A Phase 3 interventional study of Ranibizumab and Verteporfin PDT in Pathological Myopia, sponsored by Novartis Pharmaceuticals. Completed at 74 sites in 20 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2014-02-10.
Sponsored by Novartis Pharmaceuticals · Phase 3, Interventional, and Treatment
This study is designed to evaluate the efficacy and safety of two different dosing regimens of 0.5 mg ranibizumab given as intravitreal injection in comparison to verteporfin PDT in patients with visual impairment due to choroidal neovascularization (CNV) secondary to pathologic myopia (PM).
308 studies on the registry are indexed under Vision Disorders; 81 are open to participants now.
This study's enrollment of 277 is above the median of 66 across 211 interventional studies indexed under Vision Disorders.
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Exclusion Criteria:
Other protocol-defined inclusion/exclusion criteria may apply
Participants received active ranibizumab on day 1. Thereafter they received ranibizumab treatment based on disease activity criteria
Drug: Ranibizumab · Drug: Sham Ranibizumab · Drug: Sham verteporfin PDT
Participants received ranibizumab on day 1 and month 1. Thereafter they received ranibizumab based on stabilization criteria for visual acuity
Drug: Ranibizumab · Drug: Sham Ranibizumab · Drug: Sham verteporfin PDT
Participants received active vPDT on day 1. From month 3 onwards participants could receive ranibizumab, vPDT or a combination of the two if needed.
Drug: Ranibizumab · Drug: Verteporfin PDT · Drug: Sham Ranibizumab · Drug: Sham verteporfin PDT
0.5 mg ranibizumab intravitreal injection
Verteporfin (6 mg/m2) intravenous infusion
Also known as: vPDT
Empty vial to mimic the intravitreal injection
Sham vPDT intravenous infusion of dextrose 5% solution followed by light application (PDT).
Average Change From Baseline to Month 1 Through Month 3 on Visual Acuity of the Study Eye
The Best Corrected Visual Acuity (BCVA) was tested using the Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity (VA) testing protocol. VA measurements were taken in a sitting position at an initial test distance of 4 meters using ETDRS charts at baseline and compared to the average from month 1 to month 3.
Time frame: Baseline, Month 1 through Month 3
Average Change From Baseline to Month 6 in Visual Acuity of the Study Eye
The Best Corrected Visual Acuity (BCVA) was tested using the Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity (VA) testing protocol. VA measurements were taken in a sitting position at an initial test distance of 4 meters using ETDRS charts at baseline and month 6. The overall BCVA score was calculated using the BCVA worksheet.
Time frame: Baseline and Month 6
Average Change From Baseline to Month 1 Through Month 12 in Visual Acuity of the Study Eye
The Best Corrected Visual Acuity (BCVA) was tested using the Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity (VA) testing protocol. VA measurements were taken in a sitting position at an initial test distance of 4 meters using ETDRS charts at baseline and Month 1 through 12
Time frame: Baseline and Month 1 through Month 12
Percentage of Patients With Best Corrected Visual Acuity (BCVA) ≥10 and ≥15 Letters Gain or Reach 84 Letters at Month 3
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An ETDRS visual acuity score of 85 is approximately 20/20. An increased score indicates improvement in acuity. This outcome assessed the percentage of participants who gained more than 10 or more than 15 of visual acuity at month 3.
Time frame: Month 3
Percentage of Patients With Best Corrected Visual Acuity (BCVA) ≥10 and ≥15 Letters Gain or Reach 84 Letters at Month 6 and Month 12
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An increased score indicates improvement in acuity. This outcome assessed the percentage of participants who gained more than 10 or more than 15 letters of visual acuity at month 6 and month 12.
Time frame: Months 6 and 12
Percentage of Patients With Best Corrected Visual Acuity (BCVA) ≥10 and ≥15 Letter Loss at Month 3
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An ETDRS visual acuity score of 85 is approximately 20/20. A decreased score indicates worsening in acuity. This outcome assessed the percentage of participants who lost more than 10 or more than 15 of visual acuity at month 3.
