Treatment of Non-infectious Intermediate and Posterior Uveitis Associated Macular Edema With Intravitreal Methotrexate

• Status: Terminated
• Trial end date: 2013-01-01
• Target enrollment: 0
• Participant gender: All

Summary

BACKGROUND:

Uveitis comprises of a group of diseases associated with inflammation of the eye that can lead to vision loss. Some people with uveitis also have macular edema (swelling of the retina at the back of the eye). Uveitis and macular edema are treated with medications and sometimes surgery, but treatment does not always prevent vision loss. Previous research has shown that injections of methotrexate into the eye of people with eye disease other than uveitis can help relieve the inflammation, or swelling, that causes macular edema and can slow visual loss. However, it has not yet been approved as a treatment for macular edema associated with uveitis.

OBJECTIVES:

To evaluate the safety and effectiveness of methotrexate injections as a treatment for macular edema associated with uveitis.

ELIGIBILITY:

Individuals at least 18 years of age who have been diagnosed with uveitis and macular edema in at least one eye.

DESIGN:

• This study requires at least nine visits to the National Eye Institute study clinic over a period of 6 months (24 weeks).

• Participants will be screened with a physical and ophthalmic examination, medical history, blood and urine tests, and additional eye and other tests as needed.

• Participants will receive a methotrexate injection in a selected treatment eye. After the injection, participants will receive antibiotic eye drops to place in the eye three times a day for the 3 days following the injection, leucovorin (folic acid) drops to place in the eye four times a day for 1 week following the injection, and a dose of folic acid to be taken by mouth the day after the injection.

• Participants who tolerate the initial injection may continue to receive injections in their study eye every month for 6 months. After 6 months, participants who show improvement from the injections may be evaluated to receive additional injections every 4 to 8 weeks until researchers end the study.

• Phase: Phase 1/Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Eye Institute (NEI)
• Treatments: Methotrexate

Criteria

INCLUSION CRITERIA:

1. Participant must be 18 years of age or older.

2. Participant must understand and sign the protocol's informed consent document.

3. Participant is willing to comply with the study procedures and return for all study visits.

4. Participant has chronic macular edema secondary to non-infectious panuveitis, posterior or intermediate uveitis in at least one eye (the study eye) that has:

1. not been responsive to conventional immunosuppressive therapy in the past 3 months; OR

2. recurred while on conventional immunosuppressive therapy.

5. Participant has central macular thickness of ≥ 270 microns in the study eye.

6. Participant has visual acuity of 20/400 or better (≥ 19 ETDRS letters) in the study eye.

7. Female participants of childbearing potential must not be pregnant or breast-feeding, must have a negative serum pregnancy test at screening and must be willing to undergo serum pregnancy tests throughout the study.

8. Both female participants of childbearing potential (see Appendix 1 for definition) and male participants able to father children must have (or have a partner who has) had a hysterectomy or vasectomy, be completely abstinent from intercourse or must agree to practice two acceptable methods of contraception throughout the course of the study and for six months after the last study medication injection. Acceptable methods of contraception include:

• hormonal contraception (i.e., birth control pills, injected hormones, dermal patch or vaginal ring),

• intrauterine device,

• barrier methods (diaphragm, condom) with spermicide, or

• surgical sterilization (tubal ligation).

EXCLUSION CRITERIA:

1. Participant is in another investigational study and actively receiving investigational therapy for macular edema.

2. Participant has evidence of infectious panuveitis, posterior or intermediate uveitis in either eye.

3. Participant is expected to need ocular surgery in the study eye during the course of the trial.

4. Participant had intraocular surgery in the study eye within the past 90 days.

5. Participant had an injection of bevacizumab or ranibizumab within the past four weeks in the study eye.

6. Participant had an injection of triamcinolone within the past six weeks in the study eye.

7. Participant has a systemic condition that, in the opinion of the investigator, would preclude participation in the study.

8. Participant has significant cataract or media opacity in the study eye that makes posterior segment visualization difficult as determined by investigator.

9. Participant has a confirmed positive serologic and/or molecular test for HIV-1/2.