ARA 290-DMO is a prospective, open label, interventional, single centre, investigator led, phase II trial to examine the effect of ARA 290 on diabetic macular oedema in patients with type 1 or 2 diabetes. The aim or primary objective of the study was to determine whether ARA 290 administered at a daily dose of 4mg subcutaneously for 12 weeks to patients with diabetes mellitus (DM) and DMO would have a beneficial effect on mean change in best corrected visual acuity (BCVA) from baseline values to week 12.
Diabetic retinopathy a very most common cause of sight loss in people of working age. Sight loss occurs in diabetes because of diabetic macular oedema (DMO) and/or proliferative diabetic retinopathy (PDR), both are complications of diabetes in the eye. In DMO fluid accumulates in the macula, the area responsible for our central sight. As the fluid accumulates the sight drops. The current treatments for DMO include laser and anti VEGF drugs and steroids. Anti VEGF drugs have been very helpful in the treatment of DMO. However, anti VEGF drugs need to be given by an injection into the eye, an Ophthalmologist (eye specialist) or a specialist nurse (a nurse trained for this purpose) will need to deliver this treatment to patients with DMO in the hospital. Furthermore, patients require injections every four weeks during the first months of treatment and long term treatment is required. Moreover, not all patients respond to anti VEGFs: In 40% of patients the sight may not improve despite these injections. Because many patients with DMO have DMO in both eyes, injections need to be given in both eyes to many patients. Given the above facts there appeared a clear need to develop new treatments for people with DMO. ARA 290 is a drug that has marked anti-inflammatory properties and has an effect in preventing the death of cells. As inflammation is known to play a role in the occurrence of DMO, it was thought that ARA 290 could potentially be helpful in treating patients with this condition. In light of this, the Investigators carried out this study to find out if ARA 290 was effective in drying the fluid in DMO. If this treatment was successful, benefits may have included a reduction of the demands on health care services and patient benefits of: self administration of the drug at home by the patients; a reduction in hospital visits; treatment of both eyes at once, reduced risks associated with injections; a more pleasant treatment (subcutaneous injection versus an injection into the eye).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
9
4 mg subcutaneous injections of ARA290 over an 84 day period
Belfast Health & Social Care Trust
Belfast, Co Antrim, United Kingdom
Primary Outcome - Best corrected distance visual acuity.
Best corrected distance visual acuity will be obtained in both eyes by a trained optometrist using the Early Treatment Diabetic Retinopathy Study (ETDRS) charts at baseline and at week 12. The EDTRS total score will be recorded and used for the analysis.
Time frame: From baseline to week 12 (+/- 7 days)
Secondary Outcome - Central subfield thickness
Central subfield retinal thickness (CST), as obtained in the central 1 mm area, will be determined by spectral domain optical coherence tomography (SD-OCT) and used for the analysis.
Time frame: Changes from baseline to week 12 (+/- 7 days).
Secondary Outcome - Central retinal sensitivity
Retinal sensitivity will be determined by macular microperimetry in both eyes.
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome - Retinal perfusion
Retinal perfusion will be assessed by wide angle fundus fluorescein angiography (FFA).
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome - Tear production
The Schirmer test will be performed to measure tear production.
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome - Patient reported outcome
Patient reported outcomes will be evaluated by means of EQ-5D 5L questionnaires which will be administered to patients at baseline and at week 12 (and at week 16 if applicable).
Time frame: Changes from baseline to week 12 (+/- 7 days)
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Secondary Outcome - Change in inflammatory markers
A blood sample will be used to test for ARA 290 antibodies and to complete an exploratory analysis to determine levels of inflammatory markers and carbamylated and glycosylated albumin.
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome - Number of Adverse events
Adverse events
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome -% of participants with ≥ 15 ETDRS letter gain
using Best corrected distance visual acuity
Time frame: baseline to week 12
Secondary Outcome -% of participants with ≥ 10 ETDRS letter gain
using Best corrected distance visual acuity
Time frame: baseline to week 12
Secondary Outcome - Patient reported outcomes
Patient reported outcomes will be evaluated by means of NEI VFQ-25 questionnaires which will be administered to patients at baseline and at week 12 (and at week 16 if applicable).
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome - Change in glycosylated albumin
A blood sample will be used to test for ARA 290 antibodies and to complete an exploratory analysis to determine levels of inflammatory markers and carbamylated and glycosylated albumin.
Time frame: Changes from baseline to week 12 (+/- 7 days)
Secondary Outcome - Change in carbamylated albumin
A blood sample will be used to test for ARA 290 antibodies and to complete an exploratory analysis to determine levels of inflammatory markers and carbamylated and glycosylated albumin.
Time frame: Changes from baseline to week 12 (+/- 7 days)