ProgSTAR: A Natural History of the Progression of Stargardt Disease: Retrospective and Prospective Studies

Sponsor
Foundation Fighting Blindness (Other)
Overall Status
Completed
CT.gov ID
NCT01977846
Collaborator
United States Department of Defense (U.S. Fed)
259
9
42.1
28.8
0.7

Study Details

Study Description

Brief Summary

Stargardt disease is currently an incurable and untreatable macular dystrophy that causes severe visual loss in children and young adults, thereby causing enormous morbidity with economic, psychological, emotional, and social implications. There are no FDA approved therapeutic treatments for this disease. Therefore, the objective of this study is to collect natural history data from a large population of children and adults in order to evaluate possible efficacy measures for planned clinical trials.

Participants will be recruited from each Investigator's own patient population as the study requires the availability of both multiyear retrospective data, as well as ongoing prospectively collected data. A concurrent ancillary study (SMART study) is also being conducted with a subset of the prospective study patients during their regular ProgSTAR study visits to expand the collection of retinal images to include microperimetry measurements gathered under scotopic (low light) conditions.

Condition or Disease Intervention/Treatment Phase

    Study Design

    Study Type:
    Observational
    Actual Enrollment :
    259 participants
    Observational Model:
    Case-Only
    Time Perspective:
    Other
    Official Title:
    Natural History of Progression of Atrophy Secondary to Stargardt Disease: Retrospective, and Prospective Longitudinal Observational Study Incl. Ancillary SMART Study- Scotopic Microperimetric Assessment of Rod Function in Stargardt Disease
    Study Start Date :
    Aug 1, 2013
    Actual Primary Completion Date :
    Feb 1, 2017
    Actual Study Completion Date :
    Feb 1, 2017

    Outcome Measures

    Primary Outcome Measures

    1. Yearly Progression Rate of Atrophic Lesions Using Fundus Autofluorescence (FAF) Images [2-12 years]

      Yearly increase in area of decreased auto-fluorescence (DAF) which is defined as the sum of definite and questionable decreased auto-fluorescence

    Secondary Outcome Measures

    1. Yearly Rate of Loss of Retinal Sensitivity as Measured by Scotopic Microperimetry (MP) [2 years]

      The yearly rate of change in retinal sensitivity. Sensitivity tested with a Nidek MP-1 machine using a modified Humphrey 10-2 grid. The sensitivity was the average sensitivity from a 68-points test pattern (Prospective cohort only)

    2. Yearly Rate of Visual Acuity Loss [2-12 years]

      Yearly change of visual acuity. Visual acuity measures of best-corrected or presenting VA extracted from medical record charts. Prospective cohort is best-corrected visual acuity using Early-Treatment Diabetic Retinopathy study methods

    3. Difference in the Rate of Retinal Sensitivity Change Per Year Between Photopic and Scotopic Micro-perimetry Testing [2 years]

      Difference in the yearly rate of change in retinal sensitivity under photopic and scotopic conditions. Sensitivity tested with a Nidek MP-1. Scotopic sensitivity was obtained using a 40 points test pattern, and photopic sensitivity was obtained using a 68 points test pattern in a subset of Prospective cohort patients

    4. Yearly Rate of Loss of Overall Retinal Thickness [Participants followed at Baseline, 6 months, 12 months and 24 months]

      Yearly decrease of overall retinal thickness using spectral domain optical coherence tomography (SD-OCT) scans from a 20° x 20° scan area centered on the fovea. Data are only available for the Prospective cohort.

    5. Yearly Rate of Loss of Outer Ring Retinal Thickness [Participants followed at Baseline, 6 months, 12 months and 24 months]

      Yearly decrease of outer ring retinal thickness using SD-OCT scans from a 20° x 20° scan area centered on the fovea. Outer ring defined as ETDRS fields 1-4.

    6. Yearly Rate of Loss of the Inner Ring Retinal Thickness [Participants followed at Baseline, 6 months, 12 months and 24 months]

      Yearly decrease of the inner ring retinal thickness using SD-OCT scans from a 20° x 20° scan area centered on the fovea. Inner ring defined as ETDRS fields 5-8. Data are only available for the Prospective cohort.