Time frame: Month 3
Percentage of Patients With Best Corrected Visual Acuity (BCVA) ≥10 and ≥15 Letter Loss at Month 6 and 12
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An ETDRS visual acuity score of 85 is approximately 20/20. A decreased score indicates worsening in acuity. This outcome assessed the percentage of participants who lost more than 10 or more than 15 of visual acuity at month 6 and 12.
Time frame: Months 6 and 12
Change From Baseline in Central Retinal Thickness of the Study Eye Over Time
Retinal thickness was measured by Central Reading Center using patient's Optical Coherence Tomography (OCT) images provided by investigators.
Time frame: Baseline, Month 3, Month 6 and Month 12
Percentage of Patients With Choroidal Neovascularization (CNV) Leakage in the Study Eye
CNV leakage assessment plus other choroid and retinal disorders were assessed by Central Reading Center using patient's fluorescein angiography and color fundus photography images provided by investigators.
Time frame: Baseline and Month 12
Number of Ranibizumab Injections Received Prior to Month 3
In order to describe exposure to the study drug the number of ejections was evaluated
Time frame: Day 1 and prior to month 3
Number of Ranibizumab Injections Received by Patients Randomized to the Ranibizumab Groups, by Period
Number of ranibizumab injections received by patients randomized to the ranibizumab groups, by period
Time frame: Day 1 prior to month 6 and prior to month 12
Number of Ranibizumab Injections Received by Patients Randomized to vPDT With Ranibizumab From Month 3 by Period
Number of ranibizumab injections received by patients randomized to the vPDT with ranibizumab groups, by period.
Time frame: Month 3 up to month 12
Out of the 334 patients screened, 277 patients were randomized into the study on a 2:2:1 basis: 106 patients to Group I (treatment with ranibizumab according to visual acuity stabilization), 116 patients to Group II (ranibizumab treatment according to disease activity), and 55 patients to Group III (treatment with vPDT)
| Milestone | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Started | 106 | 116 | 55 |
| Completed 3 months | 105 | 116 | 55 |
| Completed 6 months | 103 | 116 | 55 |
| Completed | 100 | 112 | 55 |
| Not completed | 6 | 4 | 0 |
| Withdrew: Protocol violation | 1 | 1 | 0 |
| Withdrew: Lost to follow-up | 3 | 1 | 0 |
| Withdrew: Withdrawal by subject | 1 | 2 | 0 |
| Withdrew: Lack of efficacy | 1 | 0 | 0 |
The Best Corrected Visual Acuity (BCVA) was tested using the Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity (VA) testing protocol. VA measurements were taken in a sitting position at an initial test distance of 4 meters using ETDRS charts at baseline and compared to the average from month 1 to month 3.
| Letters | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Baseline | 55.4 ± 13.43 | 55.8 ± 12.59 | 54.7 ± 13.84 |
| Average Month 1 to month 3 | 66.0 ± 12.98 | 66.4 ± 12.28 | 56.9 ± 14.49 |
The Best Corrected Visual Acuity (BCVA) was tested using the Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity (VA) testing protocol. VA measurements were taken in a sitting position at an initial test distance of 4 meters using ETDRS charts at baseline and month 6. The overall BCVA score was calculated using the BCVA worksheet.
| Letters | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Baseline | 55.4 ± 13.43 | 55.8 ± 12.59 | 54.7 ± 13.84 |
| Average month 1 to month 6 | 69.2 ± 12.44 | 68.4 ± 13.56 | 62.7 ± 14.65 |
The Best Corrected Visual Acuity (BCVA) was tested using the Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity (VA) testing protocol. VA measurements were taken in a sitting position at an initial test distance of 4 meters using ETDRS charts at baseline and Month 1 through 12
| Letters | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Baseline | 55.4 ± 13.43 | 55.8 ± 12.59 | 54.7 ± 13.84 |
| Average Month 1 to Month 12 | 68.3 ± 12.61 | 68.3 ± 12.45 | 61.1 ± 14.86 |
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An ETDRS visual acuity score of 85 is approximately 20/20. An increased score indicates improvement in acuity. This outcome assessed the percentage of participants who gained more than 10 or more than 15 of visual acuity at month 3.
