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A Study of Ranibizumab Injection in Subjects With Clinically Significant Macular Edema (ME) With Center Involvement Secondary to Diabetes Mellitus (RISE)

A Phase III, Double-masked, Multicenter, Randomized, Sham Injection-controlled Study of the Efficacy and Safety of Ranibizumab Injection in Subjects With Clinically Significant Macular Edema With Center Involvement Secondary to Diabetes Mellitus

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00473330
Acronym
RISE
Enrollment
377
Registered
2007-05-15
Start date
2007-06-30
Completion date
2012-11-30
Last updated
2017-04-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Diabetes Mellitus, Macular Edema

Keywords

Lucentis, DME, Diabetes, Vision loss

Brief summary

This study is a Phase III, double-masked, multicenter, randomized, sham injection-controlled study of the efficacy and safety of ranibizumab injection in patients with clinically significant macular edema with center involvement (CSME-CI) secondary to diabetes mellitus (Type 1 or 2). This study is identical in design to study NCT00473382 (Protocol ID FVF4168g). The open-label extension phase of the study was stopped after receiving FDA approval of the study drug (ranibizumab) for diabetic macular edema.

Detailed description

This study is composed of 3 phases: (1) A 24-month controlled treatment period (monthly treatment with ranibizumab 0.3 mg, ranibizumab 0.5 mg, or sham injection) followed by (2) a 12-month treatment period in which patients randomized to the sham group who had not discontinued from treatment (still masked) could choose to receive monthly ranibizumab 0.5 mg while the 2 ranibizumab treatment groups continued on the same treatment they received in the first 2 years. Patients who had not discontinued treatment by Month 36 were eligible to continue treatment with ranibizumab 0.5 mg as needed (pro re nata, PRN) in (3) an extension phase of the study for up to 2 more years, resulting in up to 5 years possible total treatment time for some patients.

Interventions

DRUGRanibizumab

Sterile solution for intravitreal injection.

DRUGSham injection

Sponsors

Genentech, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Willingness to provide written informed consent and, at U.S. sites, Health Insurance Portability and Accountability Act (HIPAA) authorization, and in other countries, as applicable according to national laws. * Age ≥ 18 years. * Diabetes mellitus (Type 1 or 2) . * Retinal thickening secondary to diabetes mellitus (DME) involving the center of the fovea with central macular thickness ≥ 275 µm in the center subfield as assessed on optical coherence tomography (OCT). * Best corrected visual acuity (BCVA) score in the study eye of 20/40 to 20/320 approximate Snellen equivalent using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol at an initial testing distance of 4 meters. * Decrease in vision determined to be primarily the result of DME and not to other causes. * For sexually active women of childbearing potential, use of an appropriate form of contraception (or abstinence) for the duration of the study. * Ability (in the opinion of the investigator) and willingness to return for all scheduled visits and assessments.

Exclusion criteria

* History of vitreoretinal surgery in the study eye. * Panretinal photocoagulation (PRP) or macular laser photocoagulation in the study eye within 3 months of screening. * Previous use of intraocular corticosteroids in the study eye (eg, triamcinolone acetonide \[TA\]) within 3 months of screening. * Previous treatment with anti-angiogenic drugs in either eye (pegaptanib sodium, anecortave acetate, bevacizumab, ranibizumab, etc) within 3 months of the Day 0 (first day of treatment) visit. * Proliferative diabetic retinopathy (PDR) in the study eye, with the exception of inactive, regressed PDR. * Iris neovascularization, vitreous hemorrhage, traction retinal detachment, or preretinal fibrosis involving the macula in the study eye. Concurrent Ocular Conditions * Vitreomacular traction or epiretinal membrane in the study eye. * Ocular inflammation (including trace or above) in the study eye. * History of idiopathic or autoimmune uveitis in either eye. * Structural damage to the center of the macula in the study eye that is likely to preclude improvement in VA following the resolution of macular edema, including atrophy of the retinal pigment epithelium (RPE), subretinal fibrosis, or organized hard-exudate plaque. * Ocular disorders in the study eye that may confound interpretation of study results, including retinal vascular occlusion, retinal detachment, macular hole, or choroidal neovascularization (CNV) of any cause (eg, age-related macular degeneration (AMD), ocular histoplasmosis, or pathologic myopia). * Concurrent disease in the study eye that would compromise visual acuity or require medical or surgical intervention during the study period. * Cataract surgery in the study eye within 3 months, yttrium-aluminum-garnet (YAG) laser capsulotomy within the past 2 months, or any other intraocular surgery within the 90 days preceding Day 0. * Aphakia or absence of the posterior capsule in the study eye. * Uncontrolled glaucoma or previous filtration surgery in the study eye. * Spherical equivalent of the refractive error in the study eye of more than -8 diopters myopia. * Evidence at examination of infectious blepharitis, keratitis, scleritis, or conjunctivitis in either eye or current treatment for serious systemic infection. * Uncontrolled blood pressure. * History of cerebral vascular accident or myocardial infarction within 3 months prior to Day 0. * Uncontrolled diabetes mellitus. * Renal failure requiring dialysis or renal transplant. * Participation in an investigational trial within 30 days prior to screening that involved treatment with any drug (excluding vitamins and minerals) or device. * History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use an investigational drug, might affect interpretation of the results of the study, or renders the subject at high risk from treatment complications. * Pregnancy or lactation. * History of allergy to fluorescein. * History of allergy to ranibizumab injection or related molecule.

