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MMP-9 Inhibition for Recalcitrant Wet AMD

Sponsor
University of Iowa (Other)
Overall Status
Recruiting
CT.gov ID
NCT04504123
Collaborator
(none)
50
Enrollment
1
Location
2
Arms
39.9
Anticipated Duration (Months)
1.3
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Wet (or neovascular) form of age-related macular degeneration (wAMD) is the most common cause of blindness in the Western world. Currently, anti-vascular endothelial growth factor (VEGF) intravitreal injections (IVI) remain the standard-of-care treatment for wAMD. Previous studies show that about 90% of treated patients lose minimal visual function after 2 years of follow-up. There is still, a subset of 15% patients, incomplete responders, that do not improve and possibly worsen due to the persistence of sub-retinal fluid (with or without intra-retinal fluid) with chronic treatment.

The investigators plan to evaluate the effect of oral doxycycline versus placebo on the anatomic and functional outcomes in persistent sub-retinal eye fluid in neovascular wet age-related macular degeneration. This subset are incomplete or non-responders to current anti-VEGF intravitreal therapy.

Condition or Disease Intervention/Treatment Phase
  • Drug: Doxycycline Hyclate
  • Drug: Placebo
 Phase 2

Detailed Description

The investigators plan to conduct a double masked, randomized study to assess the effect of low dose, oral doxycycline 50 mg once a day versus placebo in patients with wet age-related macular degeneration who are incomplete responders to anti-VEGF extended treatment regimens.

The study will be conducted over 9 months with every 3 month assessments; 6 months administration period of doxycycline versus placebo (double masked, randomized) and a 3 month follow up period. The participant visits will occur during clinic visits for standard-of-care intravitreal injections (IVI).

Medical information will be acquired from the standard of care optical coherence tomography (OCT), visual acuity (VA), and IVI administered (number, frequency and type of drug).

Blood plasma and aqueous fluid (anterior chamber tap) samples and study drug tolerability will be obtained at baseline, 6 months and 9 months. Plasma will be obtained to assay for inflammatory markers: MMP-9 levels and questionnaires will be obtained on 1) vision quality of life, and 2) study drug tolerance at Baseline, 6 months and 9 months.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
50 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Intervention Model Description:
Doxycycline Hyclate 50 mg versus placebo capsuleDoxycycline Hyclate 50 mg versus placebo capsule
Masking:
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description:
Over encapsulation with opaque purple capsule
Primary Purpose:
Treatment
Official Title:
MMP-9 Inhibition for Recalcitrant Wet Age-Related Macular Degeneration (AMD)
Actual Study Start Date :
Nov 4, 2020
Anticipated Primary Completion Date :
Dec 31, 2023
Anticipated Study Completion Date :
Mar 1, 2024

Arms and Interventions

Arm Intervention/Treatment
Experimental: Doxycycline

Participants received doxycycline hyclate 50 mg capsule orally once a day for 6 months

Drug: Doxycycline Hyclate
Doxycycline Hyclate capsules, USP 50 mg
Other Names:
  • Antibiotic - tetracycline compound

    		•
    Placebo Comparator: Placebo

    Participants received placebo (inactive) capsule orally once a day for 6 months

    Drug: Placebo
    Placebo
    Other Names:
  • Inactive substance

    		•

    Outcome Measures

    Primary Outcome Measures

    1. Resolution of the persistent retinal fluid on optical coherence tomography (OCT) [9 months]

      percentage of patients with retinal fluid-free status

    Secondary Outcome Measures

    1. Change in optical coherence tomography (OCT) central media thickness (CMT) [9 months compared to baseline]

      mean change in central media thickness

    2. Change in best corrected visual acuity (BCVA) [6 months and 9 months compared to Baseline]

      mean change in logMAR / percentage of patients with a gain or loss of more than 5 ETDRS letters

    3. Number of intravitreal injections (IVI) administered [6 months and 9 months]

      total number of anti-VEGF intravitreal injections

    4. Inflammatory mediators matrix metalloproteinases MMP-9 and MMP-9 activity [Baseline, 6 months and 9 months]

      anterior eye aqueous fluid and blood plasma

    Other Outcome Measures

    1. Ocular Adverse Events [Baseline to 9 months]

      intra-ocular pressure elevation ( more than 10 mmHg) requiring topical ocular hypertensive medications, endophthalmitis, retinal tear and detachment, uveitis, and thromboembolic events will be recorded

    2. Systemic Adverse Events [Baseline to 9 months]

      Allergy or hypersensitivity drug reactions

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    50 Years to 99 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:

    • Wet age-related macular degeneration (wAMD);

    • Solely treated with anti-VEGF IVI for active CNV due to wAMD. However, enrolled patients can have other retinal pathologies such as diabetic retinopathy or vein occlusion for which they are not being treated with anti-VEGF IVI;

    • Must have persistent sub-retinal with or without intra-retinal fluid due to active CNV from wAMD despite receiving at least three consecutive injections with any anti-VEGF agent;

    • Must not have encountered previous side effects from tetracycline medications.

