Macular Edema
Conditions
Keywords
Diabetic macular edema, Intravitreal injection
Brief summary
To evaluate the change in quality of life (NEI VFQ 25) in subjects with DME during the first year of treatment with aflibercept according to the EU Label.
Interventions
2 mg aflibercept administered every 8 weeks following 5 initial monthly doses Intravitreal (IVT) injection
Sponsors
Study design
Eligibility
Inclusion criteria
* Type 1 or 2 diabetes mellitus * Diagnosis of DME secondary to diabetes mellitus involving the center of the macula (defined as the area of the center subfield on OCT) in the study eye * Decrease in vision determined to be primarily the result of DME in the study eye * BCVA in the study eye of ETDRS letter score 73 to 24 (This corresponds to a Snellen equivalent of approximately 20/40 to 20/320.)
Exclusion criteria
* Pregnancy and lactation * Mismatch with inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline to Week 52 in NEI VFQ-25 Total Score | Baseline, Week 52 | National eye institute 25-item visual function questionnaire (NEI VFQ-25) is a condition-specific measure which was designed to capture the specific impact of vision loss on health-related quality of life (HRQoL). The calculation for NEI VFQ-25 sub-scale scores and total score was performed according to the NEI VFQ-25 Scoring Algorithm - August 2000. The NEI VFQ-25 consists of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. All items are scored so that a high score represents better functioning. Each item is then converted to a 0 to 100 scale so that the lowest and highest possible scores are set at 0 and 100 points, respectively. In this format scores represent the achieved percentage of the total possible score, e.g. a score of 50 represents 50% of the highest possible score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline to Week 52 in the NEI VFQ 25 Near Activities Subscale | Baseline, Week 52 | NEI VFQ-25 is a condition-specific measure which was designed to capture the specific impact of vision loss on HRQoL. The calculation for NEI VFQ-25 sub-scale scores and total score was performed according to the NEI VFQ-25 Scoring Algorithm - August 2000. Items within each sub-scale are averaged together to create the 12 sub-scale Scores. Items that are left blank (missing data) are not taken into account when calculating the scale scores. Sub-scales with at least one item answered can be used to generate a sub-scale score. Hence, scores represent the average for all items in the subscale that the respondent answered.The NEI VFQ-25 near activities subscale was scored from 0-100 with a score of 0 being the worst outcome and 100 being the best outcome. Near activities are defined as reading ordinary print in newspapers, performing work or hobbies requiring near vision, or finding something on a crowded shelf. |
| Change From Baseline to Week 52 in the NEI VFQ 25 Distant Activities Subscale | Baseline, Week 52 | NEI VFQ-25 is a condition-specific measure which was designed to capture the specific impact of vision loss on HRQoL. The calculation for NEI VFQ-25 sub-scale scores and total score was performed according to the NEI VFQ-25 Scoring Algorithm - August 2000. Items within each sub-scale are averaged together to create the 12 sub-scale Scores. Items that are left blank (missing data) are not taken into account when calculating the scale scores. Sub-scales with at least one item answered can be used to generate a sub-scale score. Hence, scores represent the average for all items in the subscale that the respondent answered. The NEI VFQ-25 distant activities subscale was scored from 0-100 with a score of 0 being the worst outcome and 100 being the best outcome. Distant activities are defined as activities requiring distance vision, such as recognizing faces or reading street signs. |
| Change From Baseline to Week 52 in Best Corrected Visual Acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] Letter Score]) | Baseline, Week 52 | Visual function was assessed using the ETDRS protocol (Early Treatment Diabetic Retinopathy Study Research Group 1985) starting at 4 meters. The values might range from 0 to 100. A higher score represents better functioning. |
| Change From Baseline to Week 52 in Central Retinal Thickness (CRT) Measured by Optical Coherence Tomography (OCT) | Baseline, Week 52 | Retinal and lesion characteristics were evaluated using spectral domain optical coherence tomography (OCT). For all visits where the OCT procedure was scheduled, images were captured and read by the investigator. All OCTs were electronically archived at the study sites as part of the source documentation. |
| Proportion of Participants Progressing to Greater or Equal to (>=) 61 on the ETDRS Diabetic Retinopathy Severity Scale (DRSS) as Assessed by Fundus Photography (FP) | Baseline, Week 52 | The ETDRS DRSS was assessed by FP according to the following scale for both eyes. The following severities are possible. 10 = Diabetic retinopathy (DR) absent, 14 = DR questionable, 15 = DR questionable, 20 = Micro-aneurysms only, 35 = Mild Non-proliferative diabetic retinopathy (NPDR), 43 = Moderate NPDR, 47 = Moderately severe NPDR, 53 = Severe NPDR, 61 = Mild Proliferative diabetic retinopathy (PDR), 65 = Moderate PDR, 71 = High-risk PDR, 75 = High-risk PDR, 81 = Advanced PDR: fundus partially obscured, center of macula attached, 85 = Advanced PDR: posterior fundus obscured, or center of macula detached, 90 = cannot grade, even sufficiently for level 81 or 85. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Systolic Blood Pressure at Week 52 | Baseline, Week 52 | Systolic blood pressure was measured in a consistent and standardized way according to locally established practice. |