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Month 24Baseline to Month 24BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.

Secondary

MeasureTime frameDescription
Percentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Months 24, 36, and 48VA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart starting at a test distance of 4 meters. An increase in the number of lines read correctly by the patient in the ETDRS chart indicates an improvement of vision. The Snellen equivalent of 20/40 or better is 69 or more letters correctly read in the EDTRS chart.
Percentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Baseline to Month 48BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.
Mean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineBaseline to Month 36BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision. A positive change score indicates improvement.
Mean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Baseline to Month 48Central foveal thickness was assessed in optical coherence tomographic images by the central reading center. A decrease in foveal thickness suggests a reduction in macular edema. A negative change score indicates improvement.
Percentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Baseline to Month 36The severity of diabetic retinopathy was graded on a 10-point scale by the central reading center by comparing patient fundus photographic images with a set of standard images. 1=diabetic retinopathy (DR) severity level 10, 12 (DR absent), 2=DR severity level 14A-14C, 14Z, 15, 20 (DR questionable, microaneurysms only), 3=DR severity level 35A-35F (mild non-proliferative \[NP\]DR), 4=DR severity level 43A, 43B (moderate NPDR), 5=DR severity level 47A-47D (moderately severe NPDR), 6=DR severity level 53A-53E (severe NPDR), 7=DR severity level 60, 61A, 61B (mild proliferative \[P\]DR), 8=DR severity level 65A-65C (moderate PDR), 9=DR severity level 71A-71D (high-risk PDR), 10=DR severity level 90 (cannot grade). A lower score indicates less severe diabetic retinopathy.
Mean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Baseline to Month 48BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision. A positive change score indicates improvement.
Mean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Baseline to Month 36The need for macular laser treatment was evaluated by the masked (evaluating) physician. Macular laser was administered per protocol-specified objective and subjective criteria starting at Month 3.
Percentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Baseline to Month 48BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.
Mean Change From Month 36 in Best Corrected Visual Acuity (BCVA) Score in the Study Eye at Month 48Month 36 to Month 48BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision. A positive change score indicates improvement.
Percentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score in the Study Eye From Month 36 at Month 48Month 36 to Month 48BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.
Mean Change From Month 36 in Central Foveal Thickness in the Study Eye at Month 48Month 36 to Month 48Central foveal thickness was assessed in optical coherence tomographic images by the central reading center. A decrease in foveal thickness suggests a reduction in macular edema. A negative change score indicates improvement.
Percentage of Patients With Resolution of Leakage at Month 24Baseline to Month 24Resolution of leakage was defined as total area of fluorescein leakage in the central, inner, and outer subfields of the 0 Disc Area. Leakage was assessed in fluorescein angiographic images by the central reading center.

Participant flow

Recruitment details

Patients were recruited from study sites in the United States and Argentina. There were 10 patients from Argentina.

