comparative Phase | The AUC was calculated using the trapezoidal rule, where all available measurement between Day 1 and Week 12 were used. The AUC was standardized by dividing the calculated value by the number of days from first to last measurement. | Baseline up to Week 12 visit (Days 1, 2, 8, 15, 29, 43, 57, 71, 85) |
| Measure | Description | Time Frame |
|---|---|---|
| Systemic VEGF-A Protein Levels From Study Week 12 to 24 | Systemic VEGF-A protein levels in patients switching from monthly 2 mg aflibercept injections to monthly 0.5 mg ranibizumab compared to patients treated with monthly 0.5 mg ranibizumab from baseline (standardized area under the curve) | From study week 12 to 24 (Days 85, 99, 113, 127, 141, 155, 169) |
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Inclusion Criteria:
Exclusion Criteria:
For either eye:
For study eye:
For fellow eye
- Retinal or choroidal neovascularization or macula edema of any cause
Other protocol-defined inclusion/exclusion criteria may apply.
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| Name | Affiliation | Role |
|---|---|---|
| Novartis Pharmaceuticals | Novartis Pharmaceuticals | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Novartis Investigative Site | Cologne | 50924 | Germany | |||
| Novartis Investigative Site |
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At Screening, the eligibility criteria were performed.
.
The study included adult patients with active, newly diagnosed, and untreated wAMD. A total of 40 patients were treated at 6 study sites across Germany. Patients were treated in an outpatient setting.
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| ID | Title | Description |
|---|---|---|
| FG000 | Ranibizumab | 6 monthly intravitreal injections of 0.5 mg ranibizumab |
| FG001 | Aflibercept and Ranibizumab | 3 monthly intravitreal injections of 2 mg aflibercept followed by 3 monthly intravitreal injections of 0.5 mg ranibizumab |
| Title | Milestones | Reasons Not Completed | ||||
|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Apr 27, 2015 | Jun 5, 2018 |
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| Aflibercept 2 mg | Drug | Administered as an intravitreal injection |
|
|
| Systemic VEGF-A Levels From Study Week 12 to 24 (Change From Baseline) | Adjustment of systemic VEGF-A levels of patients switching from aflibercept to ranibizumab to levels comparable to baseline or to levels comparable as in patients treated from baseline with ranibizumab | From study week 12 to 24 |
| Marburg |
| 35039 |
| Germany |
| Novartis Investigative Site | München | 80336 | Germany |
| Novartis Investigative Site | München | 81675 | Germany |
| Novartis Investigative Site | Osnabrück | 49076 | Germany |
| Novartis Investigative Site | Regensburg | 93042 | Germany |
|
| Full Analysis Set (FAS) | all randomized patients who received study treatment and had ≥ 1 primary efficacy assessment |
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| Safety Set (SAF) | all patients who received study treatment and had ≥ 1 post-baseline safety assessment. |
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| Per-Protocol Set (PPS) | all patients in the FAS who did not have any major protocol deviations |
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| COMPLETED |
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| NOT COMPLETED |
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Full Analysis Set (FAS)
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| ID | Title | Description |
|---|---|---|
| BG000 | Ranibizumab | 6 monthly intravitreal injections of 0.5 mg ranibizumab |
| BG001 | Aflibercept and Ranibizumab | 3 monthly intravitreal injections of 2 mg aflibercept followed by 3 monthly intravitreal injections of 0.5 mg ranibizumab |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | Years |
| |||||||||||||||
| Sex/Gender, Customized | Full Analysis Set (FAS) | Number | Participants |
| |||||||||||||||
| Race/Ethnicity, Customized | Number | Participants |
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| 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 | Standardized Area Under the Curve (AUC) for VEGF A Levels by SIMOA (Quanterix's Single Molecule Array) Method for the Comparative Phase | The AUC was calculated using the trapezoidal rule, where all available measurement between Day 1 and Week 12 were used. The AUC was standardized by dividing the calculated value by the number of days from first to last measurement. | Per-Protocol Set (PPS) | Posted | Mean | Standard Deviation | pg/mL | Baseline up to Week 12 visit (Days 1, 2, 8, 15, 29, 43, 57, 71, 85) |
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| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Systemic VEGF-A Protein Levels From Study Week 12 to 24 | Systemic VEGF-A protein levels in patients switching from monthly 2 mg aflibercept injections to monthly 0.5 mg ranibizumab compared to patients treated with monthly 0.5 mg ranibizumab from baseline (standardized area under the curve) | Per-Protocol Set (PPS) | Posted | Mean | Standard Deviation | pg/mL | From study week 12 to 24 (Days 85, 99, 113, 127, 141, 155, 169) |
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| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Systemic VEGF-A Levels From Study Week 12 to 24 (Change From Baseline) | Adjustment of systemic VEGF-A levels of patients switching from aflibercept to ranibizumab to levels comparable to baseline or to levels comparable as in patients treated from baseline with ranibizumab | Per-Protocol Set (PPS) Number of participants analyzed at each time point represents patients with a value for both baseline and the specific post-baseline visit | Posted | Mean | Standard Deviation | pg/ml | From study week 12 to 24 |
|
|
28 weeks
