Neovascular age-related macular degeneration (nAMD), also called wet AMD, can cause serious vision loss. While anti-VEGF (anti Vascular Endothelial Growth Factor) treatments such as ranibizumab help many patients, about 20 40% have a suboptimal response. In this study, the investigators want to identify other factors (beyond VEGF) that might be driving the disease in these non-responding patients. By looking at samples from inside the eye (vitreous humor) and comparing "good responders" to "suboptimal responders", the investigators hope to find potential new treatment approaches or biomarkers for nAMD.
Patients aged ≥ 50 years old at the time of informed consent
Willing and able to provide informed consent
Willingness and ability to comply with all scheduled visits and study procedures
Female subjects must be of non-childbearing potential or show a negative pregnancy test at screening and must agree to use appropriate methods of contraception during the study and for one month after the last dose.
CNV or retinal exudation due to causes other than typical AMD, such as vitelliform dystrophy, ocular histoplasmosis, trauma, pathological myopia, angioid streaks, choroidal rupture, or uveitis
Active intraocular inflammation or suspected or active intraocular or periocular infection (eg, infectious conjunctivitis, keratitis, scleritis, endophthalmitis, infectious blepharitis) in either eye at Baseline
Any history or evidence of a concurrent intraocular condition in the study eye, including retinal diseases other than neovascular AMD, that, in the judgment of the Investigator, could either require medical or surgical intervention during the course of the study to prevent or treat visual loss that might result from that condition or that limits the potential to gain visual acuity upon treatment with the investigational product
History of cataract surgery within 6 months prior to recruitment
Sequential
Faricimab
DrugAll treatment-naïve study eyes will start on the intravitreal ranibizumab loading phase, with the initial injection given within two weeks of the screening visit and overall of x 3 monthly injections. Previously treated eyes will not undergo an in-study loading phase (baseline, week 4 and week 8 visits), as pre-enrolment injections will be considered equivalent. At week 12, patients will be evaluated for their response following the loading phase. Patients who show an absence of IRF, absence of or ≤100µm subretinal fluid (SRF), and no new hemorrhage will be categorized as good responders and will continue with four further monthly intravitreal ranibizumab. Suboptimal responders (defined as the presence of subretinal fluid \> 100 µm, any intraretinal fluid (IRF), or a new hemorrhage) will switch to four doses of monthly intravitreal faricimab.
Ranibizumab
DrugAll treatment naive study eyes will start on the intravitreal ranibizumab loading phase, with the initial injection given within two weeks of the screening visit and overall of x 3 monthly injections. Previously treated eyes will not undergo an in-study loading phase (baseline, week 4 and week 8 visits), as pre-enrolment injections will be considered equivalent. At week 12, patients will be evaluated for their response following the loading phase. Patients who show an absence of IRF, absence of or ≤100µm SRF, and no new hemorrhage will be categorized as good responders and will continue with four further monthly intravitreal ranibizumab. Suboptimal responders (defined as the presence of subretinal fluid \> 100 µm, any intraretinal fluid (IRF), or a new hemorrhage) will switch to four doses of monthly intravitreal faricimab.
Difference in vitreous biomarker concentrations between responders and non-responders
Comparison of inflammatory and angiogenic biomarkers in vitreous humor measured at baseline and week 12.
Change in concentration of inflammatory and angiogenic biomarkers in vitreous humor from baseline to week 12 (including IL-6, IL-8, MCP-1, TNF-α, VEGF-A, PlGF, ANG-2, MMP-2, MMP-9, and complement pathway proteins)
Picograms per milliliter (pg/mL)
Proportion of eyes classified as suboptimal responders at Week 12
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Singapore National Eye Centre
Lead sponsor
Singapore Eye Research Institute
Sponsor institution
