Dim Light Vision Disturbances
Conditions
Keywords
Nyxol, Night Vision Disturbances, Glare, Halos, Starbursts
Brief summary
The objectives of this study are: * To evaluate the efficacy of Nyxol to improve mesopic low contrast visual acuity (mLCVA) in subjects with Dim Light Vision Disturbances (DLD) * To evaluate efficacy of Nyxol to improve visual performance * To evaluate the safety of Nyxol
Detailed description
Placebo-controlled, double-masked, multiple-dose, Phase 3 study in approximately 160 randomized subjects with DLD (approximately 136 that are evaluable for efficacy), evaluating safety and efficacy of Nyxol in subjects with DLD following administration of Nyxol once daily (QD) at or near bedtime (at 8PM to 10PM) in both eyes (OU) for 14 days. Following the successful completion of screening, each subject will be stratified by iris color (light/dark irides) and will then be randomized to treatment (masked) 1:1, Nyxol or placebo (vehicle). Treatment (Nyxol or placebo) will be administered in both eyes (OU) by the subjects at or near bedtime each day. At the first visit subjects will be screened for study eligibility. Treatment visits will occur 2 times: Day 8 (+1 day)/Visit 2 and Day 15 (+1 day)/Visit 3. mLCVA evaluations shall be performed on each of these days. A follow-up visit (Visit 4) phone call will occur 1 to 3 days after Visit 3. At select sites OPD Scan measurements will be made using wavefront abhermettry.
Interventions
0.75% phentolamine ophthalmic solution (Nyxol), a non-selective alpha-1 and alpha-2 adrenergic antagonist
Topical sterile ophthalmic solution
Sponsors
Ocuphire Pharma, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
All subjects will be randomized into the study in a 1:1 ratio to one of the treatment arms (Nyxol or placebo), with a stratification by light/dark irides.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Males or females ≥ 18 years of age 2. Subject-reported DLD (likely subjects with a history of multifocal IOLs, post-laser-assisted in situ keratomileusis \[LASIK\], corneal scars, and keratoconus) 3. Ability to comply with all protocol-mandated procedures independently and to attend all 4. Otherwise healthy and well-controlled subjects 5. Able and willing to give written consent to participate in this study 6. Able to self-administer study medication 7. PD ≥ 6 mm under mesopic conditions (prior to illumination) in at least one eye 8. ≤ 20 (20/100 Snellen or worse) ETDRS letters in mLCVA score 9. ≥10 ETDRS letters ( ≥2 lines) improvement in mLCVA in at least one eye during illumination of the contralateral eye with a BAT system on low setting
Exclusion criteria
Ophthalmic: 1. Prior history of dry eye diagnosis, taking prescription drops for dry eye, or taking artificial tear drops occasionally for dry eye 2. Prior history of fluctuating vision 3. Clinically significant ocular disease as deemed by the Investigator that might interfere with the study 4. Known hypersensitivity to any topical alpha-adrenoceptor antagonists 5. Known allergy or contraindication to any component of the vehicle formulation 6. History of cauterization of the punctum or punctal plug (silicone or collagen) insertion or removal 7. Ocular trauma, ocular surgery (e.g., IOLs) or laser procedure (e.g., LASIK, photorefractive keratectomy \[PRK\]) within 6 months prior to screening 8. Use of any topical prescription or over-the-counter (OTC) ophthalmic medications of any kind within 7 days of screening 9. Recent or current evidence of ocular infection or inflammation in either eye. Subjects must be symptom free for at least 7 days. 10. History of diabetic retinopathy, diabetic macular edema, or dry or wet macular degeneration 11. History of any traumatic (surgical or nonsurgical) or nontraumatic condition affecting the pupil or iris 12. Unwilling or unable to discontinue use of contact lenses at screening until study completion, except for keratoconus subjects who may wear contacts up to 24 hours prior to their scheduled visits Systemic: 1. Known hypersensitivity or contraindication to alpha- and/or beta-adrenoceptor antagonists 2. Clinically significant systemic disease that might interfere with the study 3. Initiation of treatment with or any changes to the current dosage, drug, or regimen of any systemic adrenergic or cholinergic drugs within 7 days prior to screening or during the study 4. Participation in any investigational study within 30 days prior to screening and during the conduct of the study 5. Females of childbearing potential who are pregnant, nursing, planning a pregnancy, or not using a medically acceptable form of birth control 6. Resting HR outside the specified range (50-110 beats per minute) 7. Hypertension with resting diastolic BP \> 105 mmHg or systolic BP \> 160 mmHg
