This study is designed to evaluate the safety and efficacy of every 2 week intravitreal aflibercept injections in a population of neovascular AMD patients that have demonstrated refractory subretinal fluid with or without intraretinal fluid despite prior monthly intravitreal aflibercept treatment.
Eligible patients will be scheduled to receive intravitreal aflibercept (2.0mg) injections for six consecutive 2 week (13-15 days) intervals with injections administered at weeks 0, 2, 4, 6, 8, 10, and 12. The primary endpoint visit to assess response to sustained q2week therapy will be at the week 14 visit. No treatment will be administered at this visit. All patients will then return at week 16 for the randomization visit and receive a repeat intravitreal aflibercept (2.0mg) injection. For purposes of randomization, patients will be separated into the following groups: * Q2 week complete responders: absence of subretinal fluid on OCT at week 16 * Q2 week incomplete responders: persistent subretinal fluid on OCT at week 16 The "q2 week complete responders" will subsequently be transitioned to a treat and extend regimen with a minimum inter-treatment interval of 4 weeks through week 24. The "q2 week incomplete responders" will be randomized in a 1:1 fashion into one of two arms: * Continued q2 week treatment: intravitreal aflibercept (2.0mg) injections for an additional four consecutive 2 week intervals at weeks 18, 20, 22, and 24 * Transition to treat-and-extend treatment: through week 24 with a minimum inter-treatment interval of q4 weeks. This arm is identical to regimen for "q2 week complete responders." Beginning in week 24, all patients (all groups) will undergo treatment delivered on a treat-and-extend basis with a minimum inter-treatment interval of 4 weeks through the week 50. Patient visits will be treated no more frequent than q4 weeks during treat-and-extend portions of the protocol. All patients will have a mandatory study termination visit at week 52 (-1/+2 weeks). No study treatment will be administered after week 50. Patients receiving a study treatment after week 48 will return 4 weeks after this final study treatment for study termination visit. Patients receiving a study treatment at or before week 48 in whom the treat-and-extend protocol would dictate a subsequent visit after week 52 will instead return at week 52 for a study termination visit.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Aflibercept is a recombinant fusion protein consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to the Fc portion of human IgG1 formulated as an iso-osmotic solution for intravitreal administration.
Tennessee Retina
Nashville, Tennessee, United States
Adverse Events
Frequency and severity of ocular and systemic adverse events
Time frame: Through Week 14
Retinal Thickness
Central Subfield Thickness on Optical Coherence Tomography
Time frame: Weeks 14, 16, 24, 52
Subretinal Fluid Height
Max subretinal fluid height week on Optical Coherence Tomography
Time frame: Weeks 14, 16, 24, 52
Pigment Epithelial Detachment Height
Max pigment epithelial detachment height on Optical Coherence Tomography
Time frame: Weeks 14, 16, 24, 52
Proportion of Dry Maculas
Proportion of eyes with a dry macula (no subretinal fluid on Optical Coherence Tomography)
Time frame: Weeks 14, 16, 24, 52
Best-Corrected Visual Acuity
Mean best-corrected visual acuity
Time frame: Weeks 14, 24, and 52
Change in Best-Corrected Visual Acuity
Mean change in best-corrected visual acuity from baseline
Time frame: Weeks 14, 24, and 52
Proportion gaining >5 letters of Best-Corrected Visual Acuity
Proportion of eyes gaining \> 5 letters
Time frame: Weeks 14, 24, and 52
Treatment Burden
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Mean number of injections administered
Time frame: Through Week 52
Ability to Extend Treatment Interval
Proportion of eyes able to be extended during treat-and-extend dosing
Time frame: Through Week 52