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Age-Related Macular DegenerationPhase 3MERLINNCT03710564

Study of Safety and Efficacy of Brolucizumab 6 mg Dosed Every 4 Weeks Compared to Aflibercept 2 mg Dosed Every 4 Weeks in Patients With Retinal Fluid Despite Frequent Anti-VEGF Injections

A Phase 3 study testing Brolucizumab and Aflibercept in people with Age-Related Macular Degeneration, run by Novartis Pharmaceuticals at 61 sites in 2 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
Search all trials

Trial summary

This clinical study was designed to compare the safety and efficacy of brolucizumab 6 mg dosed every 4 weeks to aflibercept 2 mg dosed every 4 weeks in those neovascular age-related macular degeneration (nAMD) patients with retinal fluid despite frequent anti-Vascular Endothelial Growth Factor (VEGF) injections. Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
Age-Related Macular Degeneration
What is being tested?
Brolucizumab and Aflibercept
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
535 participants
Where
61 sitesin 2 countries
Study dates
30 Oct 2018to 1 Jul 2021
Phase
Phase 3
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 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Signed informed consent
  • Diagnosis of wet age-related macular degeneration (AMD)
  • Currently receiving anti-VEGF injections

Who cannot join

  • Active infection or inflammation in either eye
  • Significant fibrosis in the study eye
  • Recent ocular surgery
  • Uncontrolled glaucoma
  • Use of medications as specified in the protocol
  • Pregnant, nursing
  • Of child-bearing potential unless using highly effective method of contraception

Trial locations and contacts

61 sites in 2 countries.