Participants by arm

ArmCount
Ranibizumab 0.3 mg
Patients randomized to this group received ranibizumab 0.3 mg monthly administered intravitreally for 24 months. Patients who had not discontinued treatment by Month 36 could enter the open-label extension phase to receive ranibizumab 0.5 mg as needed (pro re nata \[PRN\]) for up to 24 additional months.
125
Ranibizumab 0.5 mg
Patients randomized to this group received ranibizumab 0.5 mg monthly administered intravitreally for 24 months. Patients who had not discontinued treatment by Month 36 could enter the open-label extension phase to receive ranibizumab 0.5 mg as needed (pro re nata \[PRN\]) for up to 24 additional months.
125
Sham Injection
Patients randomized to this group received a sham intravitreal injection monthly for 24 months.
127
Total377

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Core StudyAdverse Event441
Core StudyDeath644
Core StudyLost to Follow-up5510
Core StudyPhysician Decision213
Core StudySubject Non-compliance121
Core StudySubject Required Other Therapy013
Core StudySubject's Decision9819
Open-label Extension Through Month 48Adverse Event002
Open-label Extension Through Month 48Death200
Open-label Extension Through Month 48Lost to Follow-up102
Open-label Extension Through Month 48Physician's Decision213
Open-label Extension Through Month 48Sponsor's Decision to Terminate Study181516
Open-label Extension Through Month 48Subject Non-compliance210
Open-label Extension Through Month 48Subject Required Other Therapy001
Open-label Extension Through Month 48Subject's Decision133
Open-label Extension Through Month 60Adverse Event002
Open-label Extension Through Month 60Death221
Open-label Extension Through Month 60Lost to Follow-up304
Open-label Extension Through Month 60Physician's Decision213
Open-label Extension Through Month 60Sponsor's Decision to Terminate Study777162
Open-label Extension Through Month 60Subject Non-compliance210
Open-label Extension Through Month 60Subject Required Other Therapy101
Open-label Extension Through Month 60Subject's Decision134

Baseline characteristics

CharacteristicRanibizumab 0.3 mgRanibizumab 0.5 mgSham InjectionTotal
Age, Continuous61.7 years
STANDARD_DEVIATION 8.9
62.8 years
STANDARD_DEVIATION 10
61.8 years
STANDARD_DEVIATION 9.8
62.1 years
STANDARD_DEVIATION 9.6
Sex: Female, Male
Female
52 Participants60 Participants53 Participants165 Participants
Sex: Female, Male
Male
73 Participants65 Participants74 Participants212 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
EG005
affected / at risk
EG006
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —— / —— / —— / —
other
Total, other adverse events
122 / 124122 / 124123 / 125121 / 12560 / 7676 / 9069 / 79
serious
Total, serious adverse events
47 / 12459 / 12460 / 12569 / 12518 / 7626 / 9023 / 79

Outcome results

Primary

Percentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Month 24

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.

Time frame: Baseline to Month 24

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed using the last observation carried forward.

ArmMeasureValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Month 2444.8 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Month 2439.2 Percentage of patients
Sham InjectionPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Month 2418.1 Percentage of patients
p-value: <0.000195% CI: [13.8, 34.8]Cochran-Mantel-Haenszel
p-value: 0.000295% CI: [10.7, 31.1]Cochran-Mantel-Haenszel
Secondary

Mean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision. A positive change score indicates improvement.

Time frame: Baseline to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed up to Month 36 using the last observation carried forward method. The Month 48 outcome measures are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureGroupValue (MEAN)Dispersion
Ranibizumab 0.3 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 2412.5 LettersStandard Deviation 14.1
Ranibizumab 0.3 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 48 (n=62,56,0,48)13.8 LettersStandard Deviation 12.2
Ranibizumab 0.3 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 3614.2 LettersStandard Deviation 12.8
Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 2411.9 LettersStandard Deviation 12.1
Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 48 (n=62,56,0,48)14.4 LettersStandard Deviation 11.8
Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 3611.0 LettersStandard Deviation 12.9
Sham InjectionMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 36NA Letters
Sham InjectionMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 242.6 LettersStandard Deviation 13.9
Sham InjectionMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 48 (n=62,56,0,48)NA Letters
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 24NA Letters
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 48 (n=62,56,0,48)10.2 LettersStandard Deviation 11.2
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24, 36, and 48Month 364.3 LettersStandard Deviation 14.9
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: <0.000195% CI: [6.1, 13]ANOVA
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: <0.000195% CI: [6.2, 12.6]ANOVA
Secondary

Mean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at Baseline

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision. A positive change score indicates improvement.

