The purpose of this study is to determine whether metformin, an FDA-approved drug for the treatment of type II diabetes, is a safe and effective treatment to decrease the progression of geographic atrophy in non-diabetic patients with Age-related Macular Degeneration (AMD).
This is a phase II, single-blind, randomized, evaluation of the safety and efficacy of metformin use to decrease geographic atrophy (GA) progression in non-diabetic patients with dry Age-related Macular Degeneration (AMD). Approximately 186 study subjects throughout four separate study sites will be randomized in a 1:1 ratio to the treatment group and the observation group. The treatment group will be assigned to the study intervention (oral Metformin) for 18 months while the observation group will receive no intervention for 18 months, instead continuing with standard of care ophthalmic exams and close monitoring of their disease. There will be one additional follow up visit at 24 months. Throughout the 24 month study period, the progression of subjects' GA or drusen growth will be measured via ocular imaging taken at standard of care follow-up examinations, including fundus autofluorescence imaging, optical coherence tomography (OCT), and fundus photography.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
66
University of California, Davis
Davis, California, United States
Palo Alto Veteran Affairs Medical Center
Palo Alto, California, United States
Retinal Consultants Medical Group
Sacramento, California, United States
Fundus Autofluorescence Imaging to Measure the Rate of Change in Area of Geographic Atrophy
The primary efficacy endpoint was the annualized growth rate of the square root of geographic atrophy (GA) area in mm/year in the study eye as imaged by fundus autofluorescence (FAF) imaging. Change = (Month 18 GA Area - Baseline GA Area).
Time frame: 0 months, 18 months
Change in Best Corrected Visual Acuity (BCVA)
BCVA is the best possible vision an eye can see with corrective lenses and is measured as then number of letters read on the ETDRS chart. Change = (Month 18 Score - Baseline Score).
Time frame: 0 months, 18 months
Change in Low-luminance Visual Acuity (LLVA)
LLVA involves standard BCVA testing in low-light conditions, which is achieved by adding a neutral density filter in front of the eye being tested. LLVA is measured as the number of letters read on the ETDRS chart. This measure has been shown to correlate well with enlargement of GA. Change = (Month 18 Score - Baseline Score).
Time frame: 0 months, 18 months
Ocular Safety as Measured by the Presence of Novel Intraocular Inflammation Judged by the Investigator to be Due to the Study Drug Metformin
Subjects assigned to the Metformin study arm will be assessed at each follow-up eye exam to confirm ocular safety of metformin. The Data Safety and Management Board for this study will also assess the safety of metformin at different time points throughout the study. They will formally meet to discuss study subject safety at 25% enrollment and 75% enrollment. The potential for ocular side effects due to metformin is thought to be very low, due to the large number of diabetic patients who take this drug and are followed closely for diabetic retinopathy or other ocular disease. This outcome measures the number of treatment arm patients who experienced adverse ocular events during 1 or more follow-up visits.
Time frame: 0 months, 6 months, 12 months, 18 months, 24 months
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San Francisco Veteran Affairs Medical Center
San Francisco, California, United States
University of California San Francisco
San Francisco, California, United States
California Retina Consultants
Santa Maria, California, United States
North Bay Vitreoretinal Consultants
Santa Rosa, California, United States
Retina Health Center
Fort Myers, Florida, United States
Northwestern University
Chicago, Illinois, United States
University of Illinois at Chicago
Chicago, Illinois, United States
...and 2 more locations
Systemic Safety as Measured by Presence of Side Effects Listed on Metformin Drug Label as "Severe"
These include: Infrequent side effects of metformin (severe): * Trouble Breathing Rare side effects of metformin (severe): * Increased Blood Acidity due to High Levels of Lactic Acid (Lactic acidosis) * Low Blood Sugar * Megaloblastic Anemia * Reaction due to an Allergy Subjects assigned to the Metformin study arm will be assessed for these side-effects at each follow-up eye exam to confirm ocular safety of metformin. The Data Safety and Management Board for this study will also assess the safety of metformin at different time points throughout the study. They will formally meet to discuss study subject safety at 25% enrollment and 75% enrollment. This outcome measures the number of treatment arm patients who experienced side effects listed on Metformin drug label as "severe" during 1 or more follow-up visits.
Time frame: 0 months, 6 months, 12 months, 18 months, 24 months