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objective: To evaluate the efficacy of the ophthalmic emulsion PRO-145 in the treatment of inflammation and pain after phacoemulsification.
Hypothesis:
The use of the ophthalmic emulsion PRO-145 is effective in decreasing the inflammatory response evaluated by means of cellularity in the anterior chamber, after phacoemulsification.
Methodology:
Phase III clinical trial, double-blind, controlled, parallel group, multicentre, randomized.
Number of patients:
178 subjects divided into 2 groups (89 subjects per group), who will provide an eye for the evaluation of efficacy.
Diagnosis and main inclusion criteria:
Diagnosis: Postoperative phacoemulsification and foldable intraocular lens placement in a bag.
The study subjects will be recruited from various research centers in western and central Mexico.
Each research center has a monitoring plan specified according to the recruitment capabilities of the same, which must be at least once a month, where the queries of your data entered into the electronic case report report will be reported to the center. (e-CRF) for which it has as time limit the next monitoring visit to make the pertinent changes.
The report of adverse events will be made according to the standard operating procedure (PNO) where it specifies, according to Official Mexican Standard 220 (NOM 220), that the signs or symptoms of adverse events will be reported based on the Medical Dictionary. for Regulatory Activities, for which the sponsor has version 20.1 in Spanish. For serious adverse events (SAEs) will be reported in accordance with the standardized operation procedure of pharmacovigilance of the sponsor, which adheres to the guidelines of NOM 220 and international regulations, these will be reported in the regulatory framework to the regulatory entity within a period of time no more than 7 days.
The study is registered in the National Registry of Clinical Trials (RNEC), entity equivalent to Clinical Trials in Mexico.
The quality assurance plan is carried out by the sponsor through the Quality Assurance agent in Clinical Research, whose function is to conduct inspections and audits of the research sites to document and generate reports of deviations from the protocol. In addition to the visits of the monitoring plan, the reliability of the data is guaranteed.
To verify the integrity, veracity and reliability of the data entered into the e-CRF, the monitors of each center will check the information uploaded to the portal with that reported in the source document of the principal investigator (PI), such as clinical notes, clinical history and documents. and formats attached to the research protocol, physical case report format, as well as those provided by the sponsor to the PI (subject's diary and quality and satisfaction survey).
The e-CRF used for this clinical study is provided by an internationally certified provider with the highest quality standards, protection of information under current regulations and confidentiality guarantee. The information that the PIs enter into the e-CRF is collated and verified by the clinical monitors and by the service provider's personnel, later reviewed and approved by the medical ophthalmologist researcher and by the Clinical Security Pharmacologist, who authorize the monitored data of clinical information and safety of the study molecule, respectively.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PRO-145. | Experimental | Difluprednate 0.05%. Prepared by Sophia Laboratories, S.A. of C.V., Zapopan, Jalisco, Mexico. |
|
| Prednefrin | Active Comparator | Prednefrin® SF. Prednisolone Acetate 1%. Prepared by Allergan, S.A. of C.V. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Difluprednate 0.05% | Drug | Dosage: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Ability (VA) | The VA will be evaluated basally, without refractive correction with the Snellen chart. Which will be located in a place with adequate lighting, natural or artificial and at a distance of 3 meters from the subject to be evaluated. The result of the Snellen fraction will be transformed to its decimal equivalent in LogMAR, ex. 20/20= 1.0, 20/25=0.8, 20/40= 0.5, 20/200= 1.0, etc. The subjects will be averaged by group. | day 28 at the final visit |
| Adverse Events | The evaluation of adverse events requires a questioning conducted by the principal investigator and the appropriate exploratory techniques for its detection. the number of cases with adverse events will be reported per study arm | day 28 at the final visit |
| Measure | Description | Time Frame |
|---|---|---|
| Cellularity in the Anterior Chamber | unit: degrees, Direct observation (Biomicroscopy). Scale for anterior chamber cellularity. Grade/Number of cells Grade / Number of cells 0 Any ½ + 1-5
the cellularity will be measured according to the scale that is added next, considering as normal the degree 0, and abnormal any other degree. | day 28 at the final visit |
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Inclusion Criteria:
Exclusion Criteria:
Medical and therapeutic criteria.
