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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04619303
Registration number
NCT04619303
Ethics application status
Date submitted
27/10/2020
Date registered
6/11/2020
Titles & IDs
Public title
Intravitreal Dexamethasone vs Bevacizumab in Aboriginal People With DMO
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Scientific title
A Randomized Clinical Trial of Intravitreal dexamethasOne Versus Bevacizumab in Aboriginal and Torres Strait Islander patientS With Diabetic Macular Oedema (The OASIS Study)
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Secondary ID [1]
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OASIS
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Universal Trial Number (UTN)
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Trial acronym
OASIS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Diabetic Macular Edema
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Diabetic Retinopathy
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Condition category
Condition code
Eye
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Diseases / disorders of the eye
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Metabolic and Endocrine
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Diabetes
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Cardiovascular
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Diseases of the vasculature and circulation including the lymphatic system
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Dexamethasone intravitreal implant
Treatment: Drugs - Bevacizumab Injectable Product
Experimental: Dexamethasone Implant - Receive 0.7mg dexamethasone implant (Ozurdex) at baseline visit. Monthly review with repeat administration of intravitreal treatment every three months for DMO and laser as clinically indicated.
Active comparator: Bevacizumab - Receive 1.25mg/0.05ml bevacizumab (Avastin) at baseline visit. Monthly review with repeat administration of intravitreal treatment every one month for DMO and laser as clinically indicated.
Treatment: Drugs: Dexamethasone intravitreal implant
Intravitreal injection of 0.7mg dexamethasone implant
Treatment: Drugs: Bevacizumab Injectable Product
Invtravitreal injection of 1.25mg/0.05mL bevacizumab
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Difference in best corrected visual acuity change between treatment arms
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Assessment method [1]
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The primary outcome measure will be the difference in the BCVA change from baseline to 12 months between treatment arms, with a non-inferiority margin of 0.1 LogMAR (equivalent to one line of Snellen visual acuity). The BCVA will be measured for all study participants at each clinic visit.
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Timepoint [1]
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12 months
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Secondary outcome [1]
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Best corrected visual acuity loss or gain
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Assessment method [1]
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The proportion of participants with a BCVA loss or gain of \<0.3 LogMAR (termed 'stable BCVA'), a BCVA loss of =0.3 LogMAR ('decline in BCVA'), or a BCVA gain of =0.3 LogMAR ('gain in BCVA').
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Timepoint [1]
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12 months
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Secondary outcome [2]
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Change in central macular thickness
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Assessment method [2]
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Change in the CMT from baseline to 12 months as measured by OCT.
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Timepoint [2]
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12 months
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Secondary outcome [3]
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Number of injections
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Assessment method [3]
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Number of IVT injections given per participant.
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Timepoint [3]
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12 months
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Secondary outcome [4]
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Appointments attended
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Assessment method [4]
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Number of appointments attended per participant.
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Timepoint [4]
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12 months
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Secondary outcome [5]
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Intraocular pressure change
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Assessment method [5]
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The change in the mean IOP.
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Timepoint [5]
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12 months
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Secondary outcome [6]
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Intraocular pressure elevation
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Assessment method [6]
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The number of participants with one or more occasions of IOP elevation \>28 mmHg.
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Timepoint [6]
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12 months
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Secondary outcome [7]
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Intraocular pressure elevation requiring treatment
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Assessment method [7]
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IOP elevation requiring medical, laser or surgical treatment.
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Timepoint [7]
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12 months
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Secondary outcome [8]
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Adverse Events
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Assessment method [8]
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Adverse events (AEs), serious adverse events (SAEs) and serious adverse reactions (SARs) coded according to the National Medical Research Council (2016) safety monitoring and reporting in clinical trials definitions.
