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 inOphthalmology (Rochester, Minn.) Vol. 122; no. 3; pp. 579 - 588
Main Authors Csaky, Karl G., Dugel, Pravin U., Pierce, Amy J., Fries, Michael A., Kelly, Deborah S., Danis, Ronald P., Wurzelmann, John I., Xu, Chun-Fang, Hossain, Mohammad, Trivedi, Trupti
Format Journal Article
LanguageEnglish
Published 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.
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
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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
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CFH
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VEGF
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CNV
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PED
TID
BCVA
SAE
AMD
FA
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fluorescein angiography
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PublicationTitleAlternate Ophthalmology
PublicationYear 2015
Publisher Elsevier Inc
Publisher_xml – name: Elsevier Inc
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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
URI https://www.clinicalkey.com/#!/content/1-s2.0-S0161642014009427
https://www.clinicalkey.es/playcontent/1-s2.0-S0161642014009427
https://dx.doi.org/10.1016/j.ophtha.2014.09.036
https://www.ncbi.nlm.nih.gov/pubmed/25432081
https://www.proquest.com/docview/1658425387
Volume 122
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