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| Name | Affiliation | Role |
|---|---|---|
| Leopoldo Baiza Durán, MD | Laboratorios Sophia S.A de C.V. | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Catarata y Glaucoma de Occidente | Guadalajara | Jalisco | 44160 | Mexico | ||
| Novam y Vita |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32606573 | Derived | Palacio-Pastrana C, Chavez-Mondragon E, Soto-Gomez A, Suarez-Velasco R, Montes-Salcedo M, Fernandez de Ortega L, Nasser-Nasser L, Baiza-Duran L, Olvera-Montano O, Munoz-Villegas P. Difluprednate 0.05% versus Prednisolone Acetate Post-Phacoemulsification for Inflammation and Pain: An Efficacy and Safety Clinical Trial. Clin Ophthalmol. 2020 Jun 12;14:1581-1589. doi: 10.2147/OPTH.S254705. eCollection 2020. |
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| ID | Title | Description |
|---|---|---|
| FG000 | PRO-145. | Difluprednate 0.05%. Prepared by Sophia Laboratories, S.A. of C.V., Zapopan, Jalisco, Mexico. Difluprednate 0.05%: Dosage: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. |
| FG001 | Prednefrin | Prednefrin® SF. Prednisolone Acetate 1%. Prepared by Allergan, S.A. of C.V. Prednefrin: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. - Route of administration: topical ophthalmic |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | PRO-145. | Difluprednate 0.05%. Prepared by Sophia Laboratories, S.A. of C.V., Zapopan, Jalisco, Mexico. Difluprednate 0.05%: Dosage: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| 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 | Visual Ability (VA) | The VA will be evaluated basally, without refractive correction with the Snellen chart. Which will be located in a place with adequate lighting, natural or artificial and at a distance of 3 meters from the subject to be evaluated. The result of the Snellen fraction will be transformed to its decimal equivalent in LogMAR, ex. 20/20= 1.0, 20/25=0.8, 20/40= 0.5, 20/200= 1.0, etc. The subjects will be averaged by group. | the analysis was performed per protocol (PP) | Posted | Mean | Standard Deviation | units on a scale (LogMAR) | day 28 at the final visit |
|
Adverse events were monitored throughout the study, for at least 10 months.
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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 | PRO-145. | Difluprednate 0.05%. Prepared by Sophia Laboratories, S.A. of C.V., Zapopan, Jalisco, Mexico. Difluprednate 0.05%: Dosage: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| acute myocardial infarction | Vascular disorders | MedDRA (22.0) | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| ocular burning | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Ricardo Llamas (clinical safety pharmacologist) | Laboratorios Sophia | +52 (33) 3001 4200 | 1259 | ricardo.llamas@sophia.com.mx |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Feb 8, 2018 | May 10, 2019 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D002386 | Cataract |
| ID | Term |
|---|---|
| D007905 | Lens Diseases |
| D005128 | Eye Diseases |
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| ID | Term |
|---|---|
| C009020 | prednefrin |
| C015808 | difluprednate |
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double-blind, controlled, parallel group, multicentre, randomized
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Blinding and masking The blinding will correspond to the research subject and the principal investigator. In addition, the statistical analysis will be carried out in a blinded manner in the case of a partial and final analysis.
The masking will be carried out using boxes in the identical primary packaging in the two groups and re-labeling the bottles of both interventions.
Blinding for the research subject and the researcher will be done by replacing the commercial labels in the case of the comparator in the bottles and the use of identical labels that contain the assignment number.