61 sites in 2 countries

United States60 sites
  • Novartis Investigative Site

    ‘Aiea, Hawaii, 96701

  • Novartis Investigative Site

    Abilene, Texas, 79606

  • Novartis Investigative Site

    Austin, Texas, 78705

  • Novartis Investigative Site

    Austin, Texas, 78731

  • Novartis Investigative Site

    Austin, Texas, 78793

  • Novartis Investigative Site

    Beverly Hills, California, 90211

  • Novartis Investigative Site

    Bloomfield, New Jersey, 07003

  • Novartis Investigative Site

    Boston, Massachusetts, 02111

  • Novartis Investigative Site

    Boston, Massachusetts, 02114

  • Novartis Investigative Site

    Charlotte, North Carolina, 28210

  • Novartis Investigative Site

    Cleveland, Ohio, 44122

  • Novartis Investigative Site

    Colorado Springs, Colorado, 80909

  • Novartis Investigative Site

    Deerfield Beach, Florida, 33064

  • Novartis Investigative Site

    Eugene, Oregon, 97401

  • Novartis Investigative Site

    Fairfax, Virginia, 22031

  • Novartis Investigative Site

    Fairfield, Ohio, 45014

  • Novartis Investigative Site

    Fort Lauderdale, Florida, 33308

  • Novartis Investigative Site

    Fort Myers, Florida, 33912-7125

  • Novartis Investigative Site

    Fort Worth, Texas, 76102

  • Novartis Investigative Site

    Fort Worth, Texas, 76104

  • Novartis Investigative Site

    Germantown, Tennessee, 38138

  • Novartis Investigative Site

    Golden, Colorado, 80401

  • Novartis Investigative Site

    Harlingen, Texas, 78550

  • Novartis Investigative Site

    Houston, Texas, 77030

  • Novartis Investigative Site

    Huntington Beach, California, 92647

  • Novartis Investigative Site

    Kingston, Pennsylvania, 95403

  • Novartis Investigative Site

    Las Vegas, Nevada, 89144

  • Novartis Investigative Site

    Lenexa, Kansas, 66215

  • Novartis Investigative Site

    Marietta, Georgia, 30060

  • Novartis Investigative Site

    Miami, Florida, 33136

  • Novartis Investigative Site

    Mountain View, California, 94040

  • Novartis Investigative Site

    Mt. Dora, Florida, 32757

  • Novartis Investigative Site

    New Orleans, Louisiana, 70115-8139

  • Novartis Investigative Site

    Oakland, California, 94609

  • Novartis Investigative Site

    Oxnard, California, 93036

  • Novartis Investigative Site

    Palo Alto, California, 94303

  • Novartis Investigative Site

    Pensacola, Florida, 32503

  • Novartis Investigative Site

    Philadelphia, Pennsylvania, 19107

  • Novartis Investigative Site

    Phoenix, Arizona, 85016

  • Novartis Investigative Site

    Phoenix, Arizona, 85020

  • Novartis Investigative Site

    Phoenix, Arizona, 85053

  • Novartis Investigative Site

    Redlands, California, 92374

  • Novartis Investigative Site

    Reno, Nevada, 89502

  • Novartis Investigative Site

    Royal Oak, Michigan, 48073

  • Novartis Investigative Site

    Sacramento, California, 95841

  • Novartis Investigative Site

    San Antonio, Texas, 78240

  • Novartis Investigative Site

    San Francisco, California, 94107

  • Novartis Investigative Site

    Santa Barbara, California, 93103

  • Novartis Investigative Site

    Spokane, Washington, 99204

  • Novartis Investigative Site

    Springfield, Massachusetts, 01107

  • Novartis Investigative Site

    St Louis, Missouri, 63110

  • Novartis Investigative Site

    St. Petersburg, Florida, 33711

  • Novartis Investigative Site

    Stuart, Florida, 34994

  • Novartis Investigative Site

    Syracuse, New York, 13224

  • Novartis Investigative Site

    Toms River, New Jersey, 08755

  • Novartis Investigative Site

    Tyler, Texas, 75701

  • Novartis Investigative Site

    Waldorf, Maryland, 20602

  • Novartis Investigative Site

    West Des Moines, Iowa, 50266

  • Novartis Investigative Site

    West Monroe, Louisiana, 71291

  • Novartis Investigative Site

    Wheaton, Illinois, 60187

Other trials in United States

Puerto Rico1 site
  • Novartis Investigative Site

    Arecibo, 00612

Other trials in Puerto Rico

About this study

Official title: A Multicenter, Randomized, Double-masked Phase 3a Study to Assess Safety and Efficacy of Brolucizumab 6 mg q4 Weeks Compared to Aflibercept 2 mg q4 Weeks in Patients With Neovascular Age-related Macular Degeneration (nAMD) With Persistent Retinal Fluid (MERLIN)

This clinical study was designed to compare the safety and efficacy of brolucizumab 6 mg dosed every 4 weeks to aflibercept 2 mg dosed every 4 weeks in those neovascular age-related macular degeneration (nAMD) patients with retinal fluid despite frequent anti-Vascular Endothelial Growth Factor (VEGF) injections.

Read the detailed description

This was a Phase III, multi-center, randomized, double-masked, parallel group study with 2 masked arms in which participants were randomized 2:1 to receive brolucizumab or aflibercept. All participants had study visits every 4 weeks through week 104.

The study consisted of three study periods:

Screening Period: The screening period lasted up to 2 weeks prior to administration of the first dose of study treatment, dependent upon confirmation of the patient meeting eligibility criteria.

Double-Masked Treatment Period: Participants meeting eligibility criteria entered the treatment period and were randomized in a 2:1 ratio into one of the following 2 masked treatment arms at the Baseline visit: Brolucizumab 6 mg injected every 4 weeks or Aflibercept 2 mg injected every 4 weeks. Treatment period lasted up to week 100.

Safety Follow up Period: Participants were followed up for safety during 4 weeks after the last dose of study treatment. Including the Screening Period, the total study duration for a participant was up to 106 weeks.

Some participants were eligible to continue into an extension study in order to receive treatment with brolucizumab (a) after completing the 104 -week double-masked treatment period, (b) upon meeting all inclusion/exclusion criteria for the extension study, and (c) based on Investigator's judgment that the participant was expected to benefit from treatment with brolucizumab.