    7. Yearly Rate of Loss of the Central Ring Retinal Thickness [Participants followed at Baseline, 6 months, 12 months and 24 months]

      Yearly decrease of the central ring retinal thickness using SD-OCT scans from a 20° x 20° scan area centered on the fovea. Central area defined as ETDRS fields 9. Data are only available for the Prospective cohort.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    6 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Provide a signed informed consent form and authorization allowing the disclosure and use of protected health information.

    • The designated primary study eye must have at least one well-demarcated area of atrophy as imaged by fundus autofluorescence with a minimum diameter of 300 microns and all lesions together must add to less than or equal to 12 mm2 (equivalent to no more than 5 disc areas in a least one eye) and a BCVA of 20 ETDRS letters (20/400 Snellen equivalent) or better.

    • Two (2) pathogenic mutations confirmed present, in the ABCA4 gene. If only one ABCA4 allele contains a pathogenic mutation, the patient shall have a typical Stargardt phenotype, namely at least one eye must have flecks at the level of the retinal pigment epithelium typical for STGD.

    • The primary study eye must have clear ocular media and adequate pupillary dilation to permit good quality fundus autofluorescence (FAF) and Spectral-Domain optical coherence tomography (sd-OCT) imaging in the opinion of the investigator.

    • Be able to cooperate in performing the examinations.

    • Be willing to undergo ocular examinations once every 6 months for up to 24 months.

    • Be at least six years old.

    • Both eyes can be included if inclusion criteria are fulfilled for both eyes.

    Exclusion Criteria:
    • Ocular disease, such as choroidal neovascularization, glaucoma and diabetic retinopathy, in either eye that may confound assessment of the retina morphologically and functionally.

    • Intraocular surgery in the primary study eye within 90 days prior to baseline visit.

    • Current or previous participation in an interventional study to treat STGD such as gene therapy or stem cell therapy. Current participation in a drug trial or previous participation in a drug trial within six months before enrollment. The use of oral supplements of vitamins and minerals are permitted although the current use of Vitamin A supplementation shall be documented.

    • The site Principal Investigator may declare any patient at their site ineligible to participate in the study for a sound medical reason prior to the patient's enrollment into the study.

    • Any systemic disease with a limited survival prognosis (e.g. cancer, severe/unstable cardiovascular disease).

    • Any condition that would interfere with the patient attending their regular follow-up visits every 6 months for up to 24 months, e.g. personality disorder, use of major tranquilizers such as Haldol or Phenothiazine, chronic alcoholism, Alzheimer's Disease or drug abuse.

    • Evidence of significant uncontrolled concomitant diseases such as cardiovascular, neurological, pulmonary, renal, hepatic, endocrine or gastro-intestinal disorders.

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Greater Baltimore Medical Center Baltimore Maryland United States 21204
    2 Wilmer Eye Institute, Johns Hopkins University Baltimore Maryland United States 21287
    3 Cole Eye Institute, Cleveland Clinic Cleveland Ohio United States 44195
    4 Scheie Eye Institute, University of Pennsylvania Philadelphia Pennsylvania United States 19104
    5 Retina Foundation of the Southwest Dallas Texas United States 75231
    6 Moran Eye Center, University of Utah Salt Lake City Utah United States 84132
    7 Institut de la Vision Paris France 75012
    8 Center for Ophthalmic Research, University of Teubingen Tübingen Germany 72076
    9 Moorfields Eye Hospital London United Kingdom EC1V 2PD

    Sponsors and Collaborators

    • Foundation Fighting Blindness
    • United States Department of Defense

    Investigators

    • Study Chair: Hendrik Scholl, MD, Wilmer Eye Institute at the Johns Hopkins University

    Study Documents (Full-Text)

    More Information

    Additional Information:

    Publications

    Responsible Party:
    Foundation Fighting Blindness
    ClinicalTrials.gov Identifier:
    NCT01977846
    Other Study ID Numbers:
    • FFBCRI-PROGSTAR-01/02
    First Posted:
    Nov 7, 2013
    Last Update Posted:
    Nov 1, 2019
    Last Verified:
    Jul 1, 2019
    Keywords provided by Foundation Fighting Blindness
    Additional relevant MeSH terms:

    Study Results

    Participant Flow

    Recruitment Details
    Pre-assignment Detail
    Arm/Group Title Retrospective Cohort Prospective Cohort
    Arm/Group Description Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participant's data are from clinical examinations and central reading center (RC) grading of retinal imaging (fundus auto-fluorescence, and spectral domain optical coherence tomography (OCT). Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participant's data are from standardized clinical examinations and central reading center (RC) grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT) and micro-perimetry (optional).
    Period Title: Total Study - Retrospective
    STARTED 251 0
    COMPLETED 251 0
    NOT COMPLETED 0 0
    Period Title: Total Study - Retrospective
    STARTED 0 259
    COMPLETED 0 230
    NOT COMPLETED 0 29

    Baseline Characteristics

    Arm/Group Title Retrospective Cohort Prospective Cohort Total
    Arm/Group Description Subjects with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Clinical data from multiple centers extracted from medical records. Participants were to have at least two visits with at least one of the study image modalities (fundus auto-fluorescence, micro-perimetry, or spectral domain optical coherence tomography (OCT)) Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participants were to have standardized visits at baseline and every 6 months for 24 months. Participant's data are from clinical examinations and central RC grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT)) and micro-perimetry. Total of all reporting groups
    Overall Participants 251 259 510
    Age (Count of Participants)
    <=18 years
    69
    27.5%
    51
    19.7%
    120
    23.5%
    Between 18 and 65 years
    179
    71.3%
    201
    77.6%
    380
    74.5%
    >=65 years
    3
    1.2%
    7
    2.7%
    10
    2%
    Sex: Female, Male (Count of Participants)
    Female
    149
    59.4%
    141
    54.4%
    290
    56.9%
    Male
    102
    40.6%
    118
    45.6%
    220
    43.1%
    Race/Ethnicity, Customized (Count of Participants)
    White/Middle Eastern
    174
    69.3%
    222
    85.7%
    396
    77.6%
    Black or African American
    14
    5.6%
    20
    7.7%
    34
    6.7%
    Asian/Indian
    10
    4%
    10
    3.9%
    20
    3.9%
    Other
    5
    2%
    1
    0.4%
    6
    1.2%
    More than one race
    2
    0.8%
    2
    0.8%
    4
    0.8%
    Don't know/missing
    46
    18.3%
    4
    1.5%
    50
    9.8%
    Region of Enrollment (participants) [Number]
    United States
    90
    35.9%
    137
    52.9%
    227
    44.5%
    United Kingdom
    79
    31.5%
    30
    11.6%
    109
    21.4%
    France
    49
    19.5%
    48
    18.5%
    97
    19%
    Germany
    33
    13.1%
    44
    17%
    77
    15.1%

    Outcome Measures

    1. Primary Outcome
    Title Yearly Progression Rate of Atrophic Lesions Using Fundus Autofluorescence (FAF) Images
    Description Yearly increase in area of decreased auto-fluorescence (DAF) which is defined as the sum of definite and questionable decreased auto-fluorescence
    Time Frame 2-12 years

    Outcome Measure Data

    Analysis Population Description
    Eyes of participants with at least 2 visits with gradable fundus auto-fluorescence images with atrophic lesions present
    Arm/Group Title Retrospective Cohort Prospective Cohort
    Arm/Group Description Subjects with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Clinical data from multiple centers extracted from medical records. Participants were to have at least two visits with at least one of the study image modalities (fundus auto-fluorescence, micro-perimetry, or spectral domain optical coherence tomography (OCT)) Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participants were to have standardized visits at baseline and every 6 months for 24 months. Participant's data are from clinical examinations and central RC grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT)) and micro-perimetry.
    Measure Participants 215 259
    Measure eyes 386 489
    Mean (95% Confidence Interval) [mm^2/year]
    0.35
    0.64
    2. Secondary Outcome
    Title Yearly Rate of Loss of Retinal Sensitivity as Measured by Scotopic Microperimetry (MP)
    Description The yearly rate of change in retinal sensitivity. Sensitivity tested with a Nidek MP-1 machine using a modified Humphrey 10-2 grid. The sensitivity was the average sensitivity from a 68-points test pattern (Prospective cohort only)
    Time Frame 2 years

