Protocol summary

Study aim
Assessment and comparison of the efficacy of intravitreal bevacizumab and intravitreal dexamethasone co-therapy with intravitreal bevacizumab monotherapy in the treatment of patients with persistent diabetic macular edema
Design
Non-randomized, superiority, two-arm parallel trial
Settings and conduct
Torfeh Medical Center (a tertiary referral eye center)
Participants/Inclusion and exclusion criteria
Inclusion criteria: 1) patients with type 2 diabetes mellitus, 2) at least 18 years of age, 3) BCVA>20/400, 4) persistent DME: patients who had received at least 3 intravitreal injections of Bevacizumab given at monthly intervals but still had a CMT >300 microns caused by intraretinal or subretinal fluid as well as a reduction of <10% of baseline CMT based on spectral-domain OCT (SD-OCT) measured 1 month after at least 3 intravitreal bevacizumab injections Exclusion criteria: Panretinal photocoagulation (PRP), any intraocular surgery, or intravitreal steroids within the temporal vicinity of the study period; previous Pars Plana vitrectomy; intraocular pressure (IOP)>21, diagnosed glaucoma, or history of a steroid-induced rise in IO; concomitant retinal disorder causing macular edema; present vitreous hemorrhage, media opacities, ocular inflammation; myopia ≥ 6D; and poor quality OCT images.
Intervention groups
Group 1: three monthly intravitreal injections of bevacizumab (1.25 mg) Group 2: three monthly intravitreal injections of bevacizumab (1.25 mg) + intravireal dexamethasone (200 micrograms)
Main outcome variables
1- Best-corrected visual acuity 2- Central macular thickness

General information

Reason for update
Acronym
IRCT registration information
IRCT registration number: IRCT20220328054362N1
Registration date: 2022-08-22, 1401/05/31
Registration timing: retrospective

Last update: 2022-08-22, 1401/05/31
Update count: 0
Registration date
2022-08-22, 1401/05/31
Registrant information
Name
Hosein Nouri
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 21 2258 5952
Email address
hosein.nouri.2018@gmail.com
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2019-02-04, 1397/11/15
Expected recruitment end date
2021-08-11, 1400/05/20
Actual recruitment start date
2019-02-04, 1397/11/15
Actual recruitment end date
2021-08-11, 1400/05/20
Trial completion date
2021-12-21, 1400/09/30
Scientific title
Comparison of the effectiveness of Intravitreal bevacizumab and intravitreal dexamethasone with intravitreal bevacizumab in the treatment of diabetic macular edema
Public title
Intravitreal bevacizumab alone or in combination with intravitreal dexamethasone for the treatment of diabetic macular edema
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
patients with type 2 diabetes mellitus at least 18 years of age best-corrected visual acuity >20/400 persistent DME - i.e., patients who had received at least 3 intravitreal injections of Bevacizumab given at monthly intervals but still had a CMT >300 microns caused by intraretinal or subretinal fluid as well as a reduction of <10% of baseline CMT based on spectral domain OCT (SD-OCT) measured 1 month after at least 3 intravitreal bevacizimab injections Time from the last intravitreal injection more than 1 month and less than 2 months
Exclusion criteria:
Patients who had undergone laser photocoagulation (PRP) during the last 3 months or needed PRP until the end of the study patients who had received intravitreal steroids within the last 6 months Patients who had undergone any intraocular surgery during the last 3 months Patients with previous Pars Plana vitrectomy Patients with intraocular pressure (IOP)>21 or known cases of primary or secondary glaucoma or history of steroid responding Patients with other concomitant retinal disorders that could give rise to macular edema Patients with vitreous hemorrhage, media opacities, ocular inflammation myopia ≥ 6D those with poor quality OCT images
Age
From 18 years old
Gender
Both
Phase
3
Groups that have been masked
No information
Sample size
Target sample size: 54
More than 1 sample in each individual
Number of samples in each individual: 2
Individuals' eyes were the samples in this study; from each individual one or both eyes were recruited, subject to the eye(s) fulfilling the recruitment criteria
Actual sample size reached: 81
More than 1 sample in each individual
Actual sample size in each individual: 2
Individuals' eyes were the samples in this study; from each individual one or both eyes were recruited, subject to the eye(s) fulfilling the recruitment criteria.
Randomization (investigator's opinion)
Not randomized
Randomization description
Blinding (investigator's opinion)
Not blinded
Blinding description
Placebo
Not used
Assignment
Parallel
Other design features

Secondary Ids

empty

Ethics committees

1

Ethics committee
Name of ethics committee
Ethics committee of Shahid Beheshti University of Medical Science
Street address
7th Floor, Bldg No. 2 SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak
City
Tehran
Province
Tehran
Postal code
1983963113
Approval date
2022-03-15, 1400/12/24
Ethics committee reference number
IR.SBMU.MSP.REC.1400.840