Time frame: Baseline to Month 36

Population: Subgroup of the intent-to-treat population: All randomized patients with focal edema at baseline, whether or not treatment was received. Missing data were imputed using the last observation carried forward method.

ArmMeasureGroupValue (MEAN)Dispersion
Ranibizumab 0.3 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 2411.9 LettersStandard Deviation 14.2
Ranibizumab 0.3 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 3614.3 LettersStandard Deviation 11.2
Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 369.7 LettersStandard Deviation 12.6
Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 249.8 LettersStandard Deviation 11.3
Sham InjectionMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 242.0 LettersStandard Deviation 14.3
Sham InjectionMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 36NA Letters
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 24NA Letters
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Best Corrected Visual Acuity (BCVA) Score at Months 24 and 36 in Patients With Focal Edema at BaselineMonth 364.6 LettersStandard Deviation 14.4
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here.p-value: 0.000595% CI: [4.3, 15.1]ANOVA
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here.p-value: 0.001195% CI: [3.3, 13]ANOVA
Secondary

Mean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48

Central foveal thickness was assessed in optical coherence tomographic images by the central reading center. A decrease in foveal thickness suggests a reduction in macular edema. A negative change score indicates improvement.

Time frame: Baseline to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed up to Month 36 using the last observation carried forward method. The Month 48 outcome measures are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureGroupValue (MEAN)Dispersion
Ranibizumab 0.3 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 24-250.6 µmStandard Deviation 212.2
Ranibizumab 0.3 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 48 (n=59,55,0,47)-233.3 µmStandard Deviation 186.8
Ranibizumab 0.3 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 36-261.2 µmStandard Deviation 196.5
Ranibizumab 0.5 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 24-253.1 µmStandard Deviation 183.7
Ranibizumab 0.5 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 48 (n=59,55,0,47)-301.2 µmStandard Deviation 155.6
Ranibizumab 0.5 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 36-269.1 µmStandard Deviation 178.9
Sham InjectionMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 24-133.4 µmStandard Deviation 209
Sham InjectionMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 36NA µm
Sham InjectionMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 48 (n=59,55,0,47)NA µm
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 24NA µm
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 48 (n=59,55,0,47)-281.3 µmStandard Deviation 171.5
Sham Injection/Ranibizumab 0.5 mgMean Change From Baseline in Central Foveal Thickness at Months 24, 36, and 48Month 36-200.1 µmStandard Deviation 215.6
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: <0.000195% CI: [-149.2, -66.6]ANCOVA
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: <0.000195% CI: [-159.6, -78.5]ANCOVA
Secondary

Mean Change From Month 36 in Best Corrected Visual Acuity (BCVA) Score in the Study Eye at Month 48

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision. A positive change score indicates improvement.

Time frame: Month 36 to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. The Month 48 data are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureValue (MEAN)Dispersion
Ranibizumab 0.3 mgMean Change From Month 36 in Best Corrected Visual Acuity (BCVA) Score in the Study Eye at Month 48-1.7 LettersStandard Deviation 7.5
Ranibizumab 0.5 mgMean Change From Month 36 in Best Corrected Visual Acuity (BCVA) Score in the Study Eye at Month 480.8 LettersStandard Deviation 7.1
Sham InjectionMean Change From Month 36 in Best Corrected Visual Acuity (BCVA) Score in the Study Eye at Month 481.3 LettersStandard Deviation 5.4
Secondary

Mean Change From Month 36 in Central Foveal Thickness in the Study Eye at Month 48

Central foveal thickness was assessed in optical coherence tomographic images by the central reading center. A decrease in foveal thickness suggests a reduction in macular edema. A negative change score indicates improvement.

