Title

A Randomized, Multi-center, Phase II Study of the Safety, Tolerability and Bioactivity of Repeated Intravitreal Injections of iCo-007 as Monotherapy or in Combination With Ranibizumab or Laser Photocoagulation in the Treatment of Diabetic Macular Edema (the iDEAL Study)
A Randomized, Multi-center, Phase II Study of the Safety, Tolerability, and Bioactivity of Repeated Intravitreal Injections of iCo-007 as Monotherapy or in Combination With Ranibizumab or Laser Photocoagulation in the Treatment of Diabetic Macular Edema With Involvement of the FoveAL Center (the iDEAL Study)
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Intervention/Treatment

    ranibizumab ico-007 ...
  • Study Participants

    185
To assess the safety of repeated iCo-007 intravitreal injections in treatment of subjects with diabetic macular edema as monotherapy and in combination with ranibizumab or laser photocoagulation
To assess the change in visual acuity and retinal thickness on optical coherence tomography (OCT) from baseline to month 8 and month 12
Study Started
Feb 29
2012
Primary Completion
Feb 28
2014
Study Completion
Oct 31
2014
Results Posted
Aug 30
2017
Last Update
Aug 30
2017

Drug iCo-007 350 mcg

iCo-007 (350 μg) as an intravitreal injection at baseline followed by another iCo-007 dose (350 μg) at month 4

  • Other names: Group 1

Drug iCo-007 700 mcg

iCo-007 (700 μg) as an intravitreal injection at baseline followed by another iCo-007 dose (700 μg) at month 4

  • Other names: Group 2

Drug iCo-007 350 mcg and Laser

iCo-007 (350 μg) as an intravitreal injection at baseline followed 7 days later by laser photocoagulation. At M4, intravitreal injection of iCo-007 (350 μg) will be given as mandatory treatment. If the eye also meets retreatment criteria, it will also receive the second laser photocoagulation

  • Other names: Group 3

Drug Ranibizumab and iCo-007 350 mcg

Ranibizumab (0.5 mg) intravitreal injection at baseline followed by iCo-007 (350 μg) intravitreal injection 2 weeks later; re-treatment with ranibizumab (0.5 mg) mandatory at M4 followed by iCo-007 (350 μg) 2 weeks later

  • Other names: Group 4

Group 1 Experimental

Drug: iCo-007 350 mcg iCo-007 (350 μg) as an intravitreal injection at baseline followed by another iCo-007 dose (350 μg) at month 4

Group 2 Experimental

Drug: iCo-007 700 mcg iCo-007 (700 μg) as an intravitreal injection at baseline followed by another iCo-007 dose (700 μg) at month 4

Group 3 Experimental

Drug: iCo-007 350 mcg and Laser iCo-007 (350 μg) as an intravitreal injection at baseline followed 7 days later by laser photocoagulation. At M4, intravitreal injection of iCo-007 (350 μg) will be given as mandatory treatment. If the eye also meets retreatment criteria, it will also receive the second laser photocoagulation

Group 4 Experimental

Drug: Ranibizumab and iCo-007 350 mcg Ranibizumab (0.5 mg) intravitreal injection at baseline followed by iCo-007 (350 μg) intravitreal injection 2 weeks later; re-treatment with ranibizumab (0.5 mg) mandatory at M4 followed by iCo-007 (350 μg) 2 weeks later

Criteria

Inclusion Criteria:

Age ≥18 years
Have diabetes mellitus type I or II (insulin or non-insulin dependent) with HbA1c ≥5.5% and HbA1c ≤13%; have non-proliferative diabetic retinopathy, or inactive proliferative diabetic retinopathy, or proliferative diabetic retinopathy with a reasonable expectation that panretinal photocoagulation will not be required during the study follow-up period
Have diabetic macular edema with central subfield thickness of ≥250 microns (confirmed by Stratus Time-Domain(TD) OCT

Have best corrected visual acuity (ETDRS) that is Snellen equivalent of

20/32 and ≥20/320, inclusive
Be willing and able to sign an approved written informed consent. If a patient has a central nervous system disorder (i.e. dementia) that will not allow him/her to understand the consent independently, the patient will not be allowed to join the study
Be able to attend all scheduled study visits
Women who are not lactating or pregnant and are willing to use adequate contraception during the study period, if appropriate

Exclusion Criteria:

