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A Phase 3 Safety and Efficacy Study of Intravitreal Administration of Zimura (Complement C5 Inhibitor)

A Phase 3 Multicenter, Randomized, Double Masked, Sham- Controlled Clinical Trial to Assess the Safety and Efficacy of Intravitreal Administration of Zimura (Complement C5 Inhibitor) in Patients With Geographic Atrophy Secondary to Age-Related Macular Degeneration

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04435366
Enrollment
448
Registered
2020-06-17
Start date
2020-06-22
Completion date
2023-08-22
Last updated
2025-10-21

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

Conditions

Geographic Atrophy, Macular Degeneration

Keywords

Geographic Atrophy (GA), Age-related Macular Degeneration, AMD, Complement C5 inhibitor, avacincaptad pegol, IZERVAY

Brief summary

The objectives of this study was to evaluate the safety and efficacy of avacincaptad pegol intravitreal administration in participants with geographic atrophy secondary to age-related macular degeneration (AMD)

Detailed description

Participants were randomized in a 1:1 ratio to the following monthly treatment groups: * Avacincaptad pegol 2 mg * Sham At Month 12, the participants in the avacincaptad pegol 2mg treatment group were re-randomized to receive the study drug either on a monthly basis or on an every other month basis The participants initially randomized to sham treatment continued with monthly sham administration through Month 23 All participants had a final follow up visit at Month 24

Interventions

Avacincaptad Pegol Intravitreal Injection

DRUGSham

Sham Administration (includes placement of the blunt opening of an empty, needleless syringe barrel on the conjunctiva in the inferotemporal quadrant of the eyeball to simulate the pressure of an injection)

Sponsors

IVERIC bio, Inc.
Lead SponsorINDUSTRY

Study design

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

Masking description

Participant, Evaluating Investigator, Reading Center Personnel, and Sponsor Personnel are masked

Eligibility

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

Inclusion criteria

* Subjects of either gender aged ≥ 50 years * Diagnosis of Non-foveal GA secondary to dry AMD

Exclusion criteria

* Any prior treatment for AMD (dry or wet) or any prior intravitreal treatment for any indication in either eye, except oral supplements of vitamins and minerals * Any intraocular surgery or thermal laser within 3 months of trial entry. * Any prior thermal laser in the macular region, regardless of indication * Any ocular or periocular infection (including blepharitis), or ocular surface inflammation in the past 12 weeks. * Previous therapeutic radiation in the region of the study eye * Any sign of diabetic retinopathy in either eye

Design outcomes

Primary

MeasureTime frameDescription
The Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by Autofluorescence (FAF) at 3 Time Points: Baseline, Month 6, and Month 12Baseline to month 12GA was associated with age-related macular degeneration (AMD) and caused bilateral, progressive, and irreversible loss of retinal tissue (photoreceptors, retinal pigment epithelium, and choriocapillaris) leading to a permanent loss of visual function and blindness. The least squares mean used to determine mean rate of change in GA growth (slope) was measured by FAF. LS mean & SE were based on square-root transformation.
The Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by FAF at 5 Timepoints: Baseline, Month 6, Month 12, Month 18, and Month 24Baseline to month 24GA was associated with AMD and caused bilateral, progressive, and irreversible loss of retinal tissue (photoreceptors, retinal pigment epithelium, and choriocapillaris) leading to a permanent loss of visual function and blindness. The least square mean rate of GA growth (slope) was measured by FAF. LS mean & SE were based on untransformed data.

Secondary

MeasureTime frameDescription
Change From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsBaseline, months 6, 12, and 18The National Eye Institute Visual Function Questionnaire-25 (VFQ-25) measured the influence of visual disability and visual symptoms on general health domains. The VFQ-25 consisted of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. A higher score represented better visual functioning. Each item was then converted to a 0 to 100 scale so that the lowest and highest possible scores were set at 0 and 100 points, respectively. Each subscale score had a range of 0 to 100 inclusive and were calculated from the re-scaled raw data. A composite score was derived based on the average of the 11 vision-related subscales.
Change From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 24 MonthsBaseline and month 24The National Eye Institute Visual Function Questionnaire-25 (VFQ-25) measured the influence of visual disability and visual symptoms on general health domains. The VFQ-25 consisted of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. A higher score represented better visual functioning. Each item was then converted to a 0 to 100 scale so that the lowest and highest possible scores were set at 0 and 100 points, respectively. Each subscale score had a range of 0 to 100 inclusive and were calculated from the re-scaled raw data. A composite score was derived based on the average of the 11 vision-related subscales.
Change From Baseline in Best Corrected Visual Acuity (BCVA) Using Early Treatment Diabetic Retinopathy Study (ETDRS) Letters at 24 MonthsBaseline and month 24BCVA was assessed using ETDRS visual acuity testing charts. The ETDRS Visual Acuity Score (VAS) is defined as the number of letters read on the ETDRS chart. Minimum and maximum possible scores are 0-100. A higher score represented better visual functioning. A positive change from baseline indicates an improvement and a negative change from baseline indicates a worsening.
Time to Persistent Vision LossBaseline up to month 24Vision loss event was defined as a loss of ≥ 15 letters (equivalent to a loss of 3 lines on the ETDRS chart) in BCVA from Baseline measured at any two or more consecutive visits up to Month 24. These parameters were chosen as a 3-line BCVA loss (equivalent to doubling of visual angle) is widely recognized as a significant deterioration in vision and a minimum of two consecutive visits was representative of persistent disease progression. BCVA was assessed using ETDRS visual acuity testing charts. The ETDRS VAS was defined as the number of letters read on the ETDRS chart. Min and max possible scores are 0-100. A higher score represents better visual functioning. Kaplan-Meier method was used for analysis. Participants with an event were reported and not the median time to event.
Number of Participants With Categorical One-level Loss in VFQ-25 SubscaleBaseline up to month 24The National Eye Institute VFQ-25 measured the influence of visual disability and visual symptoms on general health domains. The VFQ-25 consisted of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. A higher score represented better visual functioning. Each item was then converted to a 0 to 100 scale so that the lowest and highest possible scores were set at 0 and 100 points, respectively.Categorical one-level loss in each item was defined as decline of one or more levels at Month 24 on the original scale from Baseline (equivalently 20 points for general vision and 25 points for other vision items in a 0 to 100 scale).
Change From Baseline in Low Luminance (LL) BCVA Using ETDRS Letters at 24 MonthsBaseline and month 24BCVA was assessed using ETDRS visual acuity testing charts. The ETDRS VAS is defined as the number of letters read on the ETDRS chart. Minimum and maximum possible scores are 0-100. A higher score represented better visual functioning. A positive change from baseline indicates an improvement and a negative change from baseline indicates a worsening. LL BCVA was measured by placing a 2.0 log unit neutral density filter over the best correction for that eye and having the participant read the normally illuminated ETDRS chart.

Countries

Argentina, Australia, Austria, Belgium, Brazil, Canada, Colombia, Croatia, Czechia, Estonia, France, Germany, Hungary, Israel, Italy, Latvia, Poland, Spain, United Kingdom, United States

Participant flow

Recruitment details

Participants ≥ 50 years of age diagnosed with geographic atrophy (GA) that was at least partly within 1.5 mm radius from the foveal center were enrolled in the study.

Pre-assignment details

Participants who met all inclusion criteria and none of the exclusion criteria were enrolled in the study.

Participants by arm

ArmCount
Avacincaptad Pegol
Participants received ACP 2 mg/eye via IVT injections monthly through Month 11 (Year 1). At month 12, participants were re-randomized to receive ACP 2 mg/eye via IVT injections monthly or ACP 2 mg/eye via IVT injections EOM at months 13, 15, 17, 19, 21, and 23 and sham injections at months 12, 14, 16,18, 20, and 22 (Year 2). Participants were followed up until month 24.
225
Sham
Participants received sham injections; through Month 11 (Year 1). At month 12, participants continued to receive monthly sham injection from month 12 through month 23 (Year 2). Participants were followed up until month 24.
222
Total447

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Year 1 (12 Months)Adverse Event302
Year 1 (12 Months)Death201
Year 1 (12 Months)Lost to Follow-up201
Year 1 (12 Months)Not treated001
Year 1 (12 Months)Patient non-compliance100
Year 1 (12 Months)Withdrawal by Subject17013
Year 2 (12 Months)Adverse Event216
Year 2 (12 Months)Death146
Year 2 (12 Months)Lost to Follow-up020
Year 2 (12 Months)Withdrawal by Subject437

Baseline characteristics

CharacteristicShamTotalAvacincaptad Pegol
Age, Continuous76.7 Years
STANDARD_DEVIATION 8.8
76.5 Years
STANDARD_DEVIATION 8.7
76.3 Years
STANDARD_DEVIATION 8.6
Ethnicity (NIH/OMB)
Hispanic or Latino
23 Participants50 Participants27 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
178 Participants346 Participants168 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
21 Participants51 Participants30 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
1 Participants2 Participants1 Participants
Race (NIH/OMB)
Black or African American
1 Participants1 Participants0 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
34 Participants75 Participants41 Participants
Race (NIH/OMB)
White
186 Participants368 Participants182 Participants
Sex: Female, Male
Female
156 Participants310 Participants154 Participants
Sex: Female, Male
Male
66 Participants137 Participants71 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
deaths
Total, all-cause mortality
4 / 2251 / 964 / 931 / 2227 / 203
other
Total, other adverse events
100 / 22551 / 9641 / 9383 / 22277 / 203
serious
Total, serious adverse events
31 / 22518 / 9616 / 9336 / 22225 / 203

Outcome results

Primary

The Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by Autofluorescence (FAF) at 3 Time Points: Baseline, Month 6, and Month 12

GA was associated with age-related macular degeneration (AMD) and caused bilateral, progressive, and irreversible loss of retinal tissue (photoreceptors, retinal pigment epithelium, and choriocapillaris) leading to a permanent loss of visual function and blindness. The least squares mean used to determine mean rate of change in GA growth (slope) was measured by FAF. LS mean & SE were based on square-root transformation.

Time frame: Baseline to month 12

Population: ITT analysis set

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Avacincaptad PegolThe Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by Autofluorescence (FAF) at 3 Time Points: Baseline, Month 6, and Month 120.336 millimeters (mm)/yearStandard Error 0.032
ShamThe Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by Autofluorescence (FAF) at 3 Time Points: Baseline, Month 6, and Month 120.392 millimeters (mm)/yearStandard Error 0.033
Comparison: Difference in least squares mean between groups calculated as (sham) minus (avacincaptad pegol). Mixed Model for repeated measures (MMRM) was used to compare the treatment groups.p-value: 0.006495% CI: [0.016, 0.096]MMRM
Primary

The Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by FAF at 5 Timepoints: Baseline, Month 6, Month 12, Month 18, and Month 24

GA was associated with AMD and caused bilateral, progressive, and irreversible loss of retinal tissue (photoreceptors, retinal pigment epithelium, and choriocapillaris) leading to a permanent loss of visual function and blindness. The least square mean rate of GA growth (slope) was measured by FAF. LS mean & SE were based on untransformed data.

Time frame: Baseline to month 24

Population: Re-rand analysis set-The subset of the ITT analysis set who were re-randomized at Month 12 and who were on sham and completed the Month 12 visit.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Avacincaptad PegolThe Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by FAF at 5 Timepoints: Baseline, Month 6, Month 12, Month 18, and Month 242.23 mm^2/yearStandard Error 0.124
ShamThe Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by FAF at 5 Timepoints: Baseline, Month 6, Month 12, Month 18, and Month 242.10 mm^2/yearStandard Error 0.126
ShamThe Mean Rate of Growth (Slope) Estimated Based on GA Area Measured by FAF at 5 Timepoints: Baseline, Month 6, Month 12, Month 18, and Month 242.59 mm^2/yearStandard Error 0.085
Comparison: Difference in least squares mean between groups calculated as (sham) minus (avacincaptad pegol).p-value: 0.016595% CI: [0.066, 0.657]MMRM
Comparison: Difference in least squares mean between groups calculated as (sham) minus (avacincaptad pegol and sham).p-value: 0.001595% CI: [0.189, 0.788]MMRM
Secondary

Change From Baseline in Best Corrected Visual Acuity (BCVA) Using Early Treatment Diabetic Retinopathy Study (ETDRS) Letters at 24 Months

BCVA was assessed using ETDRS visual acuity testing charts. The ETDRS Visual Acuity Score (VAS) is defined as the number of letters read on the ETDRS chart. Minimum and maximum possible scores are 0-100. A higher score represented better visual functioning. A positive change from baseline indicates an improvement and a negative change from baseline indicates a worsening.

Time frame: Baseline and month 24

Population: ITT analysis set

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Avacincaptad PegolChange From Baseline in Best Corrected Visual Acuity (BCVA) Using Early Treatment Diabetic Retinopathy Study (ETDRS) Letters at 24 Months-7.31 score on a scaleStandard Error 1.07
ShamChange From Baseline in Best Corrected Visual Acuity (BCVA) Using Early Treatment Diabetic Retinopathy Study (ETDRS) Letters at 24 Months-6.48 score on a scaleStandard Error 1.05
Comparison: Difference in least squares mean between groups calculated as (sham) minus (avacincaptad pegol).p-value: 0.5895% CI: [-3.79, 2.12]MMRM
Secondary

Change From Baseline in Low Luminance (LL) BCVA Using ETDRS Letters at 24 Months

BCVA was assessed using ETDRS visual acuity testing charts. The ETDRS VAS is defined as the number of letters read on the ETDRS chart. Minimum and maximum possible scores are 0-100. A higher score represented better visual functioning. A positive change from baseline indicates an improvement and a negative change from baseline indicates a worsening. LL BCVA was measured by placing a 2.0 log unit neutral density filter over the best correction for that eye and having the participant read the normally illuminated ETDRS chart.

Time frame: Baseline and month 24

Population: ITT analysis set

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Avacincaptad PegolChange From Baseline in Low Luminance (LL) BCVA Using ETDRS Letters at 24 Months-10.58 score on a scaleStandard Error 1.2
ShamChange From Baseline in Low Luminance (LL) BCVA Using ETDRS Letters at 24 Months-9.1 score on a scaleStandard Error 1.18
Comparison: Difference in least squares mean between groups calculated as (sham) minus (avacincaptad pegol).p-value: 0.3895% CI: [-4.79, 1.81]MMRM
Secondary

Change From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 24 Months

The National Eye Institute Visual Function Questionnaire-25 (VFQ-25) measured the influence of visual disability and visual symptoms on general health domains. The VFQ-25 consisted of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. A higher score represented better visual functioning. Each item was then converted to a 0 to 100 scale so that the lowest and highest possible scores were set at 0 and 100 points, respectively. Each subscale score had a range of 0 to 100 inclusive and were calculated from the re-scaled raw data. A composite score was derived based on the average of the 11 vision-related subscales.

Time frame: Baseline and month 24

Population: ITT analysis

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Avacincaptad PegolChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 24 Months-7.735 score on a scaleStandard Error 0.95
ShamChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 24 Months-7.023 score on a scaleStandard Error 0.931
p-value: 0.592995% CI: [-3.326, 1.903]MMRM
Secondary

Change From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 Months

The National Eye Institute Visual Function Questionnaire-25 (VFQ-25) measured the influence of visual disability and visual symptoms on general health domains. The VFQ-25 consisted of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. A higher score represented better visual functioning. Each item was then converted to a 0 to 100 scale so that the lowest and highest possible scores were set at 0 and 100 points, respectively. Each subscale score had a range of 0 to 100 inclusive and were calculated from the re-scaled raw data. A composite score was derived based on the average of the 11 vision-related subscales.

Time frame: Baseline, months 6, 12, and 18

Population: ITT analysis set with available data was analyzed

ArmMeasureGroupValue (MEAN)Dispersion
Avacincaptad PegolChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsChange at 6 months-1.2 score on a scaleStandard Deviation 10.56
Avacincaptad PegolChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsChange at 12 months-3.4 score on a scaleStandard Deviation 11.05
Avacincaptad PegolChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsChange at 18 months-5.4 score on a scaleStandard Deviation 12.8
ShamChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsChange at 6 months-1.6 score on a scaleStandard Deviation 9.98
ShamChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsChange at 12 months-3.6 score on a scaleStandard Deviation 11.01
ShamChange From Baseline in Visual Function Questionnaire (VFQ-25) Composite Scores at 6, 12 and 18 MonthsChange at 18 months-4.7 score on a scaleStandard Deviation 11.53
Secondary

Number of Participants With Categorical One-level Loss in VFQ-25 Subscale

The National Eye Institute VFQ-25 measured the influence of visual disability and visual symptoms on general health domains. The VFQ-25 consisted of a base set of 25 vision-targeted questions representing 11 vision-related constructs, plus an additional single-item general health rating question. A higher score represented better visual functioning. Each item was then converted to a 0 to 100 scale so that the lowest and highest possible scores were set at 0 and 100 points, respectively.Categorical one-level loss in each item was defined as decline of one or more levels at Month 24 on the original scale from Baseline (equivalently 20 points for general vision and 25 points for other vision items in a 0 to 100 scale).

Time frame: Baseline up to month 24

Population: ITT analysis set with available data was analyzed

ArmMeasureGroupValue (NUMBER)
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleColor Vision45 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleDistance Vision56 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleNear Vision61 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscalePeripheral Vision58 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleGeneral Vision58 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleDependency55 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleDriving27 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleGeneral Health45 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleMental Health35 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleOcular Pain27 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleRole Difficulties60 participants
Avacincaptad PegolNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleSocial Function52 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleRole Difficulties59 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleColor Vision35 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleDriving26 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleDistance Vision43 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleOcular Pain20 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleNear Vision49 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleGeneral Health67 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscalePeripheral Vision65 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleSocial Function52 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleGeneral Vision58 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleMental Health42 participants
ShamNumber of Participants With Categorical One-level Loss in VFQ-25 SubscaleDependency55 participants
Secondary

Time to Persistent Vision Loss

Vision loss event was defined as a loss of ≥ 15 letters (equivalent to a loss of 3 lines on the ETDRS chart) in BCVA from Baseline measured at any two or more consecutive visits up to Month 24. These parameters were chosen as a 3-line BCVA loss (equivalent to doubling of visual angle) is widely recognized as a significant deterioration in vision and a minimum of two consecutive visits was representative of persistent disease progression. BCVA was assessed using ETDRS visual acuity testing charts. The ETDRS VAS was defined as the number of letters read on the ETDRS chart. Min and max possible scores are 0-100. A higher score represents better visual functioning. Kaplan-Meier method was used for analysis. Participants with an event were reported and not the median time to event.

Time frame: Baseline up to month 24

Population: ITT analysis set

ArmMeasureValue (MEDIAN)
Avacincaptad PegolTime to Persistent Vision Loss17.02 months
ShamTime to Persistent Vision Loss13.93 months
p-value: 0.642495% CI: [0.57, 1.42]Log Rank

Source: ClinicalTrials.gov · Data processed: Feb 10, 2026