Diabetic Macular EdemaPhase 4TRIASTINNCT00682539
Intraocular Anti-VEGF Compared With Intraocular Triamcinolone in Patients With Diabetic Macular Edema
A Phase 4 study testing Bevacizumab (Avastin), Triamcinolone and Lucentis in people with Diabetic Macular Edema, run by Medical University of Vienna at 1 site in Austria.
Trial summary
The purpose of this study is to investigate the change in macular edema and the absolute change in visual acuity following intravitreal administered injections of Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) compared with Triamcinolone (Volon A®) in patients with clinical significant diabetic macular edema. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Diabetic Macular Edema
- What is being tested?
- Bevacizumab (Avastin), Triamcinolone and Lucentis
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 71 participants
- Where
- 1 siteAustria
- Study dates
- Oct 2007to Jul 2014
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Signed informed consent
- Patients with type 1 or type 2 diabetes mellitus
- Patients with diabetic macular edema with center involvement
- Central macular thickness (macular edema) of at least 300 microns in the central subfield as measured by OCT
- Best corrected visual acuity, using ETDRS charts, of 20/25 to 20/400 (Snellen equivalent) in the study eye
- Patients with decrease in vision in the study eye due to foveal thickening from diabetic macular edema and not to other causes, in the opinion of the investigator
- Patients without a necessity for panretinal laser photocoagulation for at least 3 months after study inclusion
- If both eyes are eligible, the one with the worse visual acuity will be selected for study treatment unless, based on medical reason, the investigator deems the other eye have got more benefit from study treatment. The other eye will be treated with Grid laser coagulation.
Who cannot join
- A condition that would preclude a patient for participation in the study in opinion of investigator, e.g., unstable medical status including glycemic control and blood pressure
- History of systemic corticosteroids within 3 months prior to randomization or topical, rectal or inhaled corticosteroids in current use more than 3 times per week
- Prior/Concomitant Treatment
- Macular laser photocoagulation
- Panretinal laser photocoagulation within the past 3 months
- Previous treatment with intravitreal or sub-Tenon triamcinolone within the past 3 months in the study eye
Show all 25Show fewer
- Previous participation in clinical trial involving anti-angiogenic drugs (pegaptanib sodium, ranibizumab, anecortave acetate, protein kinase C inhibitor, etc.)
- History of submacular surgery or other surgical intervention for diabetic macular edema in the study eye Diabetic Retinopathy Characteristics
- High risk proliferative diabetic retinopathy in the study eye without complete panretinal laser photocoagulation and having a risk for intravitreal bleeding Concurrent Ocular Conditions
- Active intraocular inflammation (grade trace or above) in either eye
- Vitreomacular traction in the study eye evident by OCT
- Ocular disorders in the study eye including retinal vascular occlusion, retinal detachment, macular hole, choroidal neovascularisation
- Intraocular surgery (including cataract surgery, YAG laser capsulotomy) in the study eye within 3 months preceding Day 0
- Uncontrolled glaucoma in the study eye (defined as intraocular pressure ≥25 mmHg despite treatment with anti-glaucoma medication)
- History of glaucoma filtration surgery, corneal transplantation in the study eye Concurrent Systemic Conditions
- History of myocardial infarction (in anamnesis or signs in ECG)
- History of congestive heart failure
- History of stroke or transient ischemic attacks
- Significant abnormalities on laboratory testing (signs on failure of kidney, liver disease)
- Premenopausal women not using adequate contraception and pregnant or nursing women
- History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use an investigational drug or that might affect interpretation of the results of the study or render the subject at high risk for treatment complications
- Current treatment for active systemic infection Other
- History of allergy to fluorescein, not amenable to treatment
- Inability to obtain fundus photographs or fluorescein angiograms of sufficient quality to be analyzed and graded
- Inability to comply with study or follow up procedures
Trial locations and contacts
1 site in 1 country.
Austria1 site
Dept. of Ophthalmology, Medical University of Vienna
Vienna, State of Vienna, 1090
About this study
Official title: A Randomized, Double-masked Study With Intraocular Anti-VEGF (Avastin®/Lucentis®) Compared With Intraocular Triamcinolone (Volon A®) in Patients With Clinical Significant Diabetic Macular Edema
The purpose of this study is to investigate the change in macular edema and the absolute change in visual acuity following intravitreal administered injections of Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) compared with Triamcinolone (Volon A®) in patients with clinical significant diabetic macular edema.
