Comparative Multicenter Randomized Study of Aflibercept Versus Placebo in Macular Telangiectasia Type 1

  • STATUS
    Recruiting
  • End date
    Jan 29, 2022
  • participants needed
    46
  • sponsor
    Centre Hospitalier Universitaire Dijon
Updated on 29 January 2021

Summary

Idiopathic juxtafoveal telangiectasia type 1 is a rare unilateral disease that mostly affects men before 50 years of age. Mac Tel 1 are characterized by microvascular telangiectasia and increased tortuosity of the macular capillary network on the temporal part of the fovea that can be identified on fundus examination. It can be associated with peripheral vascular changes, similar to manifestations of Coats' disease. It can be complicated by macular edema due to leakage from microvascular ectasia. When associated with visual loss, macular edema can be treated with different strategies although there is no consensus about the best approach. Laser can be performed on leaky aneurysms with questionable long term efficacy and potential irreversible adverse effects. Recently, anti-VEGF agents have been put forward as particularly good candidates to treat this macular edema, as observed in vein occlusion or diabetic macular edema. Indeed, in limited case series, the first anti-VEGF agents (ranibizumab and bevacizumab) showed mitigated results. More recently, authors have reported some favorable results with aflibercept in patients refractory to other anti-VEGF agents. Indeed a recent study reported both good anatomical and functional results in macular edema due to Mac Tel 1 in a non-comparative study that included 8 patients and carried out a concomitant quantification of growth factors. As an explanation, the authors found that levels of placental growth factor (PlGF), which is targeted by aflibercept but not by other anti-VEGF agents, were decreased after treatment. Moreover, PlGF correlated with capillary plexus densities assessed by OCTA. The aim of this study is thus to assess the efficacy of a 6 months treatment by aflibercept compared to placebo in macular edema linked to Mac Tel 1 with a multicenter double-blind randomized clinical trial.

Details
Condition Macular Telangiectasia
Treatment Sham injection, Aflibercept Injection [Eylea], Inclusion examinations, Examinations during study (every month)
Clinical Study IdentifierNCT03845049
SponsorCentre Hospitalier Universitaire Dijon
Last Modified on29 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Is your age greater than or equal to 18 yrs?
Gender: Male or Female
Do you have Macular Telangiectasia?
Do you have any of these conditions: Do you have Macular Telangiectasia??
Patient who have given their written informed consent
Patient major
Patient with idiopathic macular telangiectasia type 1 identified at least 4 months previously, with or without peripheral exudative abnormalities
Patient with macular edema more than 320 m confirmed by a blind review of SD-OCT images
Patient with best-corrected ETDRS visual acuity between strictly24 and 79 letters
Patient with a contraindication for laser photocoagulation or with persistence of macular edema after treatment with intravitreal bevacizumab, ranibizumab and/or laser photocoagulation administered more than 4 months previously
Patient with persistence of macular edema after treatment with corticosteroids administered more than 6 months previously
Patient with an assessment by the treating ophthalmologist that focal coagulation (for both groups) and anti-VEGF treatment (for the placebo group) could be safely deferred for 6 months
Woman of childbearing potential (WOCBP) must commit to consider and use an efficient method of birth control during the trial and at least 3 months after the last aflibercept/SHAM administration

Exclusion Criteria

Patient not affiliated to a national health insurance scheme
Patient subject to a measure of legal protection (guardianship, tutorship)
Patient subject to a court order
Patient pregnant, parturient or nursing women (WOCBP)
Patient incapable of expressing consent
Patient with edema linked to conditions other than macular telangiectasia (namely retinal vein occlusion, diabetic retinopathy, ocular ischemic syndrome, sickle-cell anemia, maculopathy, hypertensive retinopathy)
Patient treated with aflibercept in the last 4 months before inclusion
Patient presenting any cardiovascular eventwithin 6 months before inclusion
Poor media clarity, which can prevent adequate fundus imaging
Patient having prior focal photocoagulation within the previous 4 months
Patient with hypersensitivity to the active substance (aflibercept) or to any of the excipients of EYLEA
Patient with active or suspected ocular or periocular infection or severe active intraocular inflammation
Any history of allergy to the antiseptic used during preparation of the eye for the IVT injection in the investigational site (e.g. povidone iodine or chlorhexidine)
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