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Sirolimus to Treat Geographic Atrophy Associated With Age-Related Macular Degeneration
This study is currently recruiting participants.
Verified by National Institutes of Health Clinical Center (CC), June 2008
Sponsored by: National Eye Institute (NEI)
Information provided by: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier: NCT00766649
  Purpose

This study will examine the safety and effectiveness of sirolimus in preserving vision in patients with geographic atrophy (GA) associated with age-related macular degeneration (AMD). The macula is the central part of the retina responsible for sharp vision needed for activities like reading, sewing and driving. In dry AMD, cells in the macula die. GA is the advanced form of dry AMD. Sirolimus helps prevent inflammation and may therefore help treat GA.

Patients 55 years of age or older with GA due to AMD in both eyes who have a visual acuity between 20/20 and 20/400 in each eye may be eligible for this study.

Participants receive a sirolimus injection in one eye (the study eye) every 3 months. To prepare for the injection, patients receive antibiotic and numbing eye drops, and the eye and the area around it is cleaned with an antiseptic. Patients return to the clinic for follow-up visits at 1 month and 2 months after the first injection, and then every 3 months for up to 2 years. At the 3-month visits, patients have the following tests and procedures:

  • Eye examination (with dilation) to measure visual acuity and eye pressure and to check eye movements.
  • Optical coherence tomography and photography to take regular photographs of the eye and special photographs that measure the thickness of various layers of the retina.
  • Autofluorescence imaging to help evaluate disease progression. For this test, the subject sits in a chair with the head placed in a chin rest in front of a camera. A light in the camera is used to scan the eye.
  • Blood tests.

Condition Intervention Phase
Age-Related Macular Degeneration
Drug: Sirolimus
Phase I
Phase II

Genetics Home Reference related topics: X-linked juvenile retinoschisis
MedlinePlus related topics: Macular Degeneration
Drug Information available for: Sirolimus
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Open Label, Placebo Control, Single Group Assignment, Safety/Efficacy Study
Official Title: Pilot Study of the Evaluation of Subconjunctival Sirolimus in the Treatment of Bilateral Geographic Atrophy Associated With Age-Related Macular Degeneration

Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • The rate of change in area of GA of fundus photography in the study eye and fellow eye at two years compared with baseline.

Secondary Outcome Measures:
  • Worsening of best-corrected visual acuity (BCVA) of three or more lines (15 or more letters), changes in area of GA as measured on autoflourescence, as well as changes in drusen area based on fundus photographs.

Estimated Enrollment: 15
Study Start Date: October 2008
Intervention Details:
    Drug: Sirolimus
    N/A
Detailed Description:

Objective:

Age-related macular degeneration (AMD), the leading cause of blindness in people over age 55 in the United States, is a heterogeneous clinical entity in which retinal degeneration occurs predominantly in the macula in the context of aging and leads to impairment of central visual acuity. AMD occurs in two general forms, one of which involves choroidal neovascularization (CNV) with subsequent formation of a disciform scar. This is often referred to as the neovascular or wet form. A second form, the subject of this study, is termed dry or atrophic macular degeneration and involves a constellation of clinical features that can include drusen, pigment clumping and/or retinal pigment epithelium (RPE) dropout and geographic atrophy (GA). GA can begin as a thinning of the RPE with involvement of the underlying choriocapillaris and lead subsequently to an atrophic change in the macula. Inflammation may play a role in the pathogenesis of GA. Sirolimus inhibits the production, signaling and activity of many inflammatory factors relevant to the development of GA. Therefore, the objective of this study is to investigate the safety and possible efficacy of multiple sirolimus subconjunctival injections in participants with bilateral GA.

Study Population:

Ten participants with bilateral GA associated with AMD, with the potential to replace up to five participants if some fail to reach one year of follow-up.

Design:

In this controlled, unmasked, Phase I/II study, one eye of eligible participants will be randomized to treatment while the fellow eye will be observed. Participants will receive a 20 micro liter (440 micro gram) subconjunctival injection of sirolimus in the study eye at baseline and every two months thereafter. The study will be completed once all partcipants have received two years of study medication and follow-up.

Outcome Measures:

The primary outcome is the rate of change in area of GA, based on masked grading by an external Reading Center, of fundus photography in the study eye and fellow eye at two years compared with baseline. Secondary outcomes will include worsening of best-corrected visual acuity (BCVA) of three or more lines (15 or more letters), changes in area of GA as measured on autofluorescence, changes in drusen volume as measured by optical coherence tomography, as well as changes in drusen area based on masked digital grading of fundus photographs. Safety outcomes will include the number and severity of systemic and ocular toxicities, adverse events and infections.