| Change From Baseline in Diastolic Blood Pressure at Week 52 | Baseline, Week 52 | Diastolic blood pressure was measured in a consistent and standardized way according to locally established practice. |
| Change From Baseline in Heart Rate at Week 52 | Baseline, Week 52 | Heart rate was measured in a consistent and standardized way according to locally established practice. |
| Change From Baseline in Body Temperature at Week 52 | Baseline, Week 52 | Temperature was measured in a consistent and standardized way according to locally established practice. |
| Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Baseline, Weeks 4, 8, 12, 16, 24, 32, 40, 48, 52 | Intraocular pressure (IOP) was measured using applanation tonometry Goldmann, Tonopen or approved alternative). The same method of intraocular pressure measurement was used in each participant throughout the study. For the measurement of intraocular pressure, a local anesthetic combined with fluorescein was applied topically to the eye being tested (example: one drop of oxybuprocain plus fluorescein). In the below table, pre-injection intraocular pressure for study eye was reported. |
Countries
Austria, Canada, Czechia, France, Germany, Hungary, Italy, Lithuania, Poland, Portugal, Slovakia, Spain, Switzerland, United Kingdom
Participant flow
Recruitment details
Study was conducted at multiple study centers in 14 countries, between 19 November 2015 (first participant first visit) and 09 August 2017 (last participant last visit).
Pre-assignment details
Overall, 676 participants were screened. Of them, 116 participants did not complete screening: 100 failed screening; 8 withdrew, 1 had an adverse event, 1 was lost to follow-up and 6 were not assigned to treatment for other reasons. A total of 560 participants were assigned to treatment and 31 participants discontinued the study prematurely.
Participants by arm
| Arm | Count |
|---|---|
| Aflibercept Participants were treated according to the EU-PI for treatment of DME for the first year of treatment and received 1 dose of 2 mg aflibercept injected IVT every 4 weeks for 5 consecutive doses, followed by dosing every 8 weeks thereafter until the end of the 52 week treatment period. | 560 |
| Total | 560 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 6 |
| Overall Study | Death | 4 |
| Overall Study | Lost to Follow-up | 5 |
| Overall Study | Physician Decision | 1 |
| Overall Study | Unspecified other | 3 |
| Overall Study | Withdrawal by participant | 12 |
Baseline characteristics
| Characteristic | Aflibercept |
|---|---|
| Age, Continuous | 64.3 years STANDARD_DEVIATION 9.3 |
| Best Corrected Visual Acuity (BCVA) | 61.5 score on a scale STANDARD_DEVIATION 11 |
| Body Temperature | 36.37 celsius STANDARD_DEVIATION 0.38 |
| Central Retinal Thickness (CRT) | 465.08 microns STANDARD_DEVIATION 136.75 |
| Diastolic Blood Pressure | 77.7 millimeter of mercury (mmHg) STANDARD_DEVIATION 9.4 |
| Heart Rate | 75.1 beats per minute (beats/min) STANDARD_DEVIATION 10.1 |
| NEI VFQ-25 distant activities subscale | 71.964 score on a scale STANDARD_DEVIATION 23.973 |
| NEI VFQ-25 near activities subscale | 62.967 score on a scale STANDARD_DEVIATION 23.479 |
| NEI VFQ-25 total score | 70.224 score on a scale STANDARD_DEVIATION 19.221 |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 10 - DR absent | 0 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 15 - DR questionable | 2 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 35 - Mild NPDR | 144 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 43 - Moderate NPDR | 184 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 47 - Moderately severe NPDR | 151 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 53 - Severe NPDR | 48 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 61 - Mild PDR | 8 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 65 - Moderate PDR | 8 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 71 - High-risk PDR | 2 Participants |
| Number of Participants with Diabetic Retinopathy Severity Score (DRSS) 90 - Cannot grade | 6 Participants |
| Pre-injection Intraocular Pressure | 16.2 millimeter of mercury (mmHg) STANDARD_DEVIATION 3 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 34 Participants |
| Race (NIH/OMB) White | 519 Participants |
| Sex: Female, Male Female | 224 Participants |
| Sex: Female, Male Male | 336 Participants |
| Systolic Blood Pressure | 138.1 millimeter of mercury (mmHg) STANDARD_DEVIATION 13.6 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 5 / 560 |
| other Total, other adverse events | 0 / 560 |
| serious Total, serious adverse events | 66 / 560 |
Outcome results
Change From Baseline to Week 52 in NEI VFQ-25 Total Score
National eye institute 25-item visual function questionnaire (NEI VFQ-25) is a condition-specific measure which was designed to capture the specific impact of vision loss on health-related quality of life (HRQoL). The calculation for NEI VFQ-25 sub-scale scores and total score was performed according to the NEI VFQ-25 Scoring Algorithm - August 2000. The NEI VFQ-25 consists of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. All items are scored so that a high score represents better functioning. Each item is then converted to a 0 to 100 scale so that the lowest and highest possible scores are set at 0 and 100 points, respectively. In this format scores represent the achieved percentage of the total possible score, e.g. a score of 50 represents 50% of the highest possible score.
Time frame: Baseline, Week 52
Population: FAS included all participants who received at least one injection of study drug and completed the baseline and at least one post-baseline NEI VFQ-25 questionnaire.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Aflibercept | Change From Baseline to Week 52 in NEI VFQ-25 Total Score | 6.106 score on a scale |
Change From Baseline to Week 52 in Best Corrected Visual Acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] Letter Score])
Visual function was assessed using the ETDRS protocol (Early Treatment Diabetic Retinopathy Study Research Group 1985) starting at 4 meters. The values might range from 0 to 100. A higher score represents better functioning.
Time frame: Baseline, Week 52
Population: FAS included all participants who received at least one injection of study drug and completed the baseline and at least one post-baseline NEI VFQ-25 questionnaire.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Aflibercept | Change From Baseline to Week 52 in Best Corrected Visual Acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] Letter Score]) | 10.0 score on a scale |
Change From Baseline to Week 52 in Central Retinal Thickness (CRT) Measured by Optical Coherence Tomography (OCT)
Retinal and lesion characteristics were evaluated using spectral domain optical coherence tomography (OCT). For all visits where the OCT procedure was scheduled, images were captured and read by the investigator. All OCTs were electronically archived at the study sites as part of the source documentation.
Time frame: Baseline, Week 52
Population: FAS included all participants who received at least one injection of study drug and completed the baseline and at least one post-baseline NEI VFQ-25 questionnaire. Participants who were evaluable for this measure at given time point for the arm were included in the category.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Aflibercept | Change From Baseline to Week 52 in Central Retinal Thickness (CRT) Measured by Optical Coherence Tomography (OCT) | -175.38 microns |
Change From Baseline to Week 52 in the NEI VFQ 25 Distant Activities Subscale
NEI VFQ-25 is a condition-specific measure which was designed to capture the specific impact of vision loss on HRQoL. The calculation for NEI VFQ-25 sub-scale scores and total score was performed according to the NEI VFQ-25 Scoring Algorithm - August 2000. Items within each sub-scale are averaged together to create the 12 sub-scale Scores. Items that are left blank (missing data) are not taken into account when calculating the scale scores. Sub-scales with at least one item answered can be used to generate a sub-scale score. Hence, scores represent the average for all items in the subscale that the respondent answered. The NEI VFQ-25 distant activities subscale was scored from 0-100 with a score of 0 being the worst outcome and 100 being the best outcome. Distant activities are defined as activities requiring distance vision, such as recognizing faces or reading street signs.
Time frame: Baseline, Week 52
Population: FAS included all participants who received at least one injection of study drug and completed the baseline and at least one post-baseline NEI VFQ-25 questionnaire.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Aflibercept | Change From Baseline to Week 52 in the NEI VFQ 25 Distant Activities Subscale | 7.331 score on a scale |
Change From Baseline to Week 52 in the NEI VFQ 25 Near Activities Subscale
NEI VFQ-25 is a condition-specific measure which was designed to capture the specific impact of vision loss on HRQoL. The calculation for NEI VFQ-25 sub-scale scores and total score was performed according to the NEI VFQ-25 Scoring Algorithm - August 2000. Items within each sub-scale are averaged together to create the 12 sub-scale Scores. Items that are left blank (missing data) are not taken into account when calculating the scale scores. Sub-scales with at least one item answered can be used to generate a sub-scale score. Hence, scores represent the average for all items in the subscale that the respondent answered.The NEI VFQ-25 near activities subscale was scored from 0-100 with a score of 0 being the worst outcome and 100 being the best outcome. Near activities are defined as reading ordinary print in newspapers, performing work or hobbies requiring near vision, or finding something on a crowded shelf.
Time frame: Baseline, Week 52
Population: FAS included all participants who received at least one injection of study drug and completed the baseline and at least one post-baseline NEI VFQ-25 questionnaire.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Aflibercept | Change From Baseline to Week 52 in the NEI VFQ 25 Near Activities Subscale | 11.370 score on a scale |
Proportion of Participants Progressing to Greater or Equal to (>=) 61 on the ETDRS Diabetic Retinopathy Severity Scale (DRSS) as Assessed by Fundus Photography (FP)
The ETDRS DRSS was assessed by FP according to the following scale for both eyes. The following severities are possible. 10 = Diabetic retinopathy (DR) absent, 14 = DR questionable, 15 = DR questionable, 20 = Micro-aneurysms only, 35 = Mild Non-proliferative diabetic retinopathy (NPDR), 43 = Moderate NPDR, 47 = Moderately severe NPDR, 53 = Severe NPDR, 61 = Mild Proliferative diabetic retinopathy (PDR), 65 = Moderate PDR, 71 = High-risk PDR, 75 = High-risk PDR, 81 = Advanced PDR: fundus partially obscured, center of macula attached, 85 = Advanced PDR: posterior fundus obscured, or center of macula detached, 90 = cannot grade, even sufficiently for level 81 or 85.
Time frame: Baseline, Week 52
Population: Subjects in the FAS with gradable baseline and Week 52 FP and a DRSS of less than (\<) 61 at baseline. Participants who were evaluable for this measure at given time point for the arm were included in the category.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Aflibercept | Proportion of Participants Progressing to Greater or Equal to (>=) 61 on the ETDRS Diabetic Retinopathy Severity Scale (DRSS) as Assessed by Fundus Photography (FP) | 0.4 proportion of participants |
Change From Baseline in Body Temperature at Week 52
Temperature was measured in a consistent and standardized way according to locally established practice.
Time frame: Baseline, Week 52
Population: SAF included all participants who received at least 1 injection of study drug. Participants who were evaluable for this measure at given time point for the arm were included in the category.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Aflibercept | Change From Baseline in Body Temperature at Week 52 | -0.04 celsius | Standard Deviation 0.41 |
Change From Baseline in Diastolic Blood Pressure at Week 52
Diastolic blood pressure was measured in a consistent and standardized way according to locally established practice.
Time frame: Baseline, Week 52
Population: SAF included all participants who received at least 1 injection of study drug. Participants who were evaluable for this measure at given time point for the arm were included in the category.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Aflibercept | Change From Baseline in Diastolic Blood Pressure at Week 52 | -0.3 millimeter of mercury (mmHg) | Standard Deviation 9.9 |
Change From Baseline in Heart Rate at Week 52
Heart rate was measured in a consistent and standardized way according to locally established practice.
Time frame: Baseline, Week 52
Population: SAF included all participants who received at least 1 injection of study drug. Participants who were evaluable for this measure at given time point for the arm were included in the category.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Aflibercept | Change From Baseline in Heart Rate at Week 52 | -1.0 beats per minute (beats/min) | Standard Deviation 9.5 |
Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks
Intraocular pressure (IOP) was measured using applanation tonometry Goldmann, Tonopen or approved alternative). The same method of intraocular pressure measurement was used in each participant throughout the study. For the measurement of intraocular pressure, a local anesthetic combined with fluorescein was applied topically to the eye being tested (example: one drop of oxybuprocain plus fluorescein). In the below table, pre-injection intraocular pressure for study eye was reported.
Time frame: Baseline, Weeks 4, 8, 12, 16, 24, 32, 40, 48, 52
Population: SAF included all participants who received at least 1 injection of study drug. Participants who were evaluable for this measure at given time points for the arm were included in the categories.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 4 | -0.4 millimeter of mercury (mmHg) | Standard Deviation 2.9 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 8 | -0.3 millimeter of mercury (mmHg) | Standard Deviation 2.9 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 12 | -0.5 millimeter of mercury (mmHg) | Standard Deviation 2.9 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 16 | -0.3 millimeter of mercury (mmHg) | Standard Deviation 2.9 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 24 | -0.2 millimeter of mercury (mmHg) | Standard Deviation 3 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 32 | -0.1 millimeter of mercury (mmHg) | Standard Deviation 3 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 40 | 0.0 millimeter of mercury (mmHg) | Standard Deviation 3 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 48 | 0.0 millimeter of mercury (mmHg) | Standard Deviation 3 |
| Aflibercept | Change From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 Weeks | Change at Week 52 | 0.1 millimeter of mercury (mmHg) | Standard Deviation 3.1 |
Change From Baseline in Systolic Blood Pressure at Week 52
Systolic blood pressure was measured in a consistent and standardized way according to locally established practice.
Time frame: Baseline, Week 52
Population: SAF included all participants who received at least 1 injection of study drug. Participants who were evaluable for this measure at given time point for the arm were included in the category.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Aflibercept | Change From Baseline in Systolic Blood Pressure at Week 52 | -0.1 millimeter of mercury (mmHg) | Standard Deviation 15.1 |