The investigators monitor the change in macular edema measured with standard optical coherence tomography (OCT) and the absolute change in visual acuity analyzed by standardized charts according to the protocol used in the Early Retreatment in Diabetic Retinopathy Study (ETDRS).
Read the detailed description
Diabetes mellitus is the most common endocrine disease in developed countries, with prevalence estimates ranging between 2 to 5% of the world's population. Diabetic retinopathy and diabetic macular edema are common microvascular complications in diabetic patients and may lead to decreasing of visual acuity, eventually to blindness. The Wisconsin Epidemiologic Study found an incidence of macular edema of 20.1% in the younger-onset group and of 14 to 25% in patients with type 2 diabetes mellitus over a period of 10 years.
Diabetic macular edema is characterized by the accumulation of extracellular fluid in Henle´s layer and the inner nuclear layer of the retina. There pathogenesis involves the interaction of several factors: the breakdown of the blood-retinal-barriers, production of biochemical factors, tissue hypoxia, retinal circulatory changes and vitreous tractions.
Laser photocoagulation is the most common treatment modality for diabetic macular edema. Perifoveal focal/grid laser coagulation was found to be effective saving the visual acuity in only 50% of patients with diabetic macular edema and just 3-14% of treated patients had an improved visual acuity post-operatively. The decent results of laser coagulation are associated with potential side effects as paracentral scotomas[4], change of color discrimination, development of epiretinal gliosis and subretinal fibrosis and expansion of laser scar size.
In the past few years, several studies investigating the effect of intravitreal steroids such as triamcinolone in patients with diabetic macular edema found a significant reduction in macular edema. Therefore intravitreal steroids have become part of standard therapy in the treatment of diabetic macular edema.
Furthermore, some studies showed that the vascular endothelial growth factor (VEGF) is the major angiogenic stimulus responsible for increase of vasopermeability, cell proliferation and angiogenesis in diabetic retinopathy (DRP). Evaluation of VEGF levels in the vitreous have indicated a role for VEGF in diabetic macular edema: vitreous samples of patients with diabetic macular edema contain elevated VEGF concentration and injection of VEGF in experimental studies led to breakdown of the blood-retina barrier.
Not only in age-related macular degeneration but also in other diseases like in diabetic macular edema we can find an increasing evidence for a therapeutic role of anti-VEGF drugs. Intravitreal injections have become the most favored treatment procedure for administering anti-VEGF drugs.
The side effects and the modest results of laser treatment on the visual acuity in diabetic macular edema led to studies using anti-VEGF therapy. Unpublished study results on the aptamer pegaptanib (Macugen®) are promising. A study using the antibody fragment Ranibizumab (Lucentis®) is in progress.
Currently there is one anti-VEGF drug already on the market: Bevacizumab (Avastin®), which has approved as intravenous infusion for the treatment of metastatic colo-rectal cancer. Previous studies have shown that systemic use of Bevacizumab (Avastin®) can obtain very promising results on patients with choroidal neovascularisation (CNV) by age-related macular degeneration. This drug, a monoclonal full-length antibody, designed to bind all isoforms of VEGF, is a large molecule. But case reports in patients with CNV caused by age-related macular degeneration and with macular edema from central retinal vein occlusion indicate that intravitreally given Bevacizumab (Avastin™) is effective in diseases originating from the choroids and also the retina. These findings imply a sufficient penetration of the retina by Bevacizumab (Avastin®).
A recent study investigating the effect of intravitreal bevacizumab (Avastin®) in patients with diabetic macular edema found a significant reduction in macular edema.
Based on these new findings and the important role of VEGF in diabetic macular edema and in proliferative diabetic retinopathy, we propose a double-masked, randomised pilot study for treatment of diabetic macular edema with intravitreally administered anti VEGF (Avastin®/Lucentis®) compared with intravitreally administered triamcinolone (VolonA®).