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Timepoint [8]
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12 months
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Eligibility
Key inclusion criteria
Inclusion criteria:
* Self-identifying as Aboriginal Australian or Torres Strait Islander
* Adults aged 18 years and over
* Diagnosis of DM (type 1 or type 2)
* BCVA of at best 0.2 LogMAR (20/32) 6/9 in the study eye
* Pseudophakic, or phakic with significant lens opacity and scheduled to undergo cataract surgery at the time of enrolment
* Presence of any grade of DR with centre-involving DMO, as defined by clinical examination and OCT scan findings
* Active DMO: Centre-involving/threatening DMO, as defined by clinical examination and OCT scan findings.
* At risk of DMO: Patients scheduled for cataract surgery with non-centre involving DMO who are assessed as being at risk of post-operative centre-involving DMO based on clinical examination, OCT scan findings, and Investigator discretion.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion criteria:
* Intervention: Previous treatment in the study eye including at the time of the first trial treatment with:
* IVT anti-VEGF injections within the last six weeks;
* Macular laser treatment within the last four months;
* IVT triamcinolone or triescence within the last six months; at the time of the first trial treatment.
* History of open-angle glaucoma or steroid-induced IOP elevation that required IOP-lowering treatment or, IOP =25 (Goldmann applanation) on two consecutive clinic visits.
* Eyes with concurrent ocular pathology other than DMO, or a cataract-causing visual loss, including macular ischaemia as determined by clinical examination and FFA imaging.
* Women who are breastfeeding, confirmed as pregnant or planning on becoming pregnant in the next 6-12 months.
* Participants for whom Ozurdex or Avastin treatment are contraindicated as per product information:
* Active or suspected ocular/periocular infections, including most viral diseases of the cornea and conjunctiva, active epithelia herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases.
* Aphakic eyes with rupture of the posterior lens capsule.
* Eyes with an anterior chamber intraocular lens and rupture of the posterior lens capsule.
* Known angina, myocardial infarction, TIA or CVA in the last three months.
* Known hypersensitivity to any components of these products.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
7/02/2017
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
14/02/2020
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Sample size
Target
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Accrual to date
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Final
59
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
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Broome Regional Aboriginal Medical Service - Broome
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Recruitment hospital [2]
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Derby Hospital - Derby
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Recruitment hospital [3]
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Fitzroy Crossing Hospital - Fitzroy Crossing
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Recruitment hospital [4]
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Halls Creek Health Service - Halls Creek
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Recruitment hospital [5]
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Bega Garnbirringu Health Service - Kalgoorlie
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Recruitment hospital [6]
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Nickol Bay Hospital - Karratha
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Recruitment hospital [7]
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Ord Valley Aboriginal Health Service - Kununurra
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Recruitment hospital [8]
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Laverton Hospital - Laverton
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Recruitment hospital [9]
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Derbarl Yerrigan Health Service Inc. - Perth
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Recruitment hospital [10]
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Lions Eye Institute Nedlands - Perth
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Recruitment hospital [11]
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Lions Eye Institute Midland - Perth
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Recruitment hospital [12]
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Mawarnkarra Health Service - Roebourne
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Recruitment hospital [13]
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Wirraka Maya Health Service Aboriginal Corporation - South Hedland
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Recruitment postcode(s) [1]
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6725 - Broome
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Recruitment postcode(s) [2]
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6728 - Derby
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Recruitment postcode(s) [3]
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6728 - Fitzroy Crossing
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Recruitment postcode(s) [4]
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6770 - Halls Creek
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Recruitment postcode(s) [5]
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6430 - Kalgoorlie
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Recruitment postcode(s) [6]
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6714 - Karratha
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Recruitment postcode(s) [7]
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6743 - Kununurra
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Recruitment postcode(s) [8]
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6440 - Laverton
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Recruitment postcode(s) [9]
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6004 - Perth
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Recruitment postcode(s) [10]
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6009 - Perth
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Recruitment postcode(s) [11]
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6056 - Perth
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Recruitment postcode(s) [12]
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6718 - Roebourne
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Recruitment postcode(s) [13]
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6722 - South Hedland
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Funding & Sponsors
Primary sponsor type
Other
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Name
Lions Eye Institute, Perth, Western Australia
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Lions Outback Vision
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Address [1]
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Country [1]
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Other collaborator category [2]
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Commercial sector/industry
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Name [2]
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Allergan
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Address [2]
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Country [2]
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Ethics approval
Ethics application status
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Summary
Brief summary
DMO is the most common cause of visual loss in people with diabetes. Regular injections of bevacizumab (Avastin) given as frequently as every month remain the current standard of care for centre-involving DMO; however, this regimen is impractical for many Aboriginal patients. Using Ozurdex implants every 3-6 months could be as effective as the currently used Avastin injections. In order to address this real-world problem, this study seeks to investigate whether it is possible to safely use a long-acting steroid preparation such as the dexamethasone IVT implant (Ozurdex) to manage DMO in Aboriginal patients living in Western Australia.
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Trial website
https://clinicaltrials.gov/study/NCT04619303
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Trial related presentations / publications
Xie J, Arnold AL, Keeffe J, Goujon N, Dunn RA, Fox S, Taylor HR. Prevalence of self-reported diabetes and diabetic retinopathy in indigenous Australians: the National Indigenous Eye Health Survey. Clin Exp Ophthalmol. 2011 Aug;39(6):487-93. doi: 10.1111/j.1442-9071.2011.02502.x. Epub 2011 Mar 24. Kaidonis G, Mills RA, Landers J, Lake SR, Burdon KP, Craig JE. Review of the prevalence of diabetic retinopathy in Indigenous Australians. Clin Exp Ophthalmol. 2014 Dec;42(9):875-82. doi: 10.1111/ceo.12338. Epub 2014 May 5. Wong J, Molyneaux L, Constantino M, Twigg SM, Yue DK. Timing is everything: age of onset influences long-term retinopathy risk in type 2 diabetes, independent of traditional risk factors. Diabetes Care. 2008 Oct;31(10):1985-90. doi: 10.2337/dc08-0580. Epub 2008 Jul 15. Diabetes Control and Complications Trial Research Group; Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86. doi: 10.1056/NEJM199309303291401. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Ophthalmology. 1995 Apr;102(4):647-61. doi: 10.1016/s0161-6420(95)30973-6. Wong TY, Mwamburi M, Klein R, Larsen M, Flynn H, Hernandez-Medina M, Ranganathan G, Wirostko B, Pleil A, Mitchell P. Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care. 2009 Dec;32(12):2307-13. doi: 10.2337/dc09-0615. Klein R, Klein BE. Blood pressure control and diabetic retinopathy. Br J Ophthalmol. 2002 Apr;86(4):365-7. doi: 10.1136/bjo.86.4.365. No abstract available. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985 Dec;103(12):1796-806. Michaelides M, Kaines A, Hamilton RD, Fraser-Bell S, Rajendram R, Quhill F, Boos CJ, Xing W, Egan C, Peto T, Bunce C, Leslie RD, Hykin PG. A prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema (BOLT study) 12-month data: report 2. Ophthalmology. 2010 Jun;117(6):1078-1086.e2. doi: 10.1016/j.ophtha.2010.03.045. Epub 2010 Apr 22. Diabetic Retinopathy Clinical Research Network; Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, Ferris FL 3rd, Friedman SM, Glassman AR, Miller KM, Scott IU, Stockdale CR, Sun JK. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010 Jun;117(6):1064-1077.e35. doi: 10.1016/j.ophtha.2010.02.031. Epub 2010 Apr 28. Elman MJ, Bressler NM, Qin H, Beck RW, Ferris FL 3rd, Friedman SM, Glassman AR, Scott IU, Stockdale CR, Sun JK; Diabetic Retinopathy Clinical Research Network. Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2011 Apr;118(4):609-14. doi: 10.1016/j.ophtha.2010.12.033. Dewan V, Lambert D, Edler J, Kymes S, Apte RS. Cost-effectiveness analysis of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2012 Aug;119(8):1679-84. doi: 10.1016/j.ophtha.2012.01.049. Epub 2012 Apr 13. Al Dhibi HA, Arevalo JF. Clinical trials on corticosteroids for diabetic macular edema. World J Diabetes. 2013 Dec 15;4(6):295-302. doi: 10.4239/wjd.v4.i6.295. Chew EY, Benson WE, Remaley NA, Lindley AA, Burton TC, Csaky K, Williams GA, Ferris FL 3rd. Results after lens extraction in patients with diabetic retinopathy: early treatment diabetic retinopathy study report number 25. Arch Ophthalmol. 1999 Dec;117(12):1600-6. doi: 10.1001/archopht.117.12.1600. Cetin EN, Yildirim C. Adjuvant treatment modalities to control macular edema in diabetic patients undergoing cataract surgery. Int Ophthalmol. 2013 Oct;33(5):605-10. doi: 10.1007/s10792-012-9695-1. Epub 2012 Dec 18. Chang-Lin JE, Attar M, Acheampong AA, Robinson MR, Whitcup SM, Kuppermann BD, Welty D. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant. Invest Ophthalmol Vis Sci. 2011 Jan 5;52(1):80-6. doi: 10.1167/iovs.10-5285. Zalewski D, Raczynska D, Raczynska K. Five-month observation of persistent diabetic macular edema after intravitreal injection of Ozurdex implant. Mediators Inflamm. 2014;2014:364143. doi: 10.1155/2014/364143. Epub 2014 Feb 10. Dutra Medeiros M, Postorino M, Navarro R, Garcia-Arumi J, Mateo C, Corcostegui B. Dexamethasone intravitreal implant for treatment of patients with persistent diabetic macular edema. Ophthalmologica. 2014;231(3):141-6. doi: 10.1159/000356413. Epub 2013 Dec 19. Zucchiatti I, Lattanzio R, Querques G, Querques L, Del Turco C, Cascavilla ML, Bandello F. Intravitreal dexamethasone implant in patients with persistent diabetic macular edema. Ophthalmologica. 2012;228(2):117-22. doi: 10.1159/000336225. Epub 2012 Feb 3. Haller JA, Kuppermann BD, Blumenkranz MS, Williams GA, Weinberg DV, Chou C, Whitcup SM; Dexamethasone DDS Phase II Study Group. Randomized controlled trial of an intravitreous dexamethasone drug delivery system in patients with diabetic macular edema. Arch Ophthalmol. 2010 Mar;128(3):289-96. doi: 10.1001/archophthalmol.2010.21. Boyer DS, Faber D, Gupta S, Patel SS, Tabandeh H, Li XY, Liu CC, Lou J, Whitcup SM; Ozurdex CHAMPLAIN Study Group. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina. 2011 May;31(5):915-23. doi: 10.1097/IAE.0b013e318206d18c. Hariprasad SM, Mieler WF, Grassi M, Green JL, Jager RD, Miller L. Vision-related quality of life in patients with diabetic macular oedema. Br J Ophthalmol. 2008 Jan;92(1):89-92. doi: 10.1136/bjo.2007.122416. Epub 2007 Jun 21. Chen E, Looman M, Laouri M, Gallagher M, Van Nuys K, Lakdawalla D, Fortuny J. Burden of illness of diabetic macular edema: literature review. Curr Med Res Opin. 2010 Jul;26(7):1587-97. doi: 10.1185/03007995.2010.482503.
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Public notes
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Contacts
Principal investigator
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Angus Turner, FRANZCO
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Address
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Lions Eye Institute
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Phone
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Fax
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Email
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Contact person for public queries
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
De-identified individual patient data as well as visit data with primary and secondary outcome data and accompanying data dictionary will be made available.
Supporting document/s available: Study protocol, Statistical analysis plan (SAP), Informed consent form (ICF), Analytic code
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When will data be available (start and end dates)?
6 months
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Available to whom?
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
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Other Details
Attachment
Study protocol
Study Protocol and Statistical Analysis Plan
https://cdn.clinicaltrials.gov/large-docs/03/NCT04619303/Prot_SAP_000.pdf
Statistical analysis plan
Study Protocol and Statistical Analysis Plan
https://cdn.clinicaltrials.gov/large-docs/03/NCT04619303/Prot_SAP_000.pdf
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04619303