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Evaluation of Doxycycline Verses Placebo for the Treatment of Severe Nonproliferative or Mild or Moderate Proliferative Diabetic Retinopathy

Evaluation of Effect of Doxycycline Verses Placebo on Diabetic Retinopathy Progression and Retinal Function in Patients With Severe Non-proliferative or Mild or Moderate (Non-high-risk) Proliferative Diabetic Retinopathy

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00511875
Acronym
POC1
Enrollment
30
Registered
2007-08-06
Start date
2008-07-31
Completion date
2012-05-31
Last updated
2018-11-02

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

Conditions

Diabetic Retinopathy

Keywords

diabetic retinopathy, diabetes, diabetic eye studies, neovascularization

Brief summary

This 24 month randomized research study will evaluate whether doxycycline can 1) slow the deterioration or improve retinal function and/or 2) induce regression, or slow progression, of diabetic retinopathy in participants over 18 years of age with type 1 or type 2 diabetes with severe non-proliferative or early proliferative diabetic retinopathy.

Detailed description

The objectives of this proof-of-concept study are to investigate whether doxycycline can 1) slow the deterioration or improve retinal function and/or 2) induce regression, or slow progression, of diabetic retinopathy. The tests will be performed in the Ophthalmology Departments of the Penn State College of Medicine and Glostrup Hospital, Copenhagen, Denmark. The 24 month proof-of-concept clinical study will involve a prospective, randomized, double-masked clinical trial including 60 adult patients with type 1 or type 2 diabetes who have severe non-proliferative diabetic retinopathy (ETDRS level 53E) or mild or moderate proliferative diabetic retinopathy (retinal and /or optic disk neovascularization less than the high-risk ETDRS level 61 or 65), neovascularization of the disc or neovascularization elsewhere \>1/2 disc area and in whom panretinal photocoagulation is not imminently required in the ophthalmologist's judgment. Systemic Exclusion Criteria: * unstable medical status (e.g. glycemic control, blood pressure, cardiovascular disease) in the opinion of investigator * significant renal disease (defined as a serum creatinine \> 2.5 mg/dL), * systolic blood pressure \> 180 mm Hg or diastolic blood pressure \> 110 mm Hg * history of headaches associated with tetracycline therapy * history of pseudotumor cerebri * pregnancy; for women of child-bearing potential, a serum pregnancy test will be performed. * lactating or intending to become pregnant during the study period (at least 24 months) * sexually active women of child-bearing potential not actively practicing birth control by using a medically accepted device or therapy (that is, intrauterine device, hormonal contraceptive, or barrier devices) during the study period (at least 24 months); since doxycycline may interfere with the effectiveness of hormonal contraceptives, sexually active women of child-bearing potential who use a hormonal contraceptive will be required to use a second form of contraception to safeguard against contraceptive failure while participating in the study * known allergy/intolerance to doxycycline or any ingredient in the study drug or placebo (e.g. cellulose, hypromellose, iron oxide, methacrylic acid copolymer, polyethylene glycol, polysorbate 80, sugar spheres, talc, titanium dioxide, and triethyl citrate) * patients taking phenytoin, barbiturates or carbamazepine, with gastroparesis, with a history of gastrectomy, gastric bypass surgery or otherwise deemed achlorhydric or with a BMI \> 30 kg/m2 will also be excluded because of altered doxycycline pharmacokinetics and/or bioavailability * patients taking strontium, acitretin or tretinoin will be excluded due to the potential for serious drug interactions with doxycycline * patients with abnormal ALT or AST at baseline will be referred to their primary care physician for medical clearance for participation in this study

Interventions

50mg once daily for 24 months

DRUGplacebo

placebo taken once daily for 24 months

Sponsors

Juvenile Diabetes Research Foundation
CollaboratorOTHER
Thomas Gardner
Lead SponsorOTHER

Study design

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

Eligibility

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

Inclusion criteria

* age ≥ 18 years old * diagnosis of type 1 or type 2 diabetes mellitus * have a hemoglobin A1c less than 11% at pre-qualification visit * able and willing to give informed consent * best-corrected ETDRS visual acuity in study eye ≥ 49 letters (20/100) * severe non-proliferative diabetic retinopathy (ETDRS level 53E) or retinal and/or optic disk neovascularization less than the high-risk characteristics defined by the Diabetic Retinopathy Study (ETDRS level61- 65), and in whom panretinal photocoagulation is not imminently required in the ophthalmologist's judgment * able to perform reliable visual field and dark adaptation testing * central subfield thickness on OCT of ≤ 275microns * foveal fixation present in each eye (assessed by fundus photography using an internal fixation pointer or assessed by the investigator) * media clarity and pupil dilation sufficient for high-quality fundus photographs and fluorescein angiograms