    Outcome Measure Data

    Analysis Population Description
    Microperimetry data are available for only the Prospective cohort at centers with required equipment
    Arm/Group Title Retrospective Cohort Prospective Cohort
    Arm/Group Description Subjects with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Clinical data from multiple centers extracted from medical records. Participants were to have at least two visits with at least one of the study image modalities (fundus auto-fluorescence, micro-perimetry, or spectral domain optical coherence tomography (OCT)) Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participants were to have standardized visits at baseline and every 6 months for 24 months. Participant's data are from clinical examinations and central RC grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT)) and micro-perimetry.
    Measure Participants 0 238
    Measure eyes 0 449
    Mean (95% Confidence Interval) [dB/year]
    -0.76
    3. Secondary Outcome
    Title Yearly Rate of Visual Acuity Loss
    Description Yearly change of visual acuity. Visual acuity measures of best-corrected or presenting VA extracted from medical record charts. Prospective cohort is best-corrected visual acuity using Early-Treatment Diabetic Retinopathy study methods
    Time Frame 2-12 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Retrospective Cohort Prospective Cohort
    Arm/Group Description Subjects with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Clinical data from multiple centers extracted from medical records. Participants were to have at least two visits with at least one of the study image modalities (fundus auto-fluorescence, micro-perimetry, or spectral domain optical coherence tomography (OCT)) Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participants were to have standardized visits at baseline and every 6 months for 24 months. Participant's data are from clinical examinations and central RC grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT)) and micro-perimetry.
    Measure Participants 176 259
    Measure eyes 332 489
    Mean (95% Confidence Interval) [logMAR/year]
    0.030
    0.011
    4. Secondary Outcome
    Title Difference in the Rate of Retinal Sensitivity Change Per Year Between Photopic and Scotopic Micro-perimetry Testing
    Description Difference in the yearly rate of change in retinal sensitivity under photopic and scotopic conditions. Sensitivity tested with a Nidek MP-1. Scotopic sensitivity was obtained using a 40 points test pattern, and photopic sensitivity was obtained using a 68 points test pattern in a subset of Prospective cohort patients
    Time Frame 2 years

    Outcome Measure Data

    Analysis Population Description
    Photopic microperimetry was obtained in a subset of patients, in a single designated study eye
    Arm/Group Title Retrospective Cohort Prospective Cohort
    Arm/Group Description Subjects with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Clinical data from multiple centers extracted from medical records. Participants were to have at least two visits with at least one of the study image modalities (fundus auto-fluorescence, micro-perimetry, or spectral domain optical coherence tomography (OCT)) Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participants were to have standardized visits at baseline and every 6 months for 24 months. Participant's data are from clinical examinations and central RC grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT)) and micro-perimetry.
    Measure Participants 0 118
    Measure eyes 0 118
    Mean (95% Confidence Interval) [dB/year]
    -0.78
    5. Secondary Outcome
    Title Yearly Rate of Loss of Overall Retinal Thickness
    Description Yearly decrease of overall retinal thickness using spectral domain optical coherence tomography (SD-OCT) scans from a 20° x 20° scan area centered on the fovea. Data are only available for the Prospective cohort.
    Time Frame Participants followed at Baseline, 6 months, 12 months and 24 months

    Outcome Measure Data

    Analysis Population Description
    All visits of eligible eyes of the 258 participants with gradable overall thickness. Only OCT scans with adequate and fair quality are included
    Arm/Group Title Prospective Cohort
    Arm/Group Description Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). OCT scans were graded by a central reading center.
    Measure Participants 258
    Measure eyes 487
    Mean (95% Confidence Interval) [microns/year]
    -2.85
    6. Secondary Outcome
    Title Yearly Rate of Loss of Outer Ring Retinal Thickness
    Description Yearly decrease of outer ring retinal thickness using SD-OCT scans from a 20° x 20° scan area centered on the fovea. Outer ring defined as ETDRS fields 1-4.
    Time Frame Participants followed at Baseline, 6 months, 12 months and 24 months