Time frame: Month 36 to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. The Month 48 data are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureValue (MEAN)Dispersion
Ranibizumab 0.3 mgMean Change From Month 36 in Central Foveal Thickness in the Study Eye at Month 4823.3 µmStandard Deviation 119
Ranibizumab 0.5 mgMean Change From Month 36 in Central Foveal Thickness in the Study Eye at Month 484.2 µmStandard Deviation 78.6
Sham InjectionMean Change From Month 36 in Central Foveal Thickness in the Study Eye at Month 4829.6 µmStandard Deviation 89.2
Secondary

Mean Number of Macular Laser Treatments From Baseline Through Months 24 and 36

The need for macular laser treatment was evaluated by the masked (evaluating) physician. Macular laser was administered per protocol-specified objective and subjective criteria starting at Month 3.

Time frame: Baseline to Month 36

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed using the last observation carried forward method.

ArmMeasureGroupValue (MEAN)Dispersion
Ranibizumab 0.3 mgMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 240.8 TreatmentsStandard Deviation 1.2
Ranibizumab 0.3 mgMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 360.8 TreatmentsStandard Deviation 1.4
Ranibizumab 0.5 mgMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 360.9 TreatmentsStandard Deviation 1.5
Ranibizumab 0.5 mgMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 240.8 TreatmentsStandard Deviation 1.3
Sham InjectionMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 241.8 TreatmentsStandard Deviation 1.8
Sham InjectionMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 36NA Treatments
Sham Injection/Ranibizumab 0.5 mgMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 24NA Treatments
Sham Injection/Ranibizumab 0.5 mgMean Number of Macular Laser Treatments From Baseline Through Months 24 and 36Month 361.9 TreatmentsStandard Deviation 1.8
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here.p-value: <0.000195% CI: [-1.4, -0.7]ANOVA
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here.p-value: <0.000195% CI: [-1.5, -0.7]ANOVA
Secondary

Percentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.

Time frame: Baseline to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed up to Month 36 using the last observation carried forward method. The Month 48 outcome measures are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureGroupValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Month 3651.2 Percentage of patients
Ranibizumab 0.3 mgPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Month 48 (n=62,56,48)50.0 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Month 3641.6 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Month 48 (n=62,56,48)48.2 Percentage of patients
Sham InjectionPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Month 3622.0 Percentage of patients
Sham InjectionPercentage of Patients Who Gained ≥ 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 36 and 48Month 48 (n=62,56,48)22.9 Percentage of patients
Secondary

Percentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.

Time frame: Baseline to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed up to Month 36 using the last observation carried forward method. The Month 48 outcome measures are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureGroupValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 2497.6 Percentage of patients
Ranibizumab 0.3 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 48 (n=62,56,0,48)100.0 Percentage of patients
Ranibizumab 0.3 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 3699.2 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 2497.6 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 48 (n=62,56,0,48)100.0 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 3697.6 Percentage of patients
Sham InjectionPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 36NA Percentage of patients
Sham InjectionPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 2489.8 Percentage of patients
Sham InjectionPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 48 (n=62,56,0,48)NA Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 24NA Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 48 (n=62,56,0,48)97.9 Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score From Baseline at Months 24, 36, and 48Month 3691.3 Percentage of patients
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: 0.008695% CI: [2.4, 14.1]Cochran-Mantel-Haenszel
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: 0.012695% CI: [2, 13.6]Cochran-Mantel-Haenszel
Secondary

Percentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score in the Study Eye From Month 36 at Month 48

BCVA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) chart starting at a test distance of 4 meters. The BCVA score is the number of letters read correctly by the patient. An increase in the BCVA score indicates an improvement of vision.

Time frame: Month 36 to Month 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. The Month 48 data are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score in the Study Eye From Month 36 at Month 4893.5 Percentage of participants
Ranibizumab 0.5 mgPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score in the Study Eye From Month 36 at Month 4896.4 Percentage of participants
Sham InjectionPercentage of Patients Who Lost < 15 Letters in Their Best Corrected Visual Acuity (BCVA) Score in the Study Eye From Month 36 at Month 48100.0 Percentage of participants
Secondary

Percentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36

The severity of diabetic retinopathy was graded on a 10-point scale by the central reading center by comparing patient fundus photographic images with a set of standard images. 1=diabetic retinopathy (DR) severity level 10, 12 (DR absent), 2=DR severity level 14A-14C, 14Z, 15, 20 (DR questionable, microaneurysms only), 3=DR severity level 35A-35F (mild non-proliferative \[NP\]DR), 4=DR severity level 43A, 43B (moderate NPDR), 5=DR severity level 47A-47D (moderately severe NPDR), 6=DR severity level 53A-53E (severe NPDR), 7=DR severity level 60, 61A, 61B (mild proliferative \[P\]DR), 8=DR severity level 65A-65C (moderate PDR), 9=DR severity level 71A-71D (high-risk PDR), 10=DR severity level 90 (cannot grade). A lower score indicates less severe diabetic retinopathy.