- Conditions
- Diabetic Macular Edema
- Being tested
- Bevacizumab (Avastin), Triamcinolone, Sham, Lucentis
- Keywords
- diabetic retinopathy, macular edema, intravitreal Avastin/ Triamcinolone / Lucentis
- Medical subject headings
- Diabetic Retinopathy, Macular Edema
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Bevacizumab (Avastin)Drug
Also called Avastin
The intravitreal injection of Bevacizumab (Avastin®) is performed in the operating room under sterile conditions. The patient receives an initial drop of lidocaine 4% into the study eye followed by betaisodona solution. Then the lid margins, the lids and the periocular skin are washed carefully with betaisodona. The eye is draped in a sterile fashion. A sterile lid speculum is inserted by the surgeon. Another drop of betaisodona is applied into the eye. A circle is used to mark the injection site 3.5mm from the limbus in the inferior temporal quadrant. The injection is given at the marked site, slowly, at a 90 degree angle. After injecting the total volume of 0.1ml the needle is slowly withdrawn. Another drop of betaisodona is given as well as an antibiotic/steroid ointment.
TriamcinoloneDrug
Also called Volon A
The intravitreal injection of triamcinolone (Volon A®) is performed in the operating room under sterile conditions at baseline. The patient receives an initial drop of lidocaine 4% into the study eye followed by betaisodona solution. Then the lid margins, the lids and the periocular skin are washed carefully with betaisodona. The eye is draped in a sterile fashion. A sterile lid speculum is inserted by the surgeon. Another drop of betaisodona is applied into the eye. A circle is used to mark the injection site 3.5mm from the limbus in the inferior temporal quadrant. The injection is given at the marked site, slowly, at a 90 degree angle. After injecting the total volume of 0.1ml the needle is slowly withdrawn. Another drop of betaisodona is given as well as an antibiotic/steroid ointment.
ShamDrug
Also called sham injection
Patients receiving sham intravitreal injections do not receive an actual injection of study drug. The injecting physician performing the sham injection will be unmasked to the treatment to the treatment assignment regarding active versus sham. The injecting physician will perform the same pre-injection procedures for the patients receiving bevacizumab or triamcinolone, An empty syringe without a needle will be used in the sham injection. The injecting physician will mimic an intraocular injection by making contact with the conjunctiva and applying pressure without the needle. Immediately following the sham injection, the injecting physician will perform the same post-injection procedures as those performed on patients receiving bevacizumab or triamcinolone.
LucentisProcedure or surgery
The intravitreal injection of Ranibizumab (Lucentis®) is performed in the operating room under sterile conditions. The patient receives an initial drop of lidocaine 4% into the study eye followed by betaisodona solution. Then the lid margins, the lids and the periocular skin are washed carefully with betaisodona. The eye is draped in a sterile fashion. A sterile lid speculum is inserted by the surgeon. Another drop of betaisodona is applied into the eye. A circle is used to mark the injection site 3.5mm from the limbus in the inferior temporal quadrant. The injection is given at the marked site, slowly, at a 90 degree angle. After injecting the total volume of 0.05ml the needle is slowly withdrawn. Another drop of betaisodona is given as well as an antibiotic/steroid ointment.
| Study group | Role | What they receive |
|---|---|---|
| Avastin | Active comparator | 15 patients with clinical significant macular edema receive an injection of 2,5 mg Avastin every month. After three initial injections of Avastin re-injection is performed if the central retinal thickness measured with optical coherence tomography (Stratus OCT, Zeiss) stays more than 300 microns. If the Central retinal thickness decreases under 300 microns a sham injection is performed. Receives: Drug: Bevacizumab (Avastin); Drug: Sham |
| Triamciolone | Active comparator | 30 patients with a clinical significant diabetic macular edema receive an intraocular injection of 8mg triamcinolone at baseline under sterile conditions. 1 and 2 month after the baseline injection, patients receive a sham injection. After three month re-injection of 8mg Triamcinolone is performed if the central retinal thickness measured with optical coherence tomography (Stratus OCT, Zeiss) stays more than 300 microns. If the Central retinal thickness decreases under 300 microns patients will receive a sham injection. In between two injection of 8mg Triamcinolone must be an temporal interval of at least 3 months. Receives: Drug: Triamcinolone; Drug: Sham |
| Lucentis | Active comparator | 15 patients with clinical significant macular edema receive an injection of 0,5 mg Lucentis every month. After three initial injections of Lucentis re-injection is performed if the central retinal thickness measured with optical coherence tomography (Stratus OCT, Zeiss) stays more than 300 microns. If the Central retinal thickness decreases under 300 microns a sham injection is performed. Receives: Procedure: Lucentis |
What is being measured
The primary outcome is the main question the study is designed to answer.