Being tested
Brolucizumab, Aflibercept
Keywords
neovascular age-related macular degeneration, nAMD, intravitreal injection, IVT, anti-VEGF, brolucizumab, aflibercept, EYLEA, double-masked, MERLIN, BEOVU
Medical subject headings
Macular Degeneration, Neurofibromatosis 2

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BrolucizumabBiological

    Also called RTH258

    6 mg/0.05mL solution for intravitreal injection

  • AfliberceptBiological

    Also called EYLEA

    2 mg/0.05mL solution for intravitreal injection

Study groups in NCT03710564
Study groupRoleWhat they receive
BrolucizumabExperimentalBrolucizumab 6 mg dosed every 4 weeks was administered via intravitreal injection for 100 weeks.
Receives: Biological: Brolucizumab
AfliberceptActive comparatorAflibercept 2 mg dosed every 4 weeks was administered via intravitreal injection for 100 weeks.
Receives: Biological: Aflibercept

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change From Baseline in Best-Corrected Visual Acuity (BCVA) at Week 52

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. A positive change from baseline represents better functioning.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment. Last observation carried forward (LOCF) was used for the imputation of missing values.

    Measured: Baseline, week 52

Secondary outcomes (16)
  1. Stable Visual Acuity (VA) or Improvement in VA at Week 52 and Week 104

    Visual Acuity (VA) was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. VA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of participants with no change or gain in VA compared to baseline was reported. VA stabilization or improvement is defined as a change from baseline no worse than 5 letters loss in VA compared to Baseline.

    Baseline VA was defined as the last measurement on or prior to the baseline visit. VA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 52 and 104

  2. Loss in Best-Corrected Visual Acuity (BCVA) of 5 Letters or More

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of subjects with loss in BCVA of 5 letters or more from baseline was reported for each post-baseline visit.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  3. Loss in Best-Corrected Visual Acuity (BCVA) of 10 Letters or More

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of subjects with loss in BCVA of 10 letters or more from baseline was reported for each post-baseline visit.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  4. Loss in Best-Corrected Visual Acuity (BCVA) of 15 Letters or More

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of subjects with loss in BCVA of 15 letters or more from baseline was reported for each post-baseline visit.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  5. Gain in Best-Corrected Visual Acuity (BCVA) of 5 Letters or More

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of subjects with gain in BCVA of 5 letters or more from baseline was reported for each post-baseline visit.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  6. Gain in Best-Corrected Visual Acuity (BCVA) of 10 Letters or More

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of subjects with gain in BCVA of 10 letters or more from baseline was reported for each post-baseline visit.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  7. Gain in Best-Corrected Visual Acuity (BCVA) of 15 Letters or More

    BCVA was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocol at an initial testing distance of 4 meters. BCVA min and max possible scores are 0-100 respectively and a higher score represents better functioning. The number of subjects with gain in BCVA of 15 letters or more from baseline was reported for each post-baseline visit.

    Baseline BCVA was defined as the last measurement on or prior to the baseline visit. BCVA assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  8. Change in Central Subfield Thickness (CST) From Baseline

    CST was assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. A negative change from baseline is a favorable outcome. CST assessments after start of alternative anti-VEGF treatment in the study eye were censored and imputed by the last value prior to start of alternative treatment. These results were based on analysis using the Last observation carried forward (LOCF) approach for replacement/imputation of censored/missing values and observed data.

    Measured: Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  9. Number of Participants With Intraretinal Fluid (IRF)

    IRF was assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. The number of participants with presence of IRF was reported for each post-baseline visit. These results were based on analysis using the Last observation carried forward (LOCF) approach for replacement/imputation of censored/missing values and observed data.

    Measured: Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  10. Number of Participants With Subretinal Fluid (SRF)

    SRF was assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. The number of participants with presence of SRF was reported for each post-baseline visit. These results were based on analysis using the Last observation carried forward (LOCF) approach for replacement/imputation of censored/missing values and observed data.

    Measured: Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  11. Number of Participants With Sub-Retinal Pigment Epithelium (Sub-RPE) Fluid

    Sub-RPE fluid was assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. The number of participants with presence of sub-RPE fluid in participants with sub-RPE fluid at baseline was reported for each post-baseline visit. These results were based on analysis using the Last observation carried forward (LOCF) approach for replacement/imputation of censored/missing values and observed data.