| Percentage of Patients | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Month 3 >=15 letters | 38.1 | 43.1 | 14.5 |
| Month 3 >= 10 letters | 61.9 | 65.5 | 27.3 |
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An increased score indicates improvement in acuity. This outcome assessed the percentage of participants who gained more than 10 or more than 15 letters of visual acuity at month 6 and month 12.
| Percentage of Patients | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Month 6 >=15 letters | 46.7 | 44.8 | — |
| Month 6 >= 10 letters | 71.4 | 64.7 | — |
| Month 12 >=15 letters | 53.3 | 51.7 | — |
| Month 12 >= 10 letters | 69.5 | 69.0 | — |
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An ETDRS visual acuity score of 85 is approximately 20/20. A decreased score indicates worsening in acuity. This outcome assessed the percentage of participants who lost more than 10 or more than 15 of visual acuity at month 3.
| Percentage of Patients | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Month 3 >=10 letters | 1.9 | 0.9 | 16.4 |
| Month 3 >= 15 letters | 1.9 | 0 | 7.4 |
BCVA score was based on the number of letters read correctly on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart assessed at a starting distance of 4 meters. An ETDRS visual acuity score of 85 is approximately 20/20. A decreased score indicates worsening in acuity. This outcome assessed the percentage of participants who lost more than 10 or more than 15 of visual acuity at month 6 and 12.
| Percentage of Patients | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Month 6 >=10 letters | 1.9 | 2.6 | — |
| Month 6 >= 15 letters | 0 | 0.9 | — |
| Month 12 >=10 letters | 4.8 | 1.7 | — |
| Month 12 >= 15 letters | 1.9 | 0.9 | — |
Retinal thickness was measured by Central Reading Center using patient's Optical Coherence Tomography (OCT) images provided by investigators.
| Microns | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Baseline (n=102,110, 54) | 349.2 ± 95.05 | 373.1 ± 127.44 | 352.5 ± 101.52 |
| Month 3 (n= 102,110,54) | 288.3 ± 70.14 | 295.6 ± 71.93 | 340.5 ± 106.03 |
| Month 6 (n= 102,110,55) | 283.1 ± 67.43 | 298.3 ± 81.16 | 303.5 ± 76.81 |
| Month 12 (n= 102,110,55) | 282.6 ± 68.62 | 301.8 ± 88.16 | 294.3 ± 83.25 |
CNV leakage assessment plus other choroid and retinal disorders were assessed by Central Reading Center using patient's fluorescein angiography and color fundus photography images provided by investigators.
| Percentage of Patients | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Baseline-Definite | 96.2 | 93.1 | 100.0 |
| Baseline- Questionable | 1.0 | 0.0 | 0.0 |
| Baseline-Absent | 1.0 | 0.9 | 0.0 |
| Baseline- Other | 1.9 | 6.1 | 0.0 |
| Month 12-Definite | 21.0 | 19.0 | 29.1 |
| Month 12- Questionable | 0.0 | 0.0 | 1.8 |
| Month 12-Absent | 68.6 | 69.8 | 65.5 |
| Month 12- Other | 0.5 | 11.2 | 3.6 |
In order to describe exposure to the study drug the number of ejections was evaluated
| injections | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT |
|---|---|---|---|
| Number of Ranibizumab Injections Received Prior to Month 3 | 2.5 ± 0.57 | 1.8 ± 0.82 | 0.0 ± 0.00 |
Number of ranibizumab injections received by patients randomized to the ranibizumab groups, by period
| injections | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity |
|---|---|---|
| Day 1 prior to Month 6 | 3.5 ± 1.46 | 2.5 ± 1.56 |
| Day 1 prior to month 12 | 4.6 ± 2.59 | 3.5 ± 2.92 |
Number of ranibizumab injections received by patients randomized to the vPDT with ranibizumab groups, by period.