Efficacy of the Treatment Assessed With Visual Acuity Measured by ETDRS Charts.
Efficacy of the treatment with intravitreal administered injections of anti VEGF (Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) ) compared with triamcinolone (Volon A®) in patients with diabetic macular edema is examined using Visual acuity measurements with ETDRS charts: units: logMAR; scale range: -0.1 to 1.0; higher values are considered worse outcome
Measured: 12 month
Efficacy of the Treatment Assessed by Standard Optical Coherence Tomography (OCT)
Efficacy of the treatment with intravitreal administered injections of anti VEGF (Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) ) compared with triamcinolone (Volon A®) in patients with diabetic macular edema is measured with standard Optical Coherence Tomography - (OCT): units: µm; scale range: 200-800; higher values are considered worse outcome
Measured: 12 months
Secondary outcomes (1)
To Explore the Structural Mechanisms of the Effect on Diabetic Macular Edema as Assessed by Fluorescein Angiography and Ultra High-resolution Optical Coherence Tomography. To Observe the Changes in Retinal Function a Microperimetry is Assessed.
Area of leakage and non perfusion is measured in FA, morphologic details like presence of cysts or sub retinal fluid is evaluated in OCT. Data is still under evaluation.
Measured: 12 month
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 May 2008 (estimated)
- Study startOct 2007
- Primary completionJul 2014
- Study completionJul 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Diabetic Macular EdemaStudies of the same condition, open and under way.
- More trials run by Medical University of ViennaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 71 participants (actual)
Sponsor and investigators
- Lead sponsor
- Medical University of Vienna
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Katharina Kriechbaum, Medical University of Vienna
- Investigators
- Ursula Schmidt-Erfurth, MD, Study chair, Medical University of Vienna, Dept. of OphthalmologyGeorg Rainer, MD, Principal investigator, Medical University of Vienna, Dept. of Ophthalmology
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00682539
- Sponsor's protocol ID
- TRIASTIN Study
- Acronym
- TRIASTIN
- Status last verified
- Mar 2016
- First submitted
- 20 May 2008
- Last updated
- 4 Apr 2016
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Rittiphairoj T, Mir TA, Li T, Virgili G. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2020 Nov 17;11(11):CD005656. doi: 10.1002/14651858.CD005656.pub3.
PubMed 33206392Karst SG, Lammer J, Mitsch C, Schober M, Mehta J, Scholda C, Kundi M, Kriechbaum K, Schmidt-Erfurth U. Detailed analysis of retinal morphology in patients with diabetic macular edema (DME) randomized to ranibizumab or triamcinolone treatment. Graefes Arch Clin Exp Ophthalmol. 2018 Jan;256(1):49-58. doi: 10.1007/s00417-017-3828-1. Epub 2017 Oct 28.
PubMed 29080915
Study at a glance
From the registry record, last updated by the sponsor on 4 Apr 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-masked Study With Intraocular Anti-VEGF (Avastin®/Lucentis®) Compared With Intraocular Triamcinolone (Volon A®) in Patients With Clinical Significant Diabetic Macular Edema
- ClinicalTrials.gov ID
- NCT00682539
- Acronym / sponsor ID
- TRIASTIN / TRIASTIN Study
- Conditions
- Diabetic Macular Edema
- Keywords
- diabetic retinopathy, macular edema, intravitreal Avastin/ Triamcinolone / Lucentis
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 71 participants (actual)
- Lead sponsor
- Medical University of ViennaUniversity, hospital or other
- Study start
- Oct 2007
- Primary completion
- Jul 2014 (actual)
- Study completion
- Jul 2014 (actual)
- First posted
- 22 May 2008 (estimated)
- Results
- Posted 4 Apr 2016
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to investigate the change in macular edema and the absolute change in visual acuity following intravitreal administered injections of Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) compared with Triamcinolone (Volon A®) in patients with clinical significant diabetic macular edema.
