Trial Review

Did you know?

The ANZCTR now automatically displays published trial results and simplifies the addition of trial documents such as unpublished protocols and statistical analysis plans.

These enhancements will offer a more comprehensive view of trials, regardless of whether their results are positive, negative, or inconclusive.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this information for consumers
Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/study/NCT02432547




Registration number
NCT02432547
Ethics application status
Date submitted
23/04/2015
Date registered
4/05/2015
Date last updated
31/05/2022

Titles & IDs
Public title
Laser Therapy Combined With Intravitreal Aflibercept vs Intravitreal Aflibercept Monotherapy (LADAMO)
Scientific title
A Phase IV Randomised Clinical Trial of Laser Therapy for Peripheral Retinal Ischaemia Combined With Intravitreal Aflibercept (Eylea®) Versus Intravitreal Aflibercept Monotherapy for Diabetic Macular Oedema
Secondary ID [1] 0 0
X14-0157
Universal Trial Number (UTN)
Trial acronym
LADAMO
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Diabetic Retinopathy 0 0
Condition category
Condition code
Eye 0 0 0 0
Diseases / disorders of the eye
Metabolic and Endocrine 0 0 0 0
Diabetes

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - Aflibercept
Treatment: Surgery - Targeted laser therapy

Active comparator: Aflibercept Monotherapy - Intravitreal aflibercept injections according to a treat and extend regimen.

Experimental: Targeted laser therapy with Aflibercept - Targeted laser photocoagulation therapy to areas of peripheral retinal ischaemia and intravitreal aflibercept injections using a treat and extend regimen.


Treatment: Drugs: Aflibercept
Aflibercept is a soluble decoy receptor and is produced by fusing all-human DNA sequences of the second immunoglobulin (Ig) domain of human VEGF receptor (VEGFR) 1 to the third Ig domain of human VEGFR-2, which are then fused to the Fc region of human IgG-1. By binding to VEGF-A, aflibercept prevents activation of the native VEGF receptors, VEGFR-1 and VEGFR-2. The study sites will be supplied by Bayer with aflibercept. Intravitreal injection of 2mg in 0.05 ml aflibercept will be administered to the study eye, according to a pre-defined treat and extend regimen.

Treatment: Surgery: Targeted laser therapy
In the experimental group, targeted laser photocoagulation will be applied to areas of peripheral retinal ischaemia 1 month after the initial intravitreal aflibercept. The trial design allows another session of targeted laser photocoagulation 1 month later to complete the treatment if required. Wide-field photography is planned at 3 months to determine if further targeted laser photocoagulation is required, and if so a third session can be applied. The laser settings are based on those used in current clinical practice and have been prospectively defined in the protocol.
Intervention code [1] 0 0
Treatment: Drugs
Intervention code [2] 0 0
Treatment: Surgery
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Number of intravitreal aflibercept injections over 24 months
Timepoint [1] 0 0
24 months
Secondary outcome [1] 0 0
Number of intravitreal aflibercept injections over 12 months
Timepoint [1] 0 0
12 months
Secondary outcome [2] 0 0
Proportion of eyes that have central macular thickness <300 microns at 12 months
Timepoint [2] 0 0
12 months
Secondary outcome [3] 0 0
Mean change in central macular thickness (CMT) as measured by OCT at 12 months
Timepoint [3] 0 0
12 months
Secondary outcome [4] 0 0
Mean change in best corrected visual acuity
Timepoint [4] 0 0
12 months
Secondary outcome [5] 0 0
Any change in best corrected visual acuity at 12 months
Timepoint [5] 0 0
12 months
Secondary outcome [6] 0 0
Effect of peripheral retinal ischaemia on number of aflibercept injections
Timepoint [6] 0 0
12 months
Secondary outcome [7] 0 0
Disc vessel measurement
Timepoint [7] 0 0
12 months
Secondary outcome [8] 0 0
Number of intravitreal aflibercept injections in each of the 2 groups required over 24 months
Timepoint [8] 0 0
24 months
Secondary outcome [9] 0 0
Proportion of eyes that have central macular thickness <300 microns at 24 months
Timepoint [9] 0 0
24 months
Secondary outcome [10] 0 0
Mean change in central macular thickness (CMT) as measured by OCT at 24 months
Timepoint [10] 0 0
24 months
Secondary outcome [11] 0 0
Mean change in best corrected visual acuity
Timepoint [11] 0 0
24 months
Secondary outcome [12] 0 0
Any change in best corrected visual acuity at 24 months
Timepoint [12] 0 0
24 months
Secondary outcome [13] 0 0
Effect of peripheral retinal ischaemia on number of aflibercept injections
Timepoint [13] 0 0
24 months
Secondary outcome [14] 0 0
Disc vessel measurement
Timepoint [14] 0 0
24 months
Secondary outcome [15] 0 0
Time until vision stabilisation
Timepoint [15] 0 0
24 months
Secondary outcome [16] 0 0
Quality of life assessment
Timepoint [16] 0 0
24 months
Secondary outcome [17] 0 0
Change in area of macular hard exudates
Timepoint [17] 0 0
24 months
Secondary outcome [18] 0 0
Change in distance of closest hard exudate from the foveal centre
Timepoint [18] 0 0
24 months
Secondary outcome [19] 0 0
Mean change in treatment interval over time
Timepoint [19] 0 0
24 months