    Outcome Measure Data

    Analysis Population Description
    All visits of eligible eyes of the 258 participants with gradable thickness in the outer ring. Only OCT scans with adequate and fair quality are included
    Arm/Group Title Prospective Cohort
    Arm/Group Description Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). OCT scans were graded by a central reading center.
    Measure Participants 258
    Measure eyes 487
    Mean (95% Confidence Interval) [microns/year]
    -2.84
    7. Secondary Outcome
    Title Yearly Rate of Loss of the Inner Ring Retinal Thickness
    Description Yearly decrease of the inner ring retinal thickness using SD-OCT scans from a 20° x 20° scan area centered on the fovea. Inner ring defined as ETDRS fields 5-8. Data are only available for the Prospective cohort.
    Time Frame Participants followed at Baseline, 6 months, 12 months and 24 months

    Outcome Measure Data

    Analysis Population Description
    All visits of eligible eyes of the 258 participants with gradable thickness in the inner ring. Only OCT scans with adequate and fair quality are included
    Arm/Group Title Prospective Cohort
    Arm/Group Description Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). OCT scans were graded by a central reading center.
    Measure Participants 258
    Measure eyes 487
    Mean (95% Confidence Interval) [microns/year]
    -3.20
    8. Secondary Outcome
    Title Yearly Rate of Loss of the Central Ring Retinal Thickness
    Description Yearly decrease of the central ring retinal thickness using SD-OCT scans from a 20° x 20° scan area centered on the fovea. Central area defined as ETDRS fields 9. Data are only available for the Prospective cohort.
    Time Frame Participants followed at Baseline, 6 months, 12 months and 24 months

    Outcome Measure Data

    Analysis Population Description
    All visits of eligible eyes of the 258 participants with gradable thickness in the inner ring. Only OCT scans with adequate and fair quality are included
    Arm/Group Title Prospective Cohort
    Arm/Group Description Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). OCT scans were graded by a central reading center.
    Measure Participants 258
    Measure eyes 487
    Mean (95% Confidence Interval) [microns/year]
    -2.24

    Adverse Events

    Time Frame Adverse events were not collected in this natural history study
    Adverse Event Reporting Description As there was no intervention in this study, adverse events were not collected
    Arm/Group Title Retrospective Cohort Prospective Cohort
    Arm/Group Description Subjects with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Clinical data from multiple centers extracted from medical records. Participants should had at least two visits with at least one of the study image modalities (fundus auto-fluorescence, micro-perimetry, or spectral domain optical coherence tomography (OCT)). Adverse events were not collected Multicenter prospective longitudinal cohort. Patients with at least two pathogenic mutations in the ABCA4 gene (or one mutation, but the clinical phenotype of flecks at the level of the RPE typical for STGD1). Participants had standardized visits at baseline and every 6 months for 24 months. Participant's data are from clinical examinations and central RC grading of retinal imaging (fundus auto-fluorescence, spectral domain optical coherence tomography (OCT)) and micro-perimetry. Adverse events were not collected
    All Cause Mortality
    Retrospective Cohort Prospective Cohort
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/251 (0%) 1/259 (0.4%)
    Serious Adverse Events
    Retrospective Cohort Prospective Cohort
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/0 (NaN) 0/0 (NaN)
    Other (Not Including Serious) Adverse Events
    Retrospective Cohort Prospective Cohort
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/0 (NaN) 0/0 (NaN)

    Limitations/Caveats

    [Not Specified]

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

    Results Point of Contact

    Name/Title Chief Scientific Officer
    Organization Foundation Fighting Blindness
    Phone 410-423-0600
    Email info@FightBlindness.org
    Responsible Party:
    Foundation Fighting Blindness
    ClinicalTrials.gov Identifier:
    NCT01977846
    Other Study ID Numbers:
    • FFBCRI-PROGSTAR-01/02
    First Posted:
    Nov 7, 2013
    Last Update Posted:
    Nov 1, 2019
    Last Verified:
    Jul 1, 2019