The investigators monitor the change in macular edema measured with standard optical coherence tomography (OCT) and the absolute change in visual acuity analyzed by standardized charts according to the protocol used in the Early Retreatment in Diabetic Retinopathy Study (ETDRS).
Detailed description
Diabetes mellitus is the most common endocrine disease in developed countries, with prevalence estimates ranging between 2 to 5% of the world's population. Diabetic retinopathy and diabetic macular edema are common microvascular complications in diabetic patients and may lead to decreasing of visual acuity, eventually to blindness. The Wisconsin Epidemiologic Study found an incidence of macular edema of 20.1% in the younger-onset group and of 14 to 25% in patients with type 2 diabetes mellitus over a period of 10 years.
Diabetic macular edema is characterized by the accumulation of extracellular fluid in Henle´s layer and the inner nuclear layer of the retina. There pathogenesis involves the interaction of several factors: the breakdown of the blood-retinal-barriers, production of biochemical factors, tissue hypoxia, retinal circulatory changes and vitreous tractions.
Laser photocoagulation is the most common treatment modality for diabetic macular edema. Perifoveal focal/grid laser coagulation was found to be effective saving the visual acuity in only 50% of patients with diabetic macular edema and just 3-14% of treated patients had an improved visual acuity post-operatively. The decent results of laser coagulation are associated with potential side effects as paracentral scotomas[4], change of color discrimination, development of epiretinal gliosis and subretinal fibrosis and expansion of laser scar size.
In the past few years, several studies investigating the effect of intravitreal steroids such as triamcinolone in patients with diabetic macular edema found a significant reduction in macular edema. Therefore intravitreal steroids have become part of standard therapy in the treatment of diabetic macular edema.
Furthermore, some studies showed that the vascular endothelial growth factor (VEGF) is the major angiogenic stimulus responsible for increase of vasopermeability, cell proliferation and angiogenesis in diabetic retinopathy (DRP). Evaluation of VEGF levels in the vitreous have indicated a role for VEGF in diabetic macular edema: vitreous samples of patients with diabetic macular edema contain elevated VEGF concentration and injection of VEGF in experimental studies led to breakdown of the blood-retina barrier.
Not only in age-related macular degeneration but also in other diseases like in diabetic macular edema we can find an increasing evidence for a therapeutic role of anti-VEGF drugs. Intravitreal injections have become the most favored treatment procedure for administering anti-VEGF drugs.
The side effects and the modest results of laser treatment on the visual acuity in diabetic macular edema led to studies using anti-VEGF therapy. Unpublished study results on the aptamer pegaptanib (Macugen®) are promising. A study using the antibody fragment Ranibizumab (Lucentis®) is in progress.
Currently there is one anti-VEGF drug already on the market: Bevacizumab (Avastin®), which has approved as intravenous infusion for the treatment of metastatic colo-rectal cancer. Previous studies have shown that systemic use of Bevacizumab (Avastin®) can obtain very promising results on patients with choroidal neovascularisation (CNV) by age-related macular degeneration. This drug, a monoclonal full-length antibody, designed to bind all isoforms of VEGF, is a large molecule. But case reports in patients with CNV caused by age-related macular degeneration and with macular edema from central retinal vein occlusion indicate that intravitreally given Bevacizumab (Avastin™) is effective in diseases originating from the choroids and also the retina. These findings imply a sufficient penetration of the retina by Bevacizumab (Avastin®).
A recent study investigating the effect of intravitreal bevacizumab (Avastin®) in patients with diabetic macular edema found a significant reduction in macular edema.