Exclusion criteria

* high-risk neovascularization in study eye * prior panretinal photocoagulation in the study eye * focal/grid laser photocoagulation in the macula within the past 15 weeks in the study eye * intraocular pressure \> 22mmHg by Goldmann Tonometry in the study eye * history of pars plana vitrectomy in the study eye * vitreous or pre-retinal hemorrhage in the study eye * systemic or intravitreal anti-VEGF agent to the study eye or the fellow eye within the past 3 months * peribulbar steroid injection to the study eye or the fellow eye within the past 6 months * intravitreal triamcinolone acetonide to the study eye within the past 4 months * expectation by the investigator that retinal photocoagulation or other treatment for diabetic retinopathy (e.g. focal/grid laser to study eye, intravitreal triamcinolone acetonide to study eye, intravitreal anti-VEGF agent to study or fellow eye, ruboxistaurin or systemic anti-VEGF agent for diabetic macular edema) will be administered in the subsequent 24 months * an ocular condition (other than diabetes) is present in the study eye that, in the opinion of the investigator, might alter visual acuity during the course of the study (e.g. retinal vein occlusion, uveitis or other ocular inflammatory disease, neovascular glaucoma, Irvine-Gass Syndrome, etc) * anticipated need for cataract surgery in the study eye in the subsequent 24 months in the opinion of the investigator * history of major ocular surgery (including cataract surgery, scleral buckle, any intraocular surgery, etc) in the study eye within prior 6 months or anticipated within the subsequent 24 months following randomization * aphakia in the study eye * history of YAG capsulotomy performed in the study eye within 2 months prior to randomization

Design outcomes

Primary

MeasureTime frameDescription
Change in Dark Adaptation, Rod InterceptBaseline and 24 monthsChange in dark adaptation is measured as dark adaptation time at baseline measured in minutes minus dark adaptation time measured at 24 months
Change in Photopic Visual FieldBaseline and 24 monthsChange in photopic visual fields between baseline and 24 months
Change in Frequency Doubling Perimetry (FDP)24 monthsChange in Frequency Doubling Perimetry (FDP) from baseline, shown as mean and foveal (center of retina) scores
Change in Early Treatment Diabetic Retinopathy Study (ETDRS)Baseline and 24 monthsChange in ETDRS visual acuity letter score from baseline. ETDRS is measured on a scale of 0 to 70 where 0 means inability to see anything on the chart and 70 is normal (20/20) acuity.

Secondary

MeasureTime frameDescription
Change in Central Subfield ThicknessBaseline and 24 monthsChange in central subfield thickness from baseline
Change in Arteriovenous Ratio Diameter24 monthsChange in arteriovenous ratio diameter from baseline
Change in Macular Volume24 monthsChange in macular volume from baseline
Change in Central Retinal Artery Equivalent (CRAE) Diameter24 monthsChange in Central Retinal Artery Equivalent (CRAE) diameter from baseline
Change in Central Retinal Vein Equivalent (CRVE) Diameter24 monthsChange in Central Retinal Vein Equivalent (CRVE) diameter from baseline

Countries

United States

Participant flow

Participants by arm

ArmCount
Placebo
stratified equally to placebo taken once daily for 24 months placebo: placebo taken once daily for 24 months
15
Doxycycline Monohydrate
stratified equally to doxycycline monohydrate 50mg taken once daily for 24 months doxycycline monohydrate: 50mg once daily for 24 months
15
Total30

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLost to Follow-up40
Overall StudyMissing variables10

Baseline characteristics

CharacteristicPlaceboDoxycycline MonohydrateTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
6 Participants3 Participants9 Participants
Age, Categorical
Between 18 and 65 years
9 Participants12 Participants21 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants3 Participants3 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
15 Participants12 Participants27 Participants
Region of Enrollment
Denmark
9 participants7 participants16 participants
Region of Enrollment
United States
6 participants8 participants14 participants
Sex: Female, Male
Female
6 Participants6 Participants12 Participants
Sex: Female, Male
Male
9 Participants9 Participants18 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
14 / 1515 / 15
serious
Total, serious adverse events
3 / 153 / 15

Outcome results

Primary

Change in Dark Adaptation, Rod Intercept

Change in dark adaptation is measured as dark adaptation time at baseline measured in minutes minus dark adaptation time measured at 24 months

Time frame: Baseline and 24 months

Population: Of 10 participants who completed doxycycline treatment, usable endpoint data is only available for 8.