Time frame: Baseline to Month 36

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed using the last observation carried forward method.

ArmMeasureGroupValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 24 (n=117, 115, 115)0.9 Percentage of patients
Ranibizumab 0.3 mgPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 36 (n-117, 115, 115)1.7 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 36 (n-117, 115, 115)1.7 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 24 (n=117, 115, 115)1.7 Percentage of patients
Sham InjectionPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 24 (n=117, 115, 115)4.3 Percentage of patients
Sham InjectionPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 36 (n-117, 115, 115)NA Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 24 (n=117, 115, 115)NA Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients With a ≥ 3-step Worsening From Baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale Score for Eyes at Months 24 and 36Month 36 (n-117, 115, 115)4.3 Percentage of patients
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here.p-value: 0.15995% CI: [-6.7, 0.7]Cochran-Mantel-Haenszel
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here.p-value: 0.272195% CI: [-6.5, 1.4]Cochran-Mantel-Haenszel
Secondary

Percentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48

VA was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart starting at a test distance of 4 meters. An increase in the number of lines read correctly by the patient in the ETDRS chart indicates an improvement of vision. The Snellen equivalent of 20/40 or better is 69 or more letters correctly read in the EDTRS chart.

Time frame: Months 24, 36, and 48

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed up to Month 36 using the last observation carried forward method. The Month 48 outcome measures are based on the observed data for patients enrolled in the open-label extension phase; missing data were not imputed.

ArmMeasureGroupValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 2460.0 Percentage of patients
Ranibizumab 0.3 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 48 (n=62,56,0,48)62.9 Percentage of patients
Ranibizumab 0.3 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 3663.2 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 2463.2 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 48 (n=62,56,0,48)73.2 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 3659.2 Percentage of patients
Sham InjectionPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 36NA Percentage of patients
Sham InjectionPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 2437.8 Percentage of patients
Sham InjectionPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 48 (n=62,56,0,48)NA Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 24NA Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 48 (n=62,56,0,48)54.2 Percentage of patients
Sham Injection/Ranibizumab 0.5 mgPercentage of Patients With a Visual Acuity (VA) Snellen Equivalent of 20/40 or Better at Months 24, 36, and 48Month 3642.5 Percentage of patients
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: <0.000195% CI: [13.4, 35.4]Cochran-Mantel-Haenszel
Comparison: The analysis summarized in this section is for the Month 24 time point, comparing the outcome for patients randomized to ranibizumab versus sham injections during the controlled treatment period. The statistical analysis for the Outcome Measure at Month 36 is not shown here. The statistical analysis was not performed at Month 48.p-value: <0.000195% CI: [14, 36.3]Cochran-Mantel-Haenszel
Secondary

Percentage of Patients With Resolution of Leakage at Month 24

Resolution of leakage was defined as total area of fluorescein leakage in the central, inner, and outer subfields of the 0 Disc Area. Leakage was assessed in fluorescein angiographic images by the central reading center.

Time frame: Baseline to Month 24

Population: Intent-to-treat population: All randomized patients, whether or not treatment was received. Missing data were imputed using the last observation carried forward method.

ArmMeasureValue (NUMBER)
Ranibizumab 0.3 mgPercentage of Patients With Resolution of Leakage at Month 2430.1 Percentage of patients
Ranibizumab 0.5 mgPercentage of Patients With Resolution of Leakage at Month 2426.0 Percentage of patients
Sham InjectionPercentage of Patients With Resolution of Leakage at Month 241.6 Percentage of patients
p-value: <0.000195% CI: [21.1, 38]Cochran-Mantel-Haenszel
p-value: <0.000195% CI: [16.7, 31.7]Cochran-Mantel-Haenszel

Source: ClinicalTrials.gov · Data processed: Mar 27, 2026