Clinical Trials
Clinical trials are controlled tests to see whether a promising intervention is safe and effective.
Initial tests are done on cellular or animal models to establish “Proof of principle” If these test are successful then funding and authorization for a human clinical trial is sought.
Clinical trials are registered with a government agency – FDA in America, EMA in Europe and the Department of Health in South Africa.
Clinical trials are usually conducted in three phases with rigorous control and review at every stage. Trials can only progress to the next phase when all data and safety information has been reviewed by a board.
Phase 1
This is usually a small group of patients who live in close proximity to the clinic conducting the trial. The primary outcome is usually safety only. If there are no adverse events, permission will then be granted to go onto the next phase.
Phase 2
This involves more patients and safety, dosage and effectiveness is studied. This will typically be fewer than 50 patients, but varies tremendously. Again, once all data has been assessed, then permission is given for the next phase.
Phase 3
These often go to multicentre trials as in IRD the number of patients at a single clinic may not be sufficient to achieve the required results.
The endpoint of a Phase 3 trial is usually effectiveness prior to registration
A Clinical trial is not a cure.
Many IRD are considered as Orphan [ rare ] diseases and are often given special priority and dispensations.
The estimated incidence of IRD are:
- AMD [65+ age group]
- 25% Caucasians, 15% Coloured, 10% Indian/ Asian, 1% Black African
- Retinitis Pigmentosa [1 / 3000]
- Stargardt Dystrophy [1/ 8 000]
- Leber Congenital Amaurosis [3 / 100 000]
- Usher Syndrome – Type 1[1 / 12000], Type 2 [ 1 / 25 000]
Clinical Trial Progress
The table below shows clinical trial progress for specific retinal conditions.
For more information click on the trial organisers name.
Source Foundation Fighting Blindness, USA.
GENE THERAPIES | PROGRESS |
Achromatopsia (CNGB3) – AGTC | Phase 1/2 |
Achromatopsia (CNGB3) – MeiraGTx / Janssen | Phase 1/2 |
Achromatopsia (CNGA3) – MeiraGTx / Janssen | Phase 1/2 |
Achromatopsia (CNGA3) – Tubingen Hosp | Phase 1/2 |
AMD-dry – Gyroscope | Phase 2 |
Batten disease (CLN5) – Neurogene | Phase 1/2 |
Choroideremia (REP1) – 4DMT | Phase 1/2 |
Choroideremia (REP1) – Tubingen Hosp | Phase 2 |
LCA (GUCY2D) – Atsena | Phase 1/2 |
LCA (CEP290, CRISPR) – Editas | Phase 1/2 |
LCA and RP (RPE65) – MeiraGTx / Janssen | Phase 1/2 |
RP (PDE6B) – Coave | Phase 1/2 |
RP (RLBP1) – Novartis | Phase 1/2 |
RP (NR2E3, RHO) – Ocugen | Phase 1/2 |
RP (PDE6A) – Tubingen Hosp | Phase 1/2 |
Retinoschisis (RS1) – NEI | Phase 1/2 |
X-linked RP (RPGR) – AGTC | Phase 3 |
X-linked RP (RPGR) – MeiraGTx / Janssen | Phase 1/2 |
X-linked RP (RPGR) – 4DMT | Phase 1/2 |
RNA/OTHER (MECHANISM) | PROGRESS |
AMD-dry (CB inhibitor) – Ionis | Phase 2 |
AMD-dry (C5 inhibitor) – Iveric bio | Phase 3 |
LCA (CEP290, AON) – ProQR | Phase 2/3 |
RP, Usher, others (optogenetic) – Bionic Sight | Phase 1/2 |
RP, Usher, others (optogenetic) – GenSight | Phase 1/2 |
RP, Usher, others (optogenetic) – Nanoscope | Phase 2 |
Stargardt disease (optogenetic) – Nanoscope | Phase 2 |
Usher syndrome 2A (AON) – ProQR | Phase 2/3 |
CELL-BASED THERAPIES (CELL TYPE) | PROGRESS |
AMD-dry (RPE) – Lineage | Phase 1/2 |
AMD-dry (RPE) – Luxa | Phase 1/2 |
AMD-dry (RPE from iPSC) – NEI | Phase 1/2 |
AMD-dry (RPE on scaffold) – Regen Patch | Phase 1/2 |
RP, Usher (retinal progenitors) – jCyte | Phase 2b |
SMALL MOLECULES (MECHANISM) | PROGRESS |
AMD-dry (C3 inhibitor) – Apellis | Phase 3 |
RP (NAC-anti-oxidant) – Johns Hopkins | Phase 2 |
RP (methotrexate) – Aldeyra | Phase 2 |
RP (small molecule) – Endogena | Phase 1/2 |
PR (small molecule, photoswtich) – Kiora | Phase 1/2 |
Stargardt disease (emixustat) – Kubota | Phase 3 |
Stargardt disease (deuterated vit A) – Alkeus | Phase 2 |
Stargardt disease (C5 inhibitor) – IVERIC bio | Phase 2 |
Stargardt disease (anti-RBP4) – Belite Bio | Phase 3 |
Stargardt disease (metformin) – NEI | Phase 1/2 |
Usher syndrome (NACA-anti-oxidant) – Nacuity | Phase 1/2 |
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