Clinical Evaluation of Pazopanib Eye Drops versus Ranibizumab Intravitreal Injections in Subjects with Neovascular Age-Related Macular Degeneration
To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops. A total of 510 subjects (...
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Published in | Ophthalmology (Rochester, Minn.) Vol. 122; no. 3; pp. 579 - 588 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.03.2015
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Abstract | To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops.
A total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti–vascular endothelial growth factor intravitreal injections.
Treatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n = 73); pazopanib 5 mg/ml instilled 3 (n = 72) or 4 times daily (n = 74); pazopanib 10 mg/ml instilled 2 (n = 73), 3 (n = 73), or 4 times daily (n = 72); or ranibizumab injection administered once every 4 weeks (n = 73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed.
The main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24.
At week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3–1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were application site pain (3%) and injection site hemorrhage (1%), respectively. No treatment-related serious adverse events were reported.
Pazopanib was well tolerated. Daily pazopanib eye drops in neovascular AMD subjects did not result in therapeutic benefit beyond that obtained with ranibizumab alone. |
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AbstractList | Purpose To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Design Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops. Participants A total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti–vascular endothelial growth factor intravitreal injections. Methods Treatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n = 73); pazopanib 5 mg/ml instilled 3 (n = 72) or 4 times daily (n = 74); pazopanib 10 mg/ml instilled 2 (n = 73), 3 (n = 73), or 4 times daily (n = 72); or ranibizumab injection administered once every 4 weeks (n = 73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed. Main Outcome Measures The main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24. Results At week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3–1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were application site pain (3%) and injection site hemorrhage (1%), respectively. No treatment-related serious adverse events were reported. Conclusions Pazopanib was well tolerated. Daily pazopanib eye drops in neovascular AMD subjects did not result in therapeutic benefit beyond that obtained with ranibizumab alone. To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops. A total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti–vascular endothelial growth factor intravitreal injections. Treatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n = 73); pazopanib 5 mg/ml instilled 3 (n = 72) or 4 times daily (n = 74); pazopanib 10 mg/ml instilled 2 (n = 73), 3 (n = 73), or 4 times daily (n = 72); or ranibizumab injection administered once every 4 weeks (n = 73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed. The main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24. At week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3–1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were application site pain (3%) and injection site hemorrhage (1%), respectively. No treatment-related serious adverse events were reported. Pazopanib was well tolerated. Daily pazopanib eye drops in neovascular AMD subjects did not result in therapeutic benefit beyond that obtained with ranibizumab alone. To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops. A total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti-vascular endothelial growth factor intravitreal injections. Treatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n=73); pazopanib 5 mg/ml instilled 3 (n=72) or 4 times daily (n=74); pazopanib 10 mg/ml instilled 2 (n=73), 3 (n=73), or 4 times daily (n=72); or ranibizumab injection administered once every 4 weeks (n=73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed. The main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24. At week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3-1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were application site pain (3%) and injection site hemorrhage (1%), respectively. No treatment-related serious adverse events were reported. Pazopanib was well tolerated. Daily pazopanib eye drops in neovascular AMD subjects did not result in therapeutic benefit beyond that obtained with ranibizumab alone. To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).PURPOSETo evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops.DESIGNMulticountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops.A total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti-vascular endothelial growth factor intravitreal injections.PARTICIPANTSA total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti-vascular endothelial growth factor intravitreal injections.Treatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n=73); pazopanib 5 mg/ml instilled 3 (n=72) or 4 