Study Evaluating the Efficacy and Safety of Chloroprocaine HCl Ophthalmic Gel 3% vs Proparacaine Ophthalmic Solution 0.5% Plus Subconjunctival Lidocaine in Patients Undergoing Intravitreal Injections

Official title

A Phase 4, Multisite, Randomized, Double-Masked, Well-Controlled Study Evaluating the Efficacy and Safety of Chloroprocaine HCl Ophthalmic Gel 3% vs Proparacaine Ophthalmic Solution 0.5% Plus Subconjunctival Lidocaine in Patients Undergoing Intravitreal Injections: The QUELL Study

Overview

This Phase 4, multicenter, randomized, double-masked clinical study evaluates the efficacy and safety of chloroprocaine hydrochloride ophthalmic gel 3% (IHEEZO) compared with routine anesthesia (topical proparacaine 0.5% combined with subconjunctival lidocaine 2%) for ocular surface anesthesia during intravitreal injection procedures. Adult participants scheduled to undergo unilateral intravitreal injection of an FDA-approved anti-vascular endothelial growth factor (anti-VEGF) agent for retinal conditions will be randomized in a 1:1 ratio to receive either IHEEZO with a sham subconjunctival procedure or routine anesthesia. The primary objective is to determine whether IHEEZO is non-inferior to routine anesthesia in achieving successful ocular surface anesthesia, defined as a participant-reported pain score of 0 or 1 (on a 0-5 ordinal pain scale) immediately before and immediately after intravitreal injection. Secondary outcomes include individual and cumulative pain scores, change from baseline in dry eye symptoms measured by the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and ocular safety assessments through Day 7 follow-up.

Detailed description

This is a prospective, multicenter, randomized, double-masked, controlled Phase 4 clinical trial evaluating the non-inferiority of chloroprocaine hydrochloride ophthalmic gel 3% (IHEEZO) compared with routine anesthesia (topical proparacaine 0.5% plus subconjunctival lidocaine 2%) for ocular surface anesthesia during intravitreal injection (IVT).

Adults scheduled to undergo unilateral intravitreal injection of an FDA-approved anti-vascular endothelial growth factor (anti-VEGF) agent for neovascular age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or diabetic retinopathy will be randomized 1:1 to receive either IHEEZO with a sham subconjunctival procedure or routine anesthesia. Randomization will be stratified by clinical site and baseline ocular dryness severity (Standard Patient Evaluation of Eye Dryness \[SPEED\] score).

Participants in the experimental arm will receive three topical drops of chloroprocaine ophthalmic gel 3% followed by a sham subconjunctival procedure. Participants in the comparator arm will receive three topical drops of proparacaine 0.5% followed by subconjunctival lidocaine 2%. Standard antiseptic preparation with 5% povidone-iodine will be performed prior to IVT in both arms.

The primary endpoint is the proportion of participants achieving successful ocular surface anesthesia, defined as a pain score of 0 or 1 on a 0-5 ordinal pain scale both immediately before and immediately after IVT. Participants requiring rescue anesthesia prior