|
| Prednefrin | Drug | 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. - Route of administration: topical ophthalmic |
|
|
| Clinical Corneal Edema | The evaluation of clinical edema will be evaluated by the Efron scale, which is a series of factorial sections of the cornea, including features such as grooves and folds. The Efron scale has a strong correlation with variations in intensity. The number will be reported according to the rating awarded. Efron Scale: 0 Normal, 1 very slight, 2 mild, 3 moderate and 4 severe. | day 28 at the final visit |
| Flare | In the presence of intraocular inflammation, the increased permeability of the non-pigmented layer of the ciliary epithelium, the posterior epithelium of the iris and the vascular endothelium of the iris results in the accumulation of cells and proteins (visible to the examiner as flare) in the anterior chamber. Using a light beam of 0.2mm X 0.2mm directed obliquely to the anterior chamber with a forward inclination of the light source (slit lamp tower) the degree of flare and cellularity will be determined according to the group of work of standardization for the nomenclature of uveitis. Flare scale 0 There is no flare
| day 28 at the final visit |
| Central Thickness of the Retina | By means of optical coherence tomography (OCT) the Retinal central thickness (GCR) will be measured. OCT is a noninvasive imaging test that uses light waves to take photographs of the cross section of the retina (the light-sensitive tissue that lines the back of the eye).With a OCT, each of the characteristic layers of the retina can be observed, allowing mapping and measuring its thickness a micrometer result will be obtained and the analysis will be carried out between groups. | day 28 at the final visit |
| Conjunctival Hyperemia | Conjunctival hyperemia is defined as the simplest reaction of the conjunctiva to a stimulus, a red appearance secondary to the vasodilation of the conjunctival vessels of variable intensity, we will use the Efron scale for conjunctival hyperemia. 0 normal
| day 28 at the final visit |
| Intraocular Pressure | Tonometry is the objective measure of Intraocular pressure, based primarily on the force required to flatten the cornea, or the degree of corneal indentation produced by a fixed force. Goldman's tonometry is based on the Imbert-Fick principle. the result will be expressed in millimeters of mercury and the comparison between groups will be carried out | day 28 at the final visit |
| Symptomatology Post Instillation | The subject will be questioned if after applying the medication he felt burning, pruritus, a foreign body sensation and blurred vision. Presence or absence: it will be marked as present (1) or absent (0) for each of the symptoms questioned | day 28 at the final visit |
| Guadalajara |
| Jalisco |
| 44620 |
| Mexico |
| Vision Cirugia Ambulatoria | Monterrey | Nuevo León | 64710 | Mexico |
| Hospital de la luz | Mexico City | 06030 | Mexico |
| Fundación de asistencia privada Conde de Valenciana | Mexico City | 06800 | Mexico |
| Prednefrin |
Prednefrin® SF. Prednisolone Acetate 1%. Prepared by Allergan, S.A. of C.V. Prednefrin: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. - Route of administration: topical ophthalmic |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG001 | Prednefrin | Prednefrin® SF. Prednisolone Acetate 1%. Prepared by Allergan, S.A. of C.V. Prednefrin: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. - Route of administration: topical ophthalmic |
|
|
|
| Primary | Adverse Events | The evaluation of adverse events requires a questioning conducted by the principal investigator and the appropriate exploratory techniques for its detection. the number of cases with adverse events will be reported per study arm | The analysis of the study was per protocol | Posted | Number | cases | day 28 at the final visit |
|
|
|
|
| Secondary | Cellularity in the Anterior Chamber | unit: degrees, Direct observation (Biomicroscopy). Scale for anterior chamber cellularity. Grade/Number of cells Grade / Number of cells 0 Any ½ + 1-5
the cellularity will be measured according to the scale that is added next, considering as normal the degree 0, and abnormal any other degree. | The analysis of the study was per protocol | Posted | Count of Participants | Participants | day 28 at the final visit |
|
|
|
|
| Secondary | Clinical Corneal Edema | The evaluation of clinical edema will be evaluated by the Efron scale, which is a series of factorial sections of the cornea, including features such as grooves and folds. The Efron scale has a strong correlation with variations in intensity. The number will be reported according to the rating awarded. Efron Scale: 0 Normal, 1 very slight, 2 mild, 3 moderate and 4 severe. | The study analysis was comparative, it was only sought to determine if the difference between treatments is statistically significant or not. | Posted | Count of Participants | Participants | day 28 at the final visit |
|
|
|
|
| Secondary | Flare | In the presence of intraocular inflammation, the increased permeability of the non-pigmented layer of the ciliary epithelium, the posterior epithelium of the iris and the vascular endothelium of the iris results in the accumulation of cells and proteins (visible to the examiner as flare) in the anterior chamber. Using a light beam of 0.2mm X 0.2mm directed obliquely to the anterior chamber with a forward inclination of the light source (slit lamp tower) the degree of flare and cellularity will be determined according to the group of work of standardization for the nomenclature of uveitis. Flare scale 0 There is no flare
