This is a phase III, multicenter, randomized double-blinded clinical trial with two parallel groups (ranibizumab and bevacizumab) and an observational follow-up of patients who meet elegibility criteria and decline participation due to treatment randomization. It will be performed involving 630 eyes from patients with wet age-related macular degeneration (wAMD) diagnosis without another eye disease. This clinical trial compares the treatment response for 3 years, considering genetic variants already studied between the eyes treated with one of the first options of anti-VEGF used in patients with wAMD, (ranibizumab) and the most cost-effective anti-VEGF (bevacizumab; off-label use)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
630
The dosage for each intravitreal injection is 1.25mg of BVZ in 0.05ml
The dosage for each intravitreal injection contains 0.5mg of RBZ in 0.05ml
Hospital Universitario de Canarias
San Cristóbal de La Laguna, Santa Cruz De Tenerife, Spain
RECRUITINGHospital de la Santa Creu i Sant Pau
Barcelona, Spain
RECRUITINGHospital la Esperanza
Barcelona, Spain
RECRUITINGUnidad Central de Investigación Clínica y Ensayos Clínicos (UCICEC La Paz)
Madrid, Spain
RECRUITINGFrequency of Genetic Polymorphism in VEGFA Associated With Anti-VEGF Treatment Response in AMD Patients
Proportion of patients carrying the VEGFA genetic polymorphism (VEGFA, CFH, CTFG, ARMS2, HTRA1, OR52B4, LOC387715, LOC100287225, LEPR, SERPINF1), as determined by genotyping of DNA extracted from saliva samples. This measure will be correlated with response to anti-VEGF therapy (ranibizumab or aflibercept). Unit of Measure: % of participants with polymorphism. Measurement Tool: Genotyping assay on saliva-derived DNA (e.g., TaqMan PCR-based method).
Time frame: From baseline, first dose, up to 3 years
Change in Visual Acuity Over Time in Patients With AMD Receiving Anti-VEGF Therapy
Visual acuity (VA), measured in number of letters read on the ETDRS chart, at baseline and at months 6, 12, 24, and 36. The change from baseline will be analyzed to assess treatment response over time. Unit of Measure: Number of letters (ETDRS scale). Measurement Tool: ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart.
Time frame: Baseline, 6 months, 12 months, 24 months, 36 months
Change in Retinal Fluid and Foveal Thickness Over Time as Measured by OCT in Patients With AMD Treated With Anti-VEGF Therapy
Retinal anatomical changes assessed by OCT, including presence and amount of intraretinal and/or subretinal fluid, and central foveal thickness (in microns), measured at baseline and at months 6, 12, 24, and 36. Differences between treatment arms (ranibizumab vs. bevacizumab) will be evaluated over time. Unit of Measure: Microns for foveal thickness; qualitative presence/absence or categorical grading of retinal fluid Measurement Tool: Spectral-domain Optical Coherence Tomography (SD-OCT)
Time frame: Baseline, 6 months, 12 months, 24 months, 36 months
Distribution of Sex Among Patients With AMD Receiving Anti-VEGF Therapy
Proportion of male and female participants in the study population, analyzed in relation to treatment response to anti-VEGF drugs. Unit of Measure: % of participants by sex. Measurement Tool: Demographic data collected via clinical records.
Time frame: At baseline
Distribution of Age at Diagnosis in Patients With AMD Receiving Anti-VEGF Therapy
Age in years at time of AMD diagnosis for each participant. Age will be analyzed as a continuous variable in relation to treatment response. Unit of Measure: Years. Measurement Tool: patient-reported age or medical record.
Time frame: At baseline
Proportion of Smokers Among Patients With AMD Receiving Anti-VEGF Therapy
Proportion of participants with a history of tobacco use at baseline, categorized as current, former, or never smokers. Unit of Measure: % of participants by smoking status. Measurement Tool: Patient-reported history via questionnaire or clinical interview.
Time frame: At baseline
Weight of Patients With AMD Receiving Anti-VEGF Therapy
Mean weight of participants measured at baseline. Weight will be used both as a descriptive baseline characteristic and as part of the BMI calculation. Unit of Measure: Kilograms (kg) Measurement Tool: Calibrated digital scale
Time frame: At baseline
Height of Patients With AMD Receiving Anti-VEGF Therapy
Mean height of participants measured at baseline. Height will be used both as a descriptive baseline characteristic and as part of the BMI calculation. Unit of Measure: Meters (m) Measurement Tool: Stadiometer
Time frame: At baseline
Prevalence of Obesity in Patients With AMD Receiving Anti-VEGF Therapy
Proportion of participants with obesity, defined as BMI ≥ 30 kg/m² at baseline. Unit of Measure: % of participants with BMI ≥ 30 kg/m². Measurement Tool: Body Mass Index (BMI) calculated from measured height and weight.
Time frame: At baseline
Prevalence of Hypertension in Patients With AMD Receiving Anti-VEGF Therapy
Proportion of participants with a diagnosis of hypertension at baseline. Unit of Measure: % of participants with hypertension. Measurement Tool: Clinical diagnosis from patient medical records or blood pressure measurement (≥140/90 mmHg).
Time frame: At baseline
Number of Participants With Ocular and Systemic Adverse Events Associated With Intravitreal Anti-VEGF Therapy
Total number of participants experiencing ocular or systemic adverse events, including cardiovascular events (e.g., myocardial infarction, stroke), following intravitreal injection of ranibizumab or bevacizumab. Events will be assessed cumulatively from the third intravitreal injection through the 3-year follow-up. Unit of Measure: Number of participants with at least one adverse event. Measurement Tool: Clinical assessment and adverse event reporting as per standard pharmacovigilance procedures.
Time frame: From intravitreal injection, up to 3 years
Total Direct Healthcare Cost per Patient for Anti-VEGF Therapy Over One Year From the Health System Perspective
Total direct healthcare cost per patient treated with ranibizumab or bevacizumab over a 1-year period, based on a cost minimization analysis assuming similar clinical efficacy. Costs will be calculated from the perspective of the Spanish National Health System (SNS) and will include drug acquisition (considering container cost and fractionation), number of intravitreal injections, pharmacogenomic testing, and clinical monitoring. The NEI VFQ-25 composite score will be used to contextualize quality-of-life outcomes within the economic evaluation. Unit of Measure: Euros per patient. Measurement Tool: Cost minimization analysis based on administrative and billing records; NEI VFQ-25 (National Eye Institute Visual Function Questionnaire) for quality-of-life scoring.
Time frame: From baseline up to 1 year
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