    Exclusion Criteria - Ocular:

    • History of uveitis (including endophthalmitis) or presence of intraocular inflammation;

    • Presence of significant epiretinal membrane or macular hole causing distortion of macular anatomy;

    • Presence of media opacity preventing discerning of fluid on OCT;

    • Any prior ophthalmic surgery (including YAG or retinal laser) within the previous 3 months or anticipated need for any ophthalmic surgery (including cataract extraction) for 9 months following randomization;

    • History of peribulbar corticosteroid injection to the studied eye or the fellow eye within the past 6 months;

    • History of intravitreal triamcinolone acetonide injection to the studied eye within the past 4 months;

    • An ocular condition (other than AMD) is present in the studied eye that, in the opinion of the investigator, might alter visual acuity during the course of the study (e.g., retinal vein occlusion, uveitis or other ocular inflammatory disease, neovascular glaucoma, and Irvine-Gass syndrome);

    • CNV due to causes other than wAMD;

    • Inability to follow up at the 6th and 9th months time points after recruitment;

    • Missing two or more consecutive injections during the six months treatment period;

    • Patient requiring imminent need for IVI anti-VEGF medication switch or another treatment intervention, such as photodynamic therapy, during the 9 months trial period;

    • Presence of fluid associated with geographic atrophy or disciform scar;

    • Any patient with sub-retinal and/or intra-retinal fluid that is not due to CNV (eg, overlying areas of geographic atrophy;

    • Any patient actively being actively treated for Irvine-Gass Syndrome.

    Exclusion Criteria - Systemic:

    • Patient with and/or who developed an unstable medical status (e.g., glycemic control, blood pressure, cardiovascular disease, individuals who are unlikely or unable to complete the 9 months trial period) in the opinion of the investigator;

    • Significant renal disease (defined as a serum creatinine >2.5 mg/dL);

    • Systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg;

    • History of headaches associated with tetracycline therapy

    • History of pseudotumor cerebri;

    • History of tetracycline therapy within the past 6 months;

    • Pregnancy or patient intending to become pregnant within the 9 months of the trial period. For women of child-bearing potential, a pregnancy test will be performed;

    • Sexually active women of child-bearing potential not actively practicing birth control by using a medically accepted device or therapy (i.e., intrauterine device, hormonal contraceptive, or barrier device) during the study period (at least 24 months). This is important as doxycycline may interfere with the effectiveness of hormonal contraceptives. Hence, sexually active women of child-bearing potential who use a hormonal contraceptive will be required to use a second form of contraception to safeguard against contraceptive failure while participating in the study;

    • Known allergy/intolerance to doxycycline, tetracyclines, or any ingredient in the study drug or placebo;

    • Patients receiving phenytoin, barbiturates, carbamazepine, digoxin, or isotretinoin; patients with gastroparesis; patients with a history of gastrectomy, gastric bypass surgery, or otherwise deemed achlorhydric should all be excluded due to altered doxycycline pharmacokinetics and/or bioavailability;

    • Patients taking strontium, acitretin, or tretinoin should excluded due to the potential for serious interactions with doxycycline;

    • Patients with abnormal ALT or AST at baseline will be referred to their primary care physician for medical clearance for participation in this study.

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 University of Iowa Hospitals & Clinics Department of Ophthalmology & Visual Sciences Iowa City Iowa United States 52242

    Sponsors and Collaborators

    • University of Iowa

    Investigators

    • Principal Investigator: Elliott H Sohn, MD, University of Iowa

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    Responsible Party:
    Elliott Sohn, Associate Professor, University of Iowa
    ClinicalTrials.gov Identifier:
    NCT04504123
    Other Study ID Numbers:
    • 202001041
    First Posted:
    Aug 7, 2020
    Last Update Posted:
    Apr 7, 2022
    Last Verified:
    Apr 1, 2022
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Studies a U.S. FDA-regulated Drug Product:
    Yes
    Studies a U.S. FDA-regulated Device Product:
    No
    Product Manufactured in and Exported from the U.S.:
    Yes
    Keywords provided by Elliott Sohn, Associate Professor, University of Iowa
    Active choroidal neovascularization (CNV)
    Additional relevant MeSH terms:
    Macular Degeneration
    Wet Macular Degeneration
    Anti-Bacterial Agents
    Doxycycline
    Tetracycline

    Study Results

    No Results Posted as of Apr 7, 2022