  Eligibility

Ages Eligible for Study:   55 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Participant must be 55 years of age or older.
  • Participant must understand and sign the protocol's informed consent document.
  • Participant must have at least 1/2 disc area (approximately 1 mm(2)) of GA compatible with AMD present in each eye. GA is defined as one or more well-defined, usually more or less circular patches of partial or complete de-pigmentation of the RPE, typically with exposure of underlying choroidal blood vessels. Even if much of the RPE appears to be preserved and large choroidal vessels are not visible, a round patch of RPE partial de-pigmentation may still be classified as early GA. The GA in each eye must be able to be photographed in their entirety and not contiguous with or within 1000 mico meter of any areas of peripapillary atrophy (PPA).
  • Participant must have large drusen (125 micro meter) in at least one eye.
  • Participant must have a steady fixation in both eyes in the foveal or parafoveal area and media clear enough for good quality photographs. This will permit randomization.
  • Participant must have visual acuity between 20/20 and 20/400 in each eye.
  • Female participants of childbearing potential must not be pregnant or breast-feeding, must have a negative pregnancy test at screening and must be willing to undergo urine pregnancy tests throughout the study.
  • Both female participants of childbearing potential and male participants able to father a child must agree to practice adequate birth control throughout the course of the study and for three months after their last sirolimus injection. Acceptable methods of birth control include hormonal contraception (birth control pills, injected hormones or vaginal ring), intrauterine device, barrier methods with spermicide (diaphragm with spermicide, condom and spermicide) or surgical sterilization (hysterectomy, tubal ligation or vasectomy in a partner).

EXCLUSION CRITERIA:

  • Participant is in another investigational study and actively receiving study therapy.
  • Participant is unable to comply with study procedures or follow-up visits.
  • Participant has evidence of ocular disease other than AMD in either eye that may confound the outcome of the study (e.g., diabetic retinopathy with 10 or more hemorrhages or microaneurysms, uveitis, pseudovitelliform macular degeneration, moderate/severe myopia, etc.).
  • Participant has a history of macular laser, photodynamic therapy (PDT), intravitreal injection of any agent (e.g., anti-VEGF, triamcinolone, etc.) or any previous treatment for AMD other than high-dose vitamin supplementation.
  • Participant has had a vitrectomy, penetrating keratoplasty or trabeculectomy.
  • Participant is expected to need ocular surgery during the course of the trial.
  • Participant has undergone lens removal in the last three months or YAG laser capsulotomy within the last month.
  • Participant is on chemotherapy.
  • Participant is on immunosuppressive medication.
  • Participant is on ocular or systemic medications known to be toxic to the lens, retina or optic nerve.
  • Participant with a history of malignancy that would compromise the 2-year study survival.
  • Participant with a history of ocular Herpes Simplex Virus.
  • A condition that, in the opinion of the investigator, would preclude participation in the study (e.g., unstable medical status including blood pressure and glycemic control).
  • History of cancer (other than a non-melanoma skin cancer) diagnosed within the past five years.
  • Laboratory values outside normal limits and considered clinically significant by the investigator.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00766649

Contacts
Contact: Patient Recruitment and Public Liaison Office (800) 411-1222 prpl@mail.cc.nih.gov
Contact: TTY 1-866-411-1010

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
  More Information

NIH Clinical Center Detailed Web Page  This link exits the ClinicalTrials.gov site

Publications:
Responsible Party: National Institutes of Health ( Catherine Meyerle, M.D./National Eye Institute )
Study ID Numbers: 090008, 09-EI-0008
Study First Received: October 3, 2008
Last Updated: December 24, 2008
ClinicalTrials.gov Identifier: NCT00766649  
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Age Related Macular Degeneration (AMD)
Geographic Atrophy
Sirolimus
Age-Related Macular Degeneration
AMD
Geographic Atrophy

Study placed in the following topic categories:
Sirolimus
Pathological Conditions, Anatomical
Clotrimazole
Miconazole
Eye Diseases
Tioconazole
Retinal Degeneration
Macular Degeneration
Atrophy
Retinal Diseases
Retinal degeneration

Additional relevant MeSH terms:
Anti-Bacterial Agents
Anti-Infective Agents
Immunologic Factors
Antineoplastic Agents
Antifungal Agents
Therapeutic Uses
Physiological Effects of Drugs
Antibiotics, Antineoplastic
Immunosuppressive Agents
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 16, 2009