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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 | Ranibizumab (Up to Month 3) | 3 monthly intravitreal injections of 0.5 mg ranibizumab | 0 | 19 | 3 | 19 | 14 | 19 |
| EG001 | Ranibizumab (After Month 3) | 3 monthly intravitreal injections of 0.5 mg ranibizumab | 0 | 19 | 0 | 19 | 9 | 19 |
| EG002 | Aflibercept and Ranibizumab (Up to Month 3 - Aflibercept) | 3 monthly intravitreal injections of 2 mg aflibercept (AEs reported that started before switching to ranibizumab) | 0 | 21 | 1 | 21 | 17 | 21 |
| EG003 | Aflibercept and Ranibizumab (After Month 3 - Ranibizumab) | 3 monthly intravitreal injections of 0.5 mg ranibizumab (AEs reported that started on or after switching to ranibizumab) | 0 | 21 | 3 | 21 | 17 | 21 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Atrial fibrillation | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Cardiac failure congestive | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Optic nerve cupping | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Retinal pigment epithelial tear | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Pneumonia | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
| |
| Bone cyst | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Benign lung neoplasm | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA (20.0) | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Aortic valve disease | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Aortic valve incompetence | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Atrial fibrillation | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Cardiac discomfort | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Cardiac fibrillation | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Cardiovascular disorder | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Mitral valve incompetence | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Sinus bradycardia | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Tricuspid valve incompetence | Cardiac disorders | MedDRA (20.0) | Systematic Assessment |
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| Vertigo | Ear and labyrinth disorders | MedDRA (20.0) | Systematic Assessment |
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| Thyroid mass | Endocrine disorders | MedDRA (20.0) | Systematic Assessment |
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| Anterior chamber cell | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Blepharitis | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Choroidal neovascularisation | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Conjunctival erosion | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Conjunctival haemorrhage | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Conjunctival hyperaemia | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Corneal erosion | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Dry eye | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Eye discharge | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Eye pain | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Eyelid oedema | Eye disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Foreign body sensation in eyes | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Lacrimation increased | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Macular fibrosis | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Metamorphopsia | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Ocular discomfort | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Pinguecula | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Retinal fibrosis | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Retinal scar | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Subretinal fluid | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Vision blurred | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Visual acuity reduced | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Visual impairment | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Vitreous detachment | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Vitreous floaters | Eye disorders | MedDRA (20.0) | Systematic Assessment |
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| Abdominal pain upper | Gastrointestinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Diarrhoea | Gastrointestinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Gastrooesophageal reflux disease | Gastrointestinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Nausea | Gastrointestinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Fibrosis | General disorders | MedDRA (20.0) | Systematic Assessment |
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| Influenza like illness | General disorders | MedDRA (20.0) | Systematic Assessment |
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| Injection site pain | General disorders | MedDRA (20.0) | Systematic Assessment |
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| Sensation of foreign body | General disorders | MedDRA (20.0) | Systematic Assessment |
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| Hypersensitivity | Immune system disorders | MedDRA (20.0) | Systematic Assessment |
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| Bronchitis | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Conjunctivitis | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Gastroenteritis | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Herpes simplex | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Hordeolum | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Influenza | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Rhinitis | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Viral upper respiratory tract infection | Infections and infestations | MedDRA (20.0) | Systematic Assessment |