| Posted | Count of Participants | Participants | day 28 at the final visit |
|
|
|
|
| Secondary | Central Thickness of the Retina | By means of optical coherence tomography (OCT) the Retinal central thickness (GCR) will be measured. OCT is a noninvasive imaging test that uses light waves to take photographs of the cross section of the retina (the light-sensitive tissue that lines the back of the eye).With a OCT, each of the characteristic layers of the retina can be observed, allowing mapping and measuring its thickness a micrometer result will be obtained and the analysis will be carried out between groups. | The analysis of the study was per protocol | Posted | Mean | Standard Error | microns | day 28 at the final visit |
|
|
|
|
| Secondary | Conjunctival Hyperemia | Conjunctival hyperemia is defined as the simplest reaction of the conjunctiva to a stimulus, a red appearance secondary to the vasodilation of the conjunctival vessels of variable intensity, we will use the Efron scale for conjunctival hyperemia. 0 normal
| The analysis of the study was per protocol | Posted | Count of Participants | Participants | day 28 at the final visit |
|
|
|
|
| Secondary | Intraocular Pressure | Tonometry is the objective measure of Intraocular pressure, based primarily on the force required to flatten the cornea, or the degree of corneal indentation produced by a fixed force. Goldman's tonometry is based on the Imbert-Fick principle. the result will be expressed in millimeters of mercury and the comparison between groups will be carried out | The analysis of the study was per protocol | Posted | Mean | Standard Deviation | mmHg | day 28 at the final visit |
|
|
|
|
| Secondary | Symptomatology Post Instillation | The subject will be questioned if after applying the medication he felt burning, pruritus, a foreign body sensation and blurred vision. Presence or absence: it will be marked as present (1) or absent (0) for each of the symptoms questioned | The analysis of the study was per protocol | Posted | Count of Participants | Participants | day 28 at the final visit |
|
|
|
|
| 0 |
| 85 |
| 1 |
| 85 |
| 55 |
| 85 |
| EG001 | Prednefrin | Prednefrin® SF. Prednisolone Acetate 1%. Prepared by Allergan, S.A. of C.V. Prednefrin: 1 drop 4 times a day (every 4 hours) during the period of vigil in the operated eye, for 14 days. Dose reduction for 14 days at the discretion of the principal investigator. - Route of administration: topical ophthalmic | 0 | 86 | 0 | 86 | 45 | 86 |
| blepharospasm | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| headache | Nervous system disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| anterior chamber cellularity | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| infectious conjunctivitis | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| flu | Infections and infestations | MedDRA (22.0) | Non-systematic Assessment |
|
| stomach ache | Gastrointestinal disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| ocular pain | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| chemosis | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| Diabetic Macular Edema | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| pharyngotonsillitis | Infections and infestations | MedDRA (22.0) | Non-systematic Assessment |
|
| Photophobia | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| ocular hypertension | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| urinary tract infection | Infections and infestations | MedDRA (22.0) | Non-systematic Assessment |
|
| eyelid inflammation | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| tearing | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| neovascular macular membrane | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| myodesopsia | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| red eye | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| earache | Ear and labyrinth disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| paresthesia | Skin and subcutaneous tissue disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| eye itching | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| rhinorrhea | Respiratory, thoracic and mediastinal disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| eye foreign body sensation | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| Irvine-Gass syndrome | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| head trauma | General disorders | MedDRA (22.0) | Non-systematic Assessment |
|
| Blurred Vision | Eye disorders | MedDRA (22.0) | Non-systematic Assessment |
|
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| grade 1 |
|
| grade 2 |
|
| grade 3 |
|
| grade 4 |
|
| Mild (2) |
|
| Moderate (3) |
|
| Severe (4) |
|
| 2+ |
|
| 3+ |
|
| 4+ |
|
| Mild (2) |
|
| Moderate (3) |
|
| Severe (4) |
|
| foreign body sensation eyes |
|
| blurred vision |
|
| Fisher Exact |
| 0.489 |
| Other |
The study analysis was comparative, it was only sought to determine if the difference between treatments is statistically significant or not. |
| foreign body sensation eyes comparison | Fisher Exact | 0.497 | Other | The study analysis was comparative, it was only sought to determine if the difference between treatments is statistically significant or not. |
| blurred vision comparison | Fisher Exact | 1.000 | Other | The study analysis was comparative, it was only sought to determine if the difference between treatments is statistically significant or not. |