| injections | Verteporfin PDT |
|---|---|
| Day 1 up to month 6 (n=34) | 1.9 ± 0.86 |
| Day 1 up to month 12 (n=38) | 3.2 ± 2.54 |
Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| 0.5 mg Ranibizumab Driven by Stabilization Criteria | — | 7/106 (6.6%) | 46/106 (43.4%) |
| 0.5mg Ranibizumab Driven by Disease Activity | — | 6/118 (5.1%) | 47/118 (39.8%) |
| Visudyne PDT: Grp III With 0.5mg Ranibizumab From Month 3 | — | 0/38 (0%) | 17/38 (44.7%) |
| Visudyne PDT: Grp III Without 0.5mg Ranibizumab From Month 3 | — | 0/15 (0%) | 8/15 (53.3%) |
| Event | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Visudyne PDT: Grp III With 0.5mg Ranibizumab From Month 3 | Visudyne PDT: Grp III Without 0.5mg Ranibizumab From Month 3 |
|---|---|---|---|---|
| MyocarditisCardiac disorders | 1/106 | 0/118 | 0/38 | 0/15 |
| Corneal erosion (Study eye)Eye disorders | 1/106 | 0/118 | 0/38 | 0/15 |
| Gastritis erosiveGastrointestinal disorders | 1/106 | 0/118 | 0/38 | 0/15 |
| Gastrointestinal haemorrhageGastrointestinal disorders | 1/106 | 0/118 | 0/38 | 0/15 |
| Hepatic function abnormalHepatobiliary disorders | 1/106 | 0/118 | 0/38 | 0/15 |
| Joint dislocationInjury, poisoning and procedural complications | 1/106 | 0/118 | 0/38 | 0/15 |
| Breast cancer in situNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/106 | 0/118 | 0/38 | 0/15 |
| DepressionPsychiatric disorders | 1/106 | 0/118 | 0/38 | 0/15 |
| Atrial tachycardiaCardiac disorders | 0/106 | 1/118 | 0/38 | 0/15 |
| Retinoschisis (Study eye)Eye disorders | 0/106 | 1/118 | 0/38 | 0/15 |
| Event | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Visudyne PDT: Grp III With 0.5mg Ranibizumab From Month 3 | Visudyne PDT: Grp III Without 0.5mg Ranibizumab From Month 3 |
|---|---|---|---|---|
| NasopharyngitisInfections and infestations | 12/106 | 12/118 | 1/38 | 2/15 |
| Conjunctival haemorrhage (Study eye)Eye disorders | 12/106 | 12/118 | 2/38 | 0/15 |
| Intraocular pressure increased (Study eye)Investigations | 3/106 | 7/118 | 4/38 | 0/15 |
| HeadacheNervous system disorders | 8/106 | 11/118 | 1/38 | 0/15 |
| HypertensionVascular disorders | 3/106 | 5/118 | 3/38 | 0/15 |
| Punctate keratitis (Study eye)Eye disorders | 8/106 | 3/118 | 2/38 | 0/15 |
| TinnitusEar and labyrinth disorders | 0/106 | 2/118 | 0/38 | 1/15 |
| Blindness (Study eye)Eye disorders | 0/106 | 0/118 | 1/38 | 1/15 |
| Cataract (Study eye)Eye disorders | 1/106 | 2/118 | 0/38 | 1/15 |
| Conjunctival hyperaemia (Study eye)Eye disorders | 1/106 | 0/118 | 0/38 | 1/15 |
| Age, Customized(Participants) | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT | Total |
|---|---|---|---|---|
| <45 years | 24 ± 22.6 | 24 ± 20.7 | 7 ± 12.7 | 55 |
| 45 -< 55 years | 27 | 21 | 16 | 64 |
| 55-<65 years | 30 | 34 | 14 | 78 |
| >=65 | 25 | 37 | 18 | 80 |
| Sex: Female, Male(Participants) | 0.5 mg Ranibizumab Driven by Stabilization Criteria | 0.5mg Ranibizumab Driven by Disease Activity | Verteporfin PDT | Total |
|---|---|---|---|---|
| Female | 82 | 87 | 40 | 209 |
| Male | 24 | 29 | 15 | 68 |
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Novartis Pharmaceuticals