Based on these new findings and the important role of VEGF in diabetic macular edema and in proliferative diabetic retinopathy, we propose a double-masked, randomised pilot study for treatment of diabetic macular edema with intravitreally administered anti VEGF (Avastin®/Lucentis®) compared with intravitreally administered triamcinolone (VolonA®).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Avastin | Active comparator | Drug: Bevacizumab (Avastin), Drug: Sham15 patients with clinical significant macular edema receive an injection of 2,5 mg Avastin every month. After three initial injections of Avastin re-injection is performed if the central retinal thickness measured with optical coherence tomography (Stratus OCT, Zeiss) stays more than 300 microns. If the Central retinal thickness decreases under 300 microns a sham injection is performed. |
| Triamciolone | Active comparator | Drug: Triamcinolone, Drug: Sham30 patients with a clinical significant diabetic macular edema receive an intraocular injection of 8mg triamcinolone at baseline under sterile conditions. 1 and 2 month after the baseline injection, patients receive a sham injection. After three month re-injection of 8mg Triamcinolone is performed if the central retinal thickness measured with optical coherence tomography (Stratus OCT, Zeiss) stays more than 300 microns. If the Central retinal thickness decreases under 300 microns patients will receive a sham injection. In between two injection of 8mg Triamcinolone must be an temporal interval of at least 3 months. |
| Lucentis | Active comparator | Procedure: Lucentis15 patients with clinical significant macular edema receive an injection of 0,5 mg Lucentis every month. After three initial injections of Lucentis re-injection is performed if the central retinal thickness measured with optical coherence tomography (Stratus OCT, Zeiss) stays more than 300 microns. If the Central retinal thickness decreases under 300 microns a sham injection is performed. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Signed informed consent
- Patients with type 1 or type 2 diabetes mellitus
- Patients with diabetic macular edema with center involvement
- Central macular thickness (macular edema) of at least 300 microns in the central subfield as measured by OCT
- Best corrected visual acuity, using ETDRS charts, of 20/25 to 20/400 (Snellen equivalent) in the study eye
Key exclusion criteria (25 listed)
- A condition that would preclude a patient for participation in the study in opinion of investigator, e.g., unstable medical status including glycemic control and blood pressure
- History of systemic corticosteroids within 3 months prior to randomization or topical, rectal or inhaled corticosteroids in current use more than 3 times per week
- Prior/Concomitant Treatment
- Macular laser photocoagulation
- Panretinal laser photocoagulation within the past 3 months
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Bevacizumab (Avastin)Also: AvastinThe intravitreal injection of Bevacizumab (Avastin®) is performed in the operating room under sterile conditions. The patient receives an initial drop of lidocaine 4% into the study eye followed by betaisodona solution. Then the lid margins, the lids and the periocular skin are washed carefully with betaisodona. The eye is draped in a sterile fashion. A sterile lid speculum is inserted by the surgeon. Another drop of betaisodona is applied into the eye. A circle is used to mark the injection site 3.5mm from the limbus in the inferior temporal quadrant. The injection is given at the marked site, slowly, at a 90 degree angle. After injecting the total volume of 0.1ml the needle is slowly withdrawn. Another drop of betaisodona is given as well as an antibiotic/steroid ointment. | Drug | Avastin |
| TriamcinoloneAlso: Volon AThe intravitreal injection of triamcinolone (Volon A®) is performed in the operating room under sterile conditions at baseline. The patient receives an initial drop of lidocaine 4% into the study eye followed by betaisodona solution. Then the lid margins, the lids and the periocular skin are washed carefully with betaisodona. The eye is draped in a sterile fashion. A sterile lid speculum is inserted by the surgeon. Another drop of betaisodona is applied into the eye. A circle is used to mark the injection site 3.5mm from the limbus in the inferior temporal quadrant. The injection is given at the marked site, slowly, at a 90 degree angle. After injecting the total volume of 0.1ml the needle is slowly withdrawn. Another drop of betaisodona is given as well as an antibiotic/steroid ointment. | Drug | Triamciolone |
| ShamAlso: sham injectionPatients receiving sham intravitreal injections do not receive an actual injection of study drug. The injecting physician performing the sham injection will be unmasked to the treatment to the treatment assignment regarding active versus sham. The injecting physician will perform the same pre-injection procedures for the patients receiving bevacizumab or triamcinolone, An empty syringe without a needle will be used in the sham injection. The injecting physician will mimic an intraocular injection by making contact with the conjunctiva and applying pressure without the needle. Immediately following the sham injection, the injecting physician will perform the same post-injection procedures as those performed on patients receiving bevacizumab or triamcinolone. | Drug | Avastin, Triamciolone |
| LucentisThe intravitreal injection of Ranibizumab (Lucentis®) is performed in the operating room under sterile conditions. The patient receives an initial drop of lidocaine 4% into the study eye followed by betaisodona solution. Then the lid margins, the lids and the periocular skin are washed carefully with betaisodona. The eye is draped in a sterile fashion. A sterile lid speculum is inserted by the surgeon. Another drop of betaisodona is applied into the eye. A circle is used to mark the injection site 3.5mm from the limbus in the inferior temporal quadrant. The injection is given at the marked site, slowly, at a 90 degree angle. After injecting the total volume of 0.05ml the needle is slowly withdrawn. Another drop of betaisodona is given as well as an antibiotic/steroid ointment. | Procedure or surgery | Lucentis |
Primary outcome
Efficacy of the Treatment Assessed With Visual Acuity Measured by ETDRS Charts.