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Dark Adaptation, Rod Intercept0.3 minutesStandard Deviation 3.3
Doxycycline MonohydrateChange in Dark Adaptation, Rod Intercept-0.3 minutesStandard Deviation 3.2
p-value: 0.7t-test, 2 sided
Primary

Change in Early Treatment Diabetic Retinopathy Study (ETDRS)

Change in ETDRS visual acuity letter score from baseline. ETDRS is measured on a scale of 0 to 70 where 0 means inability to see anything on the chart and 70 is normal (20/20) acuity.

Time frame: Baseline and 24 months

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Early Treatment Diabetic Retinopathy Study (ETDRS)0.3 score on a scaleStandard Deviation 8.8
Doxycycline MonohydrateChange in Early Treatment Diabetic Retinopathy Study (ETDRS)0.2 score on a scaleStandard Deviation 4.9
p-value: 0.98t-test, 2 sided
Primary

Change in Frequency Doubling Perimetry (FDP)

Change in Frequency Doubling Perimetry (FDP) from baseline, shown as mean and foveal (center of retina) scores

Time frame: 24 months

ArmMeasureGroupValue (MEAN)Dispersion
PlaceboChange in Frequency Doubling Perimetry (FDP)Foveal Sensitivity-1.9 dBStandard Deviation 3.8
PlaceboChange in Frequency Doubling Perimetry (FDP)Mean FDP sensitivity-0.7 dBStandard Deviation 3.9
Doxycycline MonohydrateChange in Frequency Doubling Perimetry (FDP)Foveal Sensitivity1.8 dBStandard Deviation 3.6
Doxycycline MonohydrateChange in Frequency Doubling Perimetry (FDP)Mean FDP sensitivity0.7 dBStandard Deviation 2.7
Comparison: Foveal Sensitivityp-value: 0.02t-test, 2 sided
Comparison: mean FDP sensitivityp-value: 0.3t-test, 2 sided
Primary

Change in Photopic Visual Field

Change in photopic visual fields between baseline and 24 months

Time frame: Baseline and 24 months

ArmMeasureGroupValue (MEAN)Dispersion
PlaceboChange in Photopic Visual FieldFoveal Sensitivity-0.8 dBStandard Deviation 12.2
PlaceboChange in Photopic Visual FieldMean Sensitivity-0.74 dBStandard Deviation 1.9
Doxycycline MonohydrateChange in Photopic Visual FieldFoveal Sensitivity-0.8 dBStandard Deviation 1.3
Doxycycline MonohydrateChange in Photopic Visual FieldMean Sensitivity-1.0 dBStandard Deviation 2.4
Comparison: Foveal Sensitivityp-value: 0.33t-test, 2 sided
Comparison: Mean field sensitivityp-value: 0.16t-test, 2 sided
Secondary

Change in Arteriovenous Ratio Diameter

Change in arteriovenous ratio diameter from baseline

Time frame: 24 months

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Arteriovenous Ratio Diameter0.013 ratioStandard Deviation 0.057
Doxycycline MonohydrateChange in Arteriovenous Ratio Diameter0.013 ratioStandard Deviation 0.056
p-value: 0.62t-test, 2 sided
Secondary

Change in Central Retinal Artery Equivalent (CRAE) Diameter

Change in Central Retinal Artery Equivalent (CRAE) diameter from baseline

Time frame: 24 months

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Central Retinal Artery Equivalent (CRAE) Diameter-0.49 μmStandard Deviation 12
Doxycycline MonohydrateChange in Central Retinal Artery Equivalent (CRAE) Diameter0.17 μmStandard Deviation 14
p-value: 0.88t-test, 2 sided
Secondary

Change in Central Retinal Vein Equivalent (CRVE) Diameter

Change in Central Retinal Vein Equivalent (CRVE) diameter from baseline

Time frame: 24 months

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Central Retinal Vein Equivalent (CRVE) Diameter-6.3 μmStandard Deviation 19
Doxycycline MonohydrateChange in Central Retinal Vein Equivalent (CRVE) Diameter-6.6 μmStandard Deviation 18
p-value: 0.75t-test, 2 sided
Secondary

Change in Central Subfield Thickness

Change in central subfield thickness from baseline

Time frame: Baseline and 24 months

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Central Subfield Thickness-1.5 μmStandard Deviation 14.9
Doxycycline MonohydrateChange in Central Subfield Thickness4.8 μmStandard Deviation 26.3
p-value: 0.46t-test, 2 sided
Secondary

Change in Macular Volume

Change in macular volume from baseline

Time frame: 24 months

ArmMeasureValue (MEAN)Dispersion
PlaceboChange in Macular Volume-0.2 mm^3Standard Deviation 0.3
Doxycycline MonohydrateChange in Macular Volume-0.1 mm^3Standard Deviation 0.7
p-value: 0.81t-test, 2 sided

Source: ClinicalTrials.gov · Data processed: Mar 8, 2026