    Measured: Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  12. Number of Participants With Fluid-free Status (no IRF, SRF or Sub-RPE Fluid)

    Intraretinal fluid (IRF), Subretinal fluid (SRF) and Sub-Retinal Pigment Epithelium fluid (sub-RPE) were assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. The number of participants with fluid-free status (simultaneous absence of IRF, SRF, and sub-RPE) was reported for each post-baseline visit. These results were based on analysis using the Last observation carried forward (LOCF) approach for replacement/imputation of censored/missing values and observed data.

    Measured: Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, 76, 80, 84, 88, 92, 96, 100 and 104

  13. Time to First Dry Retina (no IRF or SRF)

    Intraretinal fluid (IRF) and Subretinal fluid (SRF) were assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. A dry retina is defined as no IRF or SRF at the respective visit. Kaplan-Meier method was used for estimate of percentiles with 95% CI based on methodology of Brookmeyer and Crowley. Data was censored at the last time when IRF/SRF assessments for fluid-free retina were available for participants who discontinued on/or prior to the time of the start of alternative anti-VEGF treatment. IRF and SRF assessments on unscheduled visits were considered.

    Measured: Baseline, Up to Week 104 (assessments every 4 weeks)

  14. Time to Sustained Dry Retina (no IRF or SRF at ≥ 2 Consecutive Visits)

    Intraretinal fluid (IRF) and Subretinal fluid (SRF) were assessed using Spectral Domain Optical Coherence Tomography (SD-OCT) images. A sustained dry retina is defined as no IRF or SRF at 2 or more consecutive visits. Kaplan-Meier method was used for estimate of percentiles with 95% CI based on methodology of Brookmeyer and Crowley. Data was censored at the last time when IRF/SRF assessments for fluid-free retina were available for participants who discontinued on/or prior to the time of the start of alternative anti-VEGF treatment. IRF and SRF assessments on unscheduled visits were considered.

    Measured: Baseline, Up to Week 104 (assessments every 4 weeks)

  15. Number of Participants With Anti-drug Antibody (ADA) Negative Status

    A blood sample was collected for anti-drug antibody assessment. ADA negative status = ADA negative result at the corresponding study visit. The baseline sample was collected prior to first dose of study treatment and the post-baseline assessments were taken at the scheduled timepoints. A negative Titer was used to assess the ADA status for the brolucizumab arm.

    Measured: Baseline, weeks 4, 12, 24, 36, 52, 76 and 104

  16. Free Brolucizumab Serum Concentration

    A blood sample was collected for Free Brolucizumab serum concentration assessment. This outcome measure was pre-specified for the brolucizumab arm only. The baseline sample was collected prior to first dose of study treatment and the post-baseline assessments.

    Values below the limit of quantification (BLQ) (<0.5 ng/mL) were replaced by one half of the LLOQ (0.25 ng/mL) in the calculation of the summary statistics. For the Mean score at each visit, if the calculated value was less than 0.5, then "NA" was displayed instead; meaning that the score is below the limit of quantitation (<0.5 ng/mL).

    Measured: pre-dose a baseline, weeks 4, 12, 24, 36, 52, 76 and 104

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Oct 2018
  2. Study start30 Oct 2018
  3. Primary completion21 Dec 2020
  4. Study completion1 Jul 2021

Why it stopped: Sponsor Decision

Resources

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
multicenter, randomized, double-masked
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
535 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03710564
Sponsor's protocol ID
CRTH258AUS04
Acronym
MERLIN
Status last verified
Jan 2023
First submitted
16 Oct 2018
Last updated
30 Jan 2023
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Brolucizumab and Aflibercept in people with Age-Related Macular Degeneration, run by Novartis Pharmaceuticals at 61 sites in 2 countries.

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 3 inclusion and 7 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: stopped early, as of the sponsor's last update on 30 Jan 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 61 sites in United States, Puerto Rico. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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 22 Jul 2022). 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?

Change From Baseline in Best-Corrected Visual Acuity (BCVA) at Week 52 (time frame: Baseline, week 52). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 30 Jan 2023.

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