Time frame: 12 month
Efficacy of the treatment with intravitreal administered injections of anti VEGF (Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) ) compared with triamcinolone (Volon A®) in patients with diabetic macular edema is examined using Visual acuity measurements with ETDRS charts: units: logMAR; scale range: -0.1 to 1.0; higher values are considered worse outcome
Efficacy of the Treatment Assessed by Standard Optical Coherence Tomography (OCT)
Time frame: 12 months
Efficacy of the treatment with intravitreal administered injections of anti VEGF (Bevacizumab (Avastin®) or Ranibizumab (Lucentis®) ) compared with triamcinolone (Volon A®) in patients with diabetic macular edema is measured with standard Optical Coherence Tomography - (OCT): units: µm; scale range: 200-800; higher values are considered worse outcome
1 secondary outcome
To Explore the Structural Mechanisms of the Effect on Diabetic Macular Edema as Assessed by Fluorescein Angiography and Ultra High-resolution Optical Coherence Tomography. To Observe the Changes in Retinal Function a Microperimetry is Assessed.
Time frame: 12 month
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Apr 2016.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 33206392Rittiphairoj T, Mir TA, Li T, Virgili G. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2020 Nov 17;11(11):CD005656. doi: 10.1002/14651858.CD005656.pub3.
- Derived from this study: PubMed 29080915Karst SG, Lammer J, Mitsch C, Schober M, Mehta J, Scholda C, Kundi M, Kriechbaum K, Schmidt-Erfurth U. Detailed analysis of retinal morphology in patients with diabetic macular edema (DME) randomized to ranibizumab or triamcinolone treatment. Graefes Arch Clin Exp Ophthalmol. 2018 Jan;256(1):49-58. doi: 10.1007/s00417-017-3828-1. Epub 2017 Oct 28.
- Individual participant dataSharing planned: No
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Long-Term Follow-Up Study of RGX-314 Administered in the Suprachoroidal Space for Participants With and Without Diabetic Retinopathy
Diabetic Retinopathy, DR
RecruitingPhase 3
A Phase 3 Trial for Intravitreal Injection of 4D-150 in Adults With Diabetic Macular Edema (DME).
Diabetic Macular Edema (DME)
RecruitingPhase 2
Oral N-Acetylcysteine on Diabetic Macular Edema
Diabetic Macular Edema (DME)
Active, not recruitingPhase 3
COMO: A Phase 3 Randomized, Double-Masked Study Comparing the Efficacy of EYP-1901 Against Aflibercept in DME
Diabetic Macular Edema, DME
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ursula Schmidt-Erfurth, MD study chair
Medical University of Vienna, Dept. of Ophthalmology
Georg Rainer, MD principal investigator
Medical University of Vienna, Dept. of Ophthalmology
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Bevacizumab (Avastin), Triamcinolone and Lucentis in people with Diabetic Macular Edema, run by Medical University of Vienna at 1 site in Austria.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Apr 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Austria. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 4 Apr 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Efficacy of the Treatment Assessed With Visual Acuity Measured by ETDRS Charts. (time frame: 12 month). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00682539, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Apr 2016.