Health conditions studied

1

Description of health condition studied
Diabetic macular edema
ICD-10 code
E08.311
ICD-10 code description
Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema

Primary outcomes

1

Description
Best-corrected visual acuity (Logarithm of the Minimum Angle of Resolution)
Timepoint
before intervention and 1 month after the last injection
Method of measurement
Snellen chart

2

Description
Central macular thickness
Timepoint
before intervention and 1 month after the last injection
Method of measurement
Spectral-domain optical coherence tomography (SD-OCT; 6 × 6 mm images taken with the macular cube protocol on the Heidelberg SD-OCT)

Secondary outcomes

1

Description
Incidence of intraocular pressure rise (adverse event)
Timepoint
1 month after the last injection
Method of measurement
Goldmann applanation tonometry

2

Description
Incidence of other adverse events (endophthalmitis, uveitis, vitreous hemorrhage, rupture, and retinal detachment)
Timepoint
throughout the intervention and one-month follow-up periods
Method of measurement
Reported by participants - Relevant diagnostic workup upon presentation of symptoms in participants' eyes

Intervention groups

1

Description
Routine intervention group: Three consecutive monthly intravitreal injection of 1.25 mg bevacizumab (Avastin®100mg/4ml Vial, Roche Pharma, Switzerland)
Category
Treatment - Drugs

2

Description
Additive intervention group: three consecutive monthly intravitreal co-injections of 1.25 mg bevacizumab (Avastin®100mg/4ml Vial, Roche Pharma, Switzerland) and 200 μg of intravitreal dexamethasone (Dexon® 8mg/2ml Amp, Sinadarou, Iran)
Category
Treatment - Drugs

Recruitment centers

1

Recruitment center
Name of recruitment center
Torfeh Hospital
Full name of responsible person
Saeed Karimi
Street address
Ibn-Sina St, District 12
City
Tehran
Province
Tehran
Postal code
1149847514
Phone
+98 21 7762 6550
Fax
+98 21 7753 4171
Email
TorfeHospital@sbmu.ac.ir

Sponsors / Funding sources

1

Sponsor
Name of organization / entity
Shahid Beheshti University of Medical Sciences
Full name of responsible person
Afshin Zarghi
Street address
Building No. 2 - Shahid Arabi St., Yemen St., Shahid Chamran Highway
City
Tehran
Province
Tehran
Postal code
1985717443
Phone
+98 21 2243 9780
Email
info@sbmu.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Shahid Beheshti University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic

Person responsible for general inquiries

Contact
Name of organization / entity
Shahid Beheshti University of Medical Sciences
Full name of responsible person
Saeed Karimi
Position
Associate professor
Latest degree
Subspecialist
Other areas of specialty/work
Ophthalmology
Street address
Ibn-Sina St, District 12
City
Tehran
Province
Tehran
Postal code
1149847514
Phone
+98 21 7762 6559
Fax
+98 21 7753 4171
Email
dr.saeedkarimi@gmail.com

Person responsible for scientific inquiries

Contact
Name of organization / entity
Shahid Beheshti University of Medical Sciences
Full name of responsible person
Saeed Karimi
Position
Associate professor
Latest degree
Subspecialist
Other areas of specialty/work
Ophthalmology
Street address
Ibn-Sina St, District 12
City
Tehran
Province
Tehran
Postal code
1149847514
Phone
+98 21 7762 6559
Fax
+98 21 7753 4171
Email
dr.saeedkarimi@gmail.com

Person responsible for updating data

Contact
Name of organization / entity
Shahid Beheshti University of Medical Sciences
Full name of responsible person
Hosein Nouri
Position
Researcher
Latest degree
Medical doctor
Other areas of specialty/work
Ophthalmology
Street address
Ophthalmic Research Center, Labbafinejad Medical Center, Boustan 9, Paydarfard, Pasdaran, Tehran, Iran.
City
Tehran
Province
Tehran
Postal code
1666673111
Phone
+98 21 2258 5952
Fax
Email
hosein.nouri.2018@gmail.com

Sharing plan

Deidentified Individual Participant Data Set (IPD)
Undecided - It is not yet known if there will be a plan to make this available
Study Protocol
Undecided - It is not yet known if there will be a plan to make this available
Statistical Analysis Plan
Undecided - It is not yet known if there will be a plan to make this available
Informed Consent Form
Undecided - It is not yet known if there will be a plan to make this available
Clinical Study Report
Undecided - It is not yet known if there will be a plan to make this available
Analytic Code
Not applicable
Data Dictionary
Undecided - It is not yet known if there will be a plan to make this available
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