Eligibility
Key inclusion criteria
* At screening, the study eye must have DMO with retinal thickness > 300 microns in central 1mm subfield on Spectral domain OCT
* Age >= 18 years
* Diagnosis of diabetes mellitus
* Best corrected visual acuity of 35-79 LogMAR letters at 4 meters (approximately 6/7.5-6/60) in the study eye
* Women of childbearing potential must have a negative urine pregnancy test at the screening visit and prior to treatment. A woman is considered of childbearing potential unless she is postmenopausal and without menses for 12 months or is surgically sterilised
* Peripheral retinal ischaemia affecting an area greater than 10 disc diameters of the wide-field fundus fluorescein angiogram (as per the Central Vein Occlusion Study)
* Centre involving DMO, which in the opinion of the investigator, would not benefit from focal macular laser treatment (e.g. diffuse leak from the capillary bed, disruption of the foveal avascular zone or perifoveal capillary dropout, complete macular grid laser).
* Written informed consent has been obtained
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
* Known allergy to aflibercept or agents used in the study
* Women who are pregnant, nursing, or planning a pregnancy, or who are of childbearing potential and not using reliable means of contraception
* Loss of vision due to other causes (e.g. age related macular degeneration, myopic macular degeneration, retinal vein occlusion) in the study eye.
* Macular oedema due to other causes in the study eye.
* Macula hole, vitreo-macular traction or significant epiretinal membrane in the study eye.
* An ocular condition that would prevent visual acuity improvement despite resolution of oedema (such as foveal atrophy or substantial premacular fibrosis)
* Treatment with intravitreal triamcinolone acetonide (IVTA) within the last 6 months or peribulbar triamcinolone within the last 3 months, or anti-VEGF drugs (bevacizumab, ranibizumab or aflibercept) within the last 2 months in the study eye.
* Cataract surgery within the last 3 months in the study eye
* Previous PRP laser treatment in the study eye
* Previous vitrectomy in study eye
* Media opacity including cataract that already precludes adequate macular photography or cataract that is likely to require surgery within 12 months
* Intercurrent severe disease such as septicaemia, any condition which would affect follow-up or photographic documentation (e.g. geographical, psycho-social)
* History of chronic renal failure requiring dialysis or renal transplant
* Blood pressure >180/110
* Patient has a condition or is in a situation that in the investigator's opinion may put the patient at significant risk, may confound the study results, or may interfere significantly with the patient's participation in the study

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
Intervention assignment
Parallel
Other design features
Phase
Phase 4
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
15/06/2017
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
24/05/2022
Sample size
Target
Accrual to date
Final
48
Recruitment in Australia
Recruitment state(s)
NSW,VIC
Recruitment hospital [1] 0 0
Save Sight Institute - Sydney
Recruitment hospital [2] 0 0
Centre for Eye Research Australia - Melbourne
Recruitment postcode(s) [1] 0 0
2001 - Sydney
Recruitment postcode(s) [2] 0 0
3002 - Melbourne

Funding & Sponsors
Primary sponsor type
Other
Name
University of Sydney
Address
Country
Other collaborator category [1] 0 0
Other
Name [1] 0 0
Center for Eye Research Australia
Address [1] 0 0
Country [1] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
This will be a 24 month phase IV, randomised, prospective, multicentre, clinical trial of laser therapy to areas of peripheral retinal ischaemia combined with intravitreal aflibercept versus intravitreal aflibercept monotherapy. Both arms will have 2mg intravitreal aflibercept according to a treat and extend protocol.

The specific aim of the study is to test whether laser therapy of peripheral retinal ischaemia reduces the overall number of intravitreal aflibercept injections required to control DMO over a 24 month period.
Trial website
https://clinicaltrials.gov/study/NCT02432547
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 0 0
Samantha Fraser-Bell, PhD FRANZCO
Address 0 0
Save Sight Institute
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/study/NCT02432547