times daily (n=74); pazopanib 10 mg/ml instilled 2 (n=73), 3 (n=73), or 4 times daily (n=72); or ranibizumab injection administered once every 4 weeks (n=73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed.METHODSTreatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n=73); pazopanib 5 mg/ml instilled 3 (n=72) or 4 times daily (n=74); pazopanib 10 mg/ml instilled 2 (n=73), 3 (n=73), or 4 times daily (n=72); or ranibizumab injection administered once every 4 weeks (n=73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed.The main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24.MAIN OUTCOME MEASURESThe main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24.At week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3-1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were application site pain (3%) and injection site hemorrhage (1%), respectively. No treatment-related serious adverse events were reported.RESULTSAt week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3-1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were application site pain (3%) and injection site hemorrhage (1%), respectively. No treatment-related serious adverse events were reported.Pazopanib was well tolerated. Daily pazopanib eye drops in neovascular AMD subjects did not result in therapeutic benefit beyond that obtained with ranibizumab alone.CONCLUSIONSPazopanib was well tolerated. Daily pazopanib eye drops in neovascular AMD subjects did not result in therapeutic benefit beyond that obtained with ranibizumab alone. |
Author | Dugel, Pravin U. Wurzelmann, John I. Kelly, Deborah S. Xu, Chun-Fang Fries, Michael A. Csaky, Karl G. Pierce, Amy J. Hossain, Mohammad Danis, Ronald P. Trivedi, Trupti |
Author_xml | – sequence: 1 givenname: Karl G. surname: Csaky fullname: Csaky, Karl G. organization: Retina Foundation of the Southwest, Dallas, Texas – sequence: 2 givenname: Pravin U. surname: Dugel fullname: Dugel, Pravin U. organization: Retinal Consultants of Arizona, Phoenix, Arizona – sequence: 3 givenname: Amy J. surname: Pierce fullname: Pierce, Amy J. organization: GlaxoSmithKline, King of Prussia, Pennsylvania – sequence: 4 givenname: Michael A. surname: Fries fullname: Fries, Michael A. organization: GlaxoSmithKline, King of Prussia, Pennsylvania – sequence: 5 givenname: Deborah S. surname: Kelly fullname: Kelly, Deborah S. organization: GlaxoSmithKline, King of Prussia, Pennsylvania – sequence: 6 givenname: Ronald P. surname: Danis fullname: Danis, Ronald P. organization: Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin – sequence: 7 givenname: John I. surname: Wurzelmann fullname: Wurzelmann, John I. email: wurzelma@gmail.com organization: GlaxoSmithKline, King of Prussia, Pennsylvania – sequence: 8 givenname: Chun-Fang surname: Xu fullname: Xu, Chun-Fang organization: GlaxoSmithKline, King of Prussia, Pennsylvania – sequence: 9 givenname: Mohammad surname: Hossain fullname: Hossain, Mohammad organization: GlaxoSmithKline, King of Prussia, Pennsylvania – sequence: 10 givenname: Trupti surname: Trivedi fullname: Trivedi, Trupti organization: GlaxoSmithKline, King of Prussia, Pennsylvania |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25432081$$D View this record in MEDLINE/PubMed |
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Copyright | 2015 American Academy of Ophthalmology American Academy of Ophthalmology Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. |
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Keywords | OCT AE CFH CI IVT VEGF IR CNV VA QID PED TID BCVA SAE AMD FA PK SR fluorescein angiography optical coherence tomography 4 times daily serious adverse event subretinal pharmacokinetic age-related macular degeneration choroidal neovascularization visual acuity adverse event 3 times daily vascular endothelial growth factor best-corrected visual acuity intravitreal confidence interval intraretinal pigment epithelial detachment complement factor H |
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Snippet | To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).... Purpose To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration... To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration... |
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SubjectTerms | Aged Angiogenesis Inhibitors - adverse effects Angiogenesis Inhibitors - therapeutic use Antibodies, Monoclonal, Humanized - adverse effects Antibodies, Monoclonal, Humanized - therapeutic use Biomarkers - metabolism Double-Blind Method Female Fluorescein Angiography Humans Intravitreal Injections Male Neoplasm Proteins - genetics Ophthalmic Solutions Ophthalmology Pharmacogenetics Pyrimidines - adverse effects Pyrimidines - therapeutic use Ranibizumab Receptors, Vascular Endothelial Growth Factor - antagonists & inhibitors Sulfonamides - adverse effects Sulfonamides - therapeutic use Tomography, Optical Coherence Visual Acuity Wet Macular Degeneration - drug therapy Wet Macular Degeneration - genetics Wet Macular Degeneration - physiopathology |
Title | Clinical Evaluation of Pazopanib Eye Drops versus Ranibizumab Intravitreal Injections in Subjects with Neovascular Age-Related Macular Degeneration |
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