Tatsuro Ishibashi1, Xiaoxin Li2, Adrian Koh3, Timothy Y Y Lai4, Fenq-Lih Lee5, Won-Ki Lee6, Zhizhong Ma7, Masahito Ohji8, Nikolle Tan9, Sung Bok Cha10, Jila Shamsazar10, C Lillian Yau10. 1. Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan. 2. Peking University People's Hospital, Beijing, China. Electronic address: dr_lixiaoxin@163.com. 3. Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Republic of Singapore. 4. Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China. 5. Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. 6. Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea. 7. Peking University Third Hospital, Beijing, China. 8. Shiga University of Medical Science Hospital, Ohtsu, Japan. 9. Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Republic of Singapore; National Healthcare Group Eye Institute, Singapore, Republic of Singapore. 10. Novartis Pharma AG, Basel, Switzerland.
Abstract
OBJECTIVE: The primary study hypothesis was that ranibizumab 0.5 mg monotherapy or combined with laser is superior to laser monotherapy based on mean average change in best-corrected visual acuity (BCVA) over 12 months in Asian patients with visual impairment resulting from diabetic macular edema (DME). DESIGN: A 12-month, randomized, double-masked, multicenter, laser-controlled, phase III study. PARTICIPANTS: Three hundred ninety-six patients aged ≥18 years, with type 1 or 2 diabetes mellitus, BCVA of 78-39 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and visual impairment resulting from DME. METHODS: Patients were randomized to ranibizumab + sham laser (n = 133), ranibizumab + active laser (n = 132), or sham injection + active laser (n = 131). Ranibizumab/sham injections were administered on day 1 and continued monthly. As of month 3, monthly injections were continued if stable vision was not reached. Treatment was reinitiated if BCVA decreased because of DME progression. Active/sham laser was administered on day 1 and thereafter according to ETDRS guidelines. MAIN OUTCOME MEASURES: Average change in BCVA from baseline to months 1 through 12, central retinal subfield thickness (CRST), and safety over 12 months. RESULTS:Ranibizumab monotherapy or combined with laser was superior to laser in improving mean average change in BCVA from baseline to months 1 through 12 (+5.9 and +5.7 vs +1.4 letters). At month 12, greater proportion of patients gained ≥15 letters with ranibizumab and ranibizumab + laser compared with laser (18.8% and 17.8% vs 7.8%). Mean CRST reduced significantly from baseline to month 12 with ranibizumab (-134.6 μm) and ranibizumab + laser (-171.8 μm) versus laser (-57.2 μm). Patients received a mean of 7.8 and 7.0 ranibizumab injections in the ranibizumab and ranibizumab + laser arms, respectively, and 1.5-1.9 active laser across treatment arms over 12 months. Conjunctival hemorrhage was the most common ocular, whereas nasopharyngitis and hypertension were the most common nonocular adverse events. Ranibizumab was not associated with any cases of cerebrovascular hemorrhage and cerebrovascular ischemia. No death related to study treatment was reported. CONCLUSIONS:Ranibizumab monotherapy or combined with laser showed superior BCVA improvements over laser treatment alone in Asian patients with visual impairment resulting from DME. No new ocular or nonocular safety findings were observed and treatment was well tolerated over 12 months.
RCT Entities:
OBJECTIVE: The primary study hypothesis was that ranibizumab 0.5 mg monotherapy or combined with laser is superior to laser monotherapy based on mean average change in best-corrected visual acuity (BCVA) over 12 months in Asian patients with visual impairment resulting from diabetic macular edema (DME). DESIGN: A 12-month, randomized, double-masked, multicenter, laser-controlled, phase III study. PARTICIPANTS: Three hundred ninety-six patients aged ≥18 years, with type 1 or 2 diabetes mellitus, BCVA of 78-39 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and visual impairment resulting from DME. METHODS:Patients were randomized to ranibizumab + sham laser (n = 133), ranibizumab + active laser (n = 132), or sham injection + active laser (n = 131). Ranibizumab/sham injections were administered on day 1 and continued monthly. As of month 3, monthly injections were continued if stable vision was not reached. Treatment was reinitiated if BCVA decreased because of DME progression. Active/sham laser was administered on day 1 and thereafter according to ETDRS guidelines. MAIN OUTCOME MEASURES: Average change in BCVA from baseline to months 1 through 12, central retinal subfield thickness (CRST), and safety over 12 months. RESULTS:Ranibizumab monotherapy or combined with laser was superior to laser in improving mean average change in BCVA from baseline to months 1 through 12 (+5.9 and +5.7 vs +1.4 letters). At month 12, greater proportion of patients gained ≥15 letters with ranibizumab and ranibizumab + laser compared with laser (18.8% and 17.8% vs 7.8%). Mean CRST reduced significantly from baseline to month 12 with ranibizumab (-134.6 μm) and ranibizumab + laser (-171.8 μm) versus laser (-57.2 μm). Patients received a mean of 7.8 and 7.0 ranibizumab injections in the ranibizumab and ranibizumab + laser arms, respectively, and 1.5-1.9 active laser across treatment arms over 12 months. Conjunctival hemorrhage was the most common ocular, whereas nasopharyngitis and hypertension were the most common nonocular adverse events. Ranibizumab was not associated with any cases of cerebrovascular hemorrhage and cerebrovascular ischemia. No death related to study treatment was reported. CONCLUSIONS:Ranibizumab monotherapy or combined with laser showed superior BCVA improvements over laser treatment alone in Asian patients with visual impairment resulting from DME. No new ocular or nonocular safety findings were observed and treatment was well tolerated over 12 months.
Authors: Philipp K Roberts; Wolf-Dieter Vogl; Bianca S Gerendas; Adam R Glassman; Hrvoje Bogunovic; Lee M Jampol; Ursula M Schmidt-Erfurth Journal: JAMA Ophthalmol Date: 2020-09-01 Impact factor: 7.389
Authors: Marco A Zarbin; Cornelia Dunger-Baldauf; Zdenka Haskova; Prashil Koovejee; Marie-Catherine Mousseau; Philippe Margaron; Howard Snow; Paul E Beaumont; Giovanni Staurenghi; Steven Francom Journal: JAMA Ophthalmol Date: 2017-05-01 Impact factor: 7.389