Have macular or perimacular edema secondary to an etiology other than diabetes
Have concurrent retinal diseases other than diabetic retinopathy
Have additional ocular diseases compromising visual acuity and/or interfering with study assessments; patients who have glaucoma but deemed stable (intraocular pressure ≤ 25 mmHg at screening) on medications or status post surgery, may participate in the study
Participant has a history of prior pars plana vitrectomy
Subjects with significant cataract or or posterior capsular opacification that may need intervention within one year or vitreous opacity that hinder study assessment (i.e.fundus examination) which requires intervention within a year
Subjects who have DME with severe capillary non-perfusion (avascular zone diameter >1,000 microns)
Have an allergy to fluorescein dye
Have terminal renal disease (on active kidney dialysis), cerebral vascular accident(including TIA), myocardial infarction or congestive heart disease within 6 months of study enrollment, liver damage (2x upper limit of normal range for aspartate aminotransferase (AST), Alanine aminotransferase (ALT) or total bilirubin). Patients who may have received renal transplant in the past and now have stable renal function, may participate in the study
Subjects with systolic blood pressure higher than 180 mm Hg or diastolic above 100 mm Hg, with or without anti-hypertensive treatment
Have a history of panretinal photocoagulation (PRP) in the study eye within 3 months of study entry or are likely to have PRP in the study eye during study participation
Had macular photocoagulation or ocular surgery within 3 months of study entry in the study eye
Received intraocular or periocular injection of steroids in the study eye (e.g., triamcinolone) within 3 months of study entry or anti-angiogenic drugs (pegaptanib sodium, ranibizumab, bevacizumab, VEGF-TRAP, protein kinase C inhibitor, etc.) within 2 months of study entry; history of usage of topical or systemic steroids within 3 months of study entry is not an exclusion

Summary

Group 1

Group 2

Group 3

Group 4

All Events

Event Type Organ System Event Term Group 1 Group 2 Group 3 Group 4

Change in VA From Baseline to Month 8

The primary efficacy variable is the change in visual acuity (mean change in number of letters) from baseline to month 8

Group 1

-12.07
Letters (Mean)
Standard Deviation: 18.20

Group 2

-24.46
Letters (Mean)
Standard Deviation: 24.02

Group 3

-15.22
Letters (Mean)
Standard Deviation: 24.62

Group 4

-18.28
Letters (Mean)
Standard Deviation: 30.45

Change in Retinal Thickness Measured

measured by OCT

iCo-007 350 mcg

iCo-007 700 mcg

iCo-007 350 mcg and Laser

Ranibizumab and iCo-007 350 mcg

Duration of iCo-007 Treatment Effect

treatment effect as measured by VA and OCY thickness

iCo-007 350 mcg

iCo-007 700 mcg

iCo-007 350 mcg and Laser

Ranibizumab and iCo-007 350 mcg

Change in Retinal Thickness Measured by OCT From Baseline to Month 8

Group 1

Group 1

-70.68
microns (Mean)
Standard Deviation: 176.31

Group 2

-160.22
microns (Mean)
Standard Deviation: 177.36

Group 3

-54.17
microns (Mean)
Standard Deviation: 125.35

Group 4

-92.1
microns (Mean)
Standard Deviation: 185.49

Number of Participants in a Given Study Arm Experiencing the Same Drug-related Serious Adverse Event as a Measure of Safety and Tolerability

Safety of repeated iCo-007 intravitreal injections in treatment of subjects with Diabetic Macular Edema (DME) as monotherapy and in combination with ranibizumab or laser photocoagulation. Serious consideration will be given if 2 or more patients in a particular treatment arm experience the same drug-related serious adverse event;

Group 1

Group 2

Group 3

Group 4

Change in VA From Baseline to Month 12

The primary efficacy variable is the change in visual acuity (mean change in number of letters) from baseline to month 12

iCo-007 350 mcg

iCo-007 700 mcg

iCo-007 350 mcg and Laser

Ranibizumab and iCo-007 350 mcg

Peak Plasma Concentration (Cmax)of iCo-007 After Multiple Injections

cmax

iCo-007 350 mcg

iCo-007 700 mcg

iCo-007 350 mcg and Laser

Ranibizumab and iCo-007 350 mcg

Total

185
Participants

Age, Continuous

62.2
years (Mean)
Standard Deviation: 8.95

Baseline Best Corrected Visual Acuity (BCVA)

59.3
Letters (Mean)
Standard Deviation: 13.15

Sex: Female, Male

Overall Study

iCo-007 350 mcg

iCo-007 700 mcg

iCo-007 350 mcg and Laser

Ranibizumab and iCo-007 350 mcg

Drop/Withdrawal Reasons

iCo-007 350 mcg

iCo-007 700 mcg

iCo-007 350 mcg and Laser

Ranibizumab and iCo-007 350 mcg