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| Fall | Injury, poisoning and procedural complications | MedDRA (20.0) | Systematic Assessment |
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| Hand fracture | Injury, poisoning and procedural complications | MedDRA (20.0) | Systematic Assessment |
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| Laceration | Injury, poisoning and procedural complications | MedDRA (20.0) | Systematic Assessment |
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| Blood pressure increased | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Body temperature increased | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Electrocardiogram abnormal | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Gamma-glutamyltransferase increased | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Haemoglobin E present | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Intraocular pressure increased | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Mean cell haemoglobin concentration increased | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Mean cell haemoglobin increased | Investigations | MedDRA (20.0) | Systematic Assessment |
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| Hypercholesterolaemia | Metabolism and nutrition disorders | MedDRA (20.0) | Systematic Assessment |
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| Hyperglycaemia | Metabolism and nutrition disorders | MedDRA (20.0) | Systematic Assessment |
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| Iron deficiency | Metabolism and nutrition disorders | MedDRA (20.0) | Systematic Assessment |
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| Arthralgia | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Back pain | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Fibromyalgia | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Intervertebral disc protrusion | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Muscular weakness | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Neck pain | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Spinal column stenosis | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Spinal osteoarthritis | Musculoskeletal and connective tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Basal cell carcinoma | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA (20.0) | Systematic Assessment |
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| Burning sensation | Nervous system disorders | MedDRA (20.0) | Systematic Assessment |
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| Headache | Nervous system disorders | MedDRA (20.0) | Systematic Assessment |
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| Monoparesis | Nervous system disorders | MedDRA (20.0) | Systematic Assessment |
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| Sciatica | Nervous system disorders | MedDRA (20.0) | Systematic Assessment |
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| Anxiety | Psychiatric disorders | MedDRA (20.0) | Systematic Assessment |
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| Insomnia | Psychiatric disorders | MedDRA (20.0) | Systematic Assessment |
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| Chronic kidney disease | Renal and urinary disorders | MedDRA (20.0) | Systematic Assessment |
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| Bronchial wall thickening | Respiratory, thoracic and mediastinal disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Nasal congestion | Respiratory, thoracic and mediastinal disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Oropharyngeal pain | Respiratory, thoracic and mediastinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Pleural effusion | Respiratory, thoracic and mediastinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Pulmonary embolism | Respiratory, thoracic and mediastinal disorders | MedDRA (20.0) | Systematic Assessment |
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| Actinic keratosis | Skin and subcutaneous tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Hyperhidrosis | Skin and subcutaneous tissue disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Melanosis | Skin and subcutaneous tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Photosensitivity reaction | Skin and subcutaneous tissue disorders | MedDRA (20.0) | Systematic Assessment |
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| Sebaceous gland disorder | Skin and subcutaneous tissue disorders | MedDRA (20.0) | Systematic Assessment |
| |
| Jaw operation | Surgical and medical procedures | MedDRA (20.0) | Systematic Assessment |
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| Hypertension | Vascular disorders | MedDRA (20.0) | Systematic Assessment |
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| Intermittent claudication | Vascular disorders | MedDRA (20.0) | Systematic Assessment |
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The terms and conditions of Novartis' agreements with its investigators may vary. However, Novartis does not prohibit any investigator from publishing. Any publications from a single-site are postponed until the publication of the pooled data (ie, data from all sites) in the clinical trial.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Study Director | Novartis Pharmaceuticals | 862-778-8300 | Novartis.email@novartis.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Nov 10, 2017 | Jun 5, 2018 | SAP_001.pdf |
| ID | Term |
|---|---|
| D000069579 | Ranibizumab |
| C533178 | aflibercept |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
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| Male |
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