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Subjects With 3 Lines mLCVA Improvement in Study Eye | 8 days | Percent of subjects with ≥ 15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (≥3 lines) of improvement in the study eye compared to baseline in monocular mLCVA at Day 8 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Subjects With mLCVA Improvement in Study Eye | up to 15 days | Percent of subjects with ≥ 5, ≥ 10, and ≥ 15 ETDRS letters (≥ 1, ≥ 2, and ≥ 3 lines, respectively) improvement compared to baseline in mLCVA at Day 8 (excluding the primary endpoint) |
| Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | up to 15 days | Percent of subjects with ≥ 5, ≥ 10, and ≥ 15 ETDRS letters (≥ 1, ≥ 2, and ≥ 3 lines, respectively) improvement compared to baseline in pLCVA and mHCVA at Day 8 and Day 15 |
| Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | up to 15 days | Change from baseline in study eye mesopic PD |
| Percent Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | up to 15 days | Percent change from baseline in study eye mesopic PD |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Phentolamine Ophthalmic Solution 0.75% One drop in both eyes at or near bedtime (8PM to 10PM)
Phentolamine Ophthalmic Solution 0.75%: 0.75% phentolamine ophthalmic solution (Nyxol), a non-selective alpha-1 and alpha-2 adrenergic antagonist | 70 |
| Phentolamine Ophthalmic Solution Vehicle One drop in both eyes at or near bedtime (8PM to 10PM)
Phentolamine Ophthalmic Solution Vehicle (Placebo): Topical sterile ophthalmic solution | 73 |
| Total | 143 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | Phentolamine Ophthalmic Solution 0.75% | Total | Phentolamine Ophthalmic Solution Vehicle |
|---|---|---|---|
| Age, Continuous | 47 years STANDARD_DEVIATION 14.14 | 46.2 years STANDARD_DEVIATION 14.24 | 45.4 years STANDARD_DEVIATION 14.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 3 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 8 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) White | 66 Participants | 130 Participants | 64 Participants |
| Region of Enrollment United States | 70 Participants | 143 Participants | 73 Participants |
| Sex: Female, Male Female | 61 Participants | 120 Participants | 59 Participants |
| Sex: Female, Male Male | 9 Participants | 23 Participants | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 71 | 0 / 73 |
| other Total, other adverse events | 23 / 71 | 2 / 73 |
| serious Total, serious adverse events | 0 / 71 | 0 / 73 |
Outcome results
Primary
Percent of Subjects With 3 Lines mLCVA Improvement in Study Eye
Percent of subjects with ≥ 15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (≥3 lines) of improvement in the study eye compared to baseline in monocular mLCVA at Day 8
Time frame: 8 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With 3 Lines mLCVA Improvement in Study Eye | 9 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With 3 Lines mLCVA Improvement in Study Eye | 2 Participants |
Secondary
Change From Baseline in Study Eye Mesopic Pupil Diameter (PD)
Change from baseline in study eye mesopic PD
Time frame: up to 15 days
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Phentolamine Ophthalmic Solution 0.75% | Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 8 Days, Change from Baseline | -1.081 millimeters | Standard Deviation 0.6931 |
| Phentolamine Ophthalmic Solution 0.75% | Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 15 Days, Change from Baseline | -1.083 millimeters | Standard Deviation 0.6556 |
| Phentolamine Ophthalmic Solution Vehicle | Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 8 Days, Change from Baseline | -0.130 millimeters | Standard Deviation 0.5608 |
| Phentolamine Ophthalmic Solution Vehicle | Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 15 Days, Change from Baseline | -0.121 millimeters | Standard Deviation 0.4673 |
Secondary
Percent Change From Baseline in Study Eye Mesopic Pupil Diameter (PD)
Percent change from baseline in study eye mesopic PD
Time frame: up to 15 days
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Phentolamine Ophthalmic Solution 0.75% | Percent Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 8 Days, Percent Change from Baseline | -17.98 percentage of change | Standard Deviation 11.542 |
| Phentolamine Ophthalmic Solution 0.75% | Percent Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 15 Days, Percent Change from Baseline | -18.06 percentage of change | Standard Deviation 11.418 |
| Phentolamine Ophthalmic Solution Vehicle | Percent Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 8 Days, Percent Change from Baseline | -2.09 percentage of change | Standard Deviation 9.492 |
| Phentolamine Ophthalmic Solution Vehicle | Percent Change From Baseline in Study Eye Mesopic Pupil Diameter (PD) | 15 Days, Percent Change from Baseline | -1.75 percentage of change | Standard Deviation 7.581 |
Secondary
Percent of Subjects With mLCVA Improvement in Study Eye
Percent of subjects with ≥ 5, ≥ 10, and ≥ 15 ETDRS letters (≥ 1, ≥ 2, and ≥ 3 lines, respectively) improvement compared to baseline in mLCVA at Day 8 (excluding the primary endpoint)
Time frame: up to 15 days
Population: miTT
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | >= 15 letters | 9 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | 10-14 letters | 20 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | 5-9 letters | 22 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | Less than 5 | 19 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | >= 15 letters | 14 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | 10-14 letters | 16 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | 5-9 letters | 28 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | Less than 5 | 10 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | Less than 5 | 17 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | >= 15 letters | 2 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | >= 15 letters | 2 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | 10-14 letters | 14 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | 5-9 letters | 39 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | 5-9 letters | 29 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 15 | 10-14 letters | 15 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With mLCVA Improvement in Study Eye | Day 8 | Less than 5 | 28 Participants |
Secondary
Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye
Percent of subjects with ≥ 5, ≥ 10, and ≥ 15 ETDRS letters (≥ 1, ≥ 2, and ≥ 3 lines, respectively) improvement compared to baseline in pLCVA and mHCVA at Day 8 and Day 15
Time frame: up to 15 days
Population: per-protocol(PP)
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | 5-9 letters | 24 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | Less than 5 letters | 29 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | >= 15 letters | 7 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | 10-14 letters | 12 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | 5-9 letters | 22 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | Less than 5 letters | 23 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | >= 15 letters | 2 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | 10-14 letters | 5 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | 5-9 letters | 16 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | Less than 5 letters | 45 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | >= 15 letters | 3 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | 10-14 letters | 8 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | 5-9 letters | 19 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | Less than 5 letters | 34 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | >= 15 letters | 3 Participants |
| Phentolamine Ophthalmic Solution 0.75% | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | 10-14 letters | 12 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | 10-14 letters | 9 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | 5-9 letters | 11 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | 5-9 letters | 11 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | Less than 5 letters | 53 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | 5-9 letters | 14 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | >= 15 letters | 1 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | Less than 5 letters | 56 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | 10-14 letters | 4 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 8 | >= 15 letters | 0 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | 5-9 letters | 20 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | >= 15 letters | 5 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | pLVCA Day 15 | Less than 5 letters | 46 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | Less than 5 letters | 51 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | >= 15 letters | 3 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 15 | 10-14 letters | 1 Participants |
| Phentolamine Ophthalmic Solution Vehicle | Percent of Subjects With Photopic Low Contrast Visual Acuity (pLCVA) and mHCVA Improvement in Study Eye | mHCVA Day 8 | 10-14 letters | 3 Participants |