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Investigation of the Change of Vision-related Quality of Life in Subjects Treated With Aflibercept According to EU Label for DME.

Open-label Phase-4 Study to Examine the Change of Vision-related Quality of Life in Subjects With Diabetic Macular Edema (DME) During Treatment With Intravitreal Injections of 2 mg Aflibercept According to EU Label for the First Year of Treatment

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02581995
Acronym
AQUA
Enrollment
560
Registered
2015-10-21
Start date
2015-11-19
Completion date
2017-08-09
Last updated
2018-10-10

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

Conditions

Macular Edema

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

Bayer
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

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

MeasureTime frameDescription
Change From Baseline to Week 52 in NEI VFQ-25 Total ScoreBaseline, Week 52National 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

MeasureTime frameDescription
Change From Baseline to Week 52 in the NEI VFQ 25 Near Activities SubscaleBaseline, Week 52NEI 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 SubscaleBaseline, Week 52NEI 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 52Visual 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 52Retinal 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 52The 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

MeasureTime frameDescription
Change From Baseline in Systolic Blood Pressure at Week 52Baseline, Week 52Systolic blood pressure was measured in a consistent and standardized way according to locally established practice.
Change From Baseline in Diastolic Blood Pressure at Week 52Baseline, Week 52Diastolic blood pressure was measured in a consistent and standardized way according to locally established practice.
Change From Baseline in Heart Rate at Week 52Baseline, Week 52Heart rate was measured in a consistent and standardized way according to locally established practice.
Change From Baseline in Body Temperature at Week 52Baseline, Week 52Temperature 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 WeeksBaseline, Weeks 4, 8, 12, 16, 24, 32, 40, 48, 52Intraocular 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

ArmCount
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
Total560

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event6
Overall StudyDeath4
Overall StudyLost to Follow-up5
Overall StudyPhysician Decision1
Overall StudyUnspecified other3
Overall StudyWithdrawal by participant12

Baseline characteristics

CharacteristicAflibercept
Age, Continuous64.3 years
STANDARD_DEVIATION 9.3
Best Corrected Visual Acuity (BCVA)61.5 score on a scale
STANDARD_DEVIATION 11
Body Temperature36.37 celsius
STANDARD_DEVIATION 0.38
Central Retinal Thickness (CRT)465.08 microns
STANDARD_DEVIATION 136.75
Diastolic Blood Pressure77.7 millimeter of mercury (mmHg)
STANDARD_DEVIATION 9.4
Heart Rate75.1 beats per minute (beats/min)
STANDARD_DEVIATION 10.1
NEI VFQ-25 distant activities subscale71.964 score on a scale
STANDARD_DEVIATION 23.973
NEI VFQ-25 near activities subscale62.967 score on a scale
STANDARD_DEVIATION 23.479
NEI VFQ-25 total score70.224 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 Pressure16.2 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 Pressure138.1 millimeter of mercury (mmHg)
STANDARD_DEVIATION 13.6

Adverse events

Event typeEG000
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

Primary

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.

ArmMeasureValue (MEAN)
AfliberceptChange From Baseline to Week 52 in NEI VFQ-25 Total Score6.106 score on a scale
Secondary

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.

ArmMeasureValue (MEAN)
AfliberceptChange 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
Secondary

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.

ArmMeasureValue (MEAN)
AfliberceptChange From Baseline to Week 52 in Central Retinal Thickness (CRT) Measured by Optical Coherence Tomography (OCT)-175.38 microns
Secondary

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.

ArmMeasureValue (MEAN)
AfliberceptChange From Baseline to Week 52 in the NEI VFQ 25 Distant Activities Subscale7.331 score on a scale
Secondary

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.

ArmMeasureValue (MEAN)
AfliberceptChange From Baseline to Week 52 in the NEI VFQ 25 Near Activities Subscale11.370 score on a scale
Secondary

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.

ArmMeasureValue (NUMBER)
AfliberceptProportion 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
Other Pre-specified

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.

ArmMeasureValue (MEAN)Dispersion
AfliberceptChange From Baseline in Body Temperature at Week 52-0.04 celsiusStandard Deviation 0.41
Other Pre-specified

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.

ArmMeasureValue (MEAN)Dispersion
AfliberceptChange From Baseline in Diastolic Blood Pressure at Week 52-0.3 millimeter of mercury (mmHg)Standard Deviation 9.9
Other Pre-specified

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.

ArmMeasureValue (MEAN)Dispersion
AfliberceptChange From Baseline in Heart Rate at Week 52-1.0 beats per minute (beats/min)Standard Deviation 9.5
Other Pre-specified

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.

ArmMeasureGroupValue (MEAN)Dispersion
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 4-0.4 millimeter of mercury (mmHg)Standard Deviation 2.9
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 8-0.3 millimeter of mercury (mmHg)Standard Deviation 2.9
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 12-0.5 millimeter of mercury (mmHg)Standard Deviation 2.9
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 16-0.3 millimeter of mercury (mmHg)Standard Deviation 2.9
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 24-0.2 millimeter of mercury (mmHg)Standard Deviation 3
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 32-0.1 millimeter of mercury (mmHg)Standard Deviation 3
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 400.0 millimeter of mercury (mmHg)Standard Deviation 3
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 480.0 millimeter of mercury (mmHg)Standard Deviation 3
AfliberceptChange From Baseline in Pre-injection Intraocular Pressure for Study Eye Every 4 WeeksChange at Week 520.1 millimeter of mercury (mmHg)Standard Deviation 3.1
Other Pre-specified

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.

ArmMeasureValue (MEAN)Dispersion
AfliberceptChange From Baseline in Systolic Blood Pressure at Week 52-0.1 millimeter of mercury (mmHg)Standard Deviation 15.1

Source: ClinicalTrials.gov · Data processed: Feb 18, 2026