SCORE2 is a multicenter, prospective, randomized, phase III clinical trial in which all participants enrolled will be followed for up to 2.5 years. SCORE2 is designed as a non-inferiority trial, with study eyes randomized to intravitreal bevacizumab (1.25 mg) every 4 weeks vs. intravitreal aflibercept (2.0 mg) every 4 weeks. SCORE2 aims to determine if bevacizumab is non-inferior to aflibercept for the treatment of macular edema associated with central retinal vein occlusion (CRVO), with the primary outcome of visual acuity measured at Month 6.
The primary objective of SCORE2 is to test for non-inferiority based on mean change from baseline in visual acuity letter score at Month 6 for eyes randomized to intravitreal bevacizumab every 4 weeks compared with eyes randomized to intravitreal aflibercept every 4 weeks using a non-inferiority margin of 5 letters. Secondary objectives of SCORE2 are to: * compare the bevacizumab and the aflibercept groups with regards to central retinal thickness, as measured with spectral domain optical coherence tomography (SD-OCT), at Month 6 and change between baseline and Month 6; * assess Month 12 visual acuity and SD-OCT outcomes associated with different dosing strategies after Month 6 in participants who respond well to treatment; * assess Month 12 visual acuity and SD-OCT outcomes associated with alternative treatment strategies after Month 6 in participants who respond poorly to treatment; * compare area of retinal ischemia and rates of neovascular complications of CRVO in the bevacizumab vs. aflibercept groups; * add to our knowledge of the safety profile of these anti-vascular endothelial growth factor (VEGF) medications in the setting of eyes with macular edema secondary to CRVO; * conduct a cost effectiveness analysis comparing intravitreal bevacizumab to intravitreal aflibercept to assess the economic implications from a payor perspective using decision analytic methods. Other exploratory aims of SCORE2 are to: * investigate the correlation of features identified through SD-OCT segmentation analysis, such as the inner segment-outer segment (IS-OS) junction (also known as the ellipsoid zone), with such characteristics as visual acuity and central retinal thickness; * investigate the correlation of area of peripheral retinal nonperfusion from widefield fluorescein angiography with visual acuity and central retinal thickness, and the prognostic value of baseline peripheral and central retina perfusion status in predicting disease course and treatment responsiveness; * investigate the correlation of features on adaptive optics imaging with such characteristics as visual acuity and central retinal thickness.
Study Type
INTERVENTIONAL
Mean Change From Baseline in Best-corrected Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity Letter Score at Month 6
The primary analysis is based on observed data at 6 months. The measure is calculated by subtracting the baseline visual acuity letter score from the month 6 visual acuity letter score. The participant is refracted for best corrected vision, and then reads single letters on an electronic visual acuity tester at a 3 meter distance according to a specific algorithm. A letter score is provided that ranges from 0 (unable to ready any letters) to 100. A visual acuity letter score of 85 corresponds to a visual acuity of 20/20 as a Snellen equivalent.
Time frame: Month 0 to 6
Number of Study Eyes With Gain of ≥15 Letters in Visual Acuity Letter Score at Month 6
The measure is the number of study eyes that gained at least 15 letters in their visual acuity letter score at month 6
Time frame: Month 0 to 6
Number of Study Eyes With Visual Acuity Letter Score of 70 or Better at Month 6
The measure is the number of study eyes with a visual acuity letter score of 70 (Snellen equivalent of 20/40) or better at month 6
Time frame: Month 0 to 6
Mean Spectral-domain Optical Coherence Tomography Central Subfield Thickness
The measure is the mean central subfield thickness at month 6 measured by spectral-domain optical coherence tomography
Time frame: Month 0 to 6
Mean Change From Baseline in Spectral Domain Optical Coherence Tomography Central Subfield Thickness at Month 6
The measure is calculated by subtracting the baseline central subfield thickness from the month 6 central subfield thickness
Time frame: Month 0 to 6
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Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
362
Retinal Consultants of AZ
Phoenix, Arizona, United States
Retina Centers, P.C.
Tucson, Arizona, United States
Northern California Retina Vitreous Associates
Mountain View, California, United States
East Bay Retina Consultants, Inc.
Oakland, California, United States
Southern California Desert Retina Consultants
Palm Desert, California, United States
University of California Davis, Medical Center
Sacramento, California, United States
Retinal Consultants Medical Group, Inc.
Sacramento, California, United States
University of California, San Francisco
San Francisco, California, United States
New England Retina Associates
New London, Connecticut, United States
Retina Group of Florida
Fort Lauderdale, Florida, United States
...and 62 more locations
Number of Study Eyes With Central Subfield Thickness <300 μm, no Subretinal Fluid, no Intraretinal Fluid, and no Cystoid Spaces
The measure is the number of study eyes with central subfield thickness \<300 μm, no subretinal fluid, no intraretinal fluid, and no cystoid spaces at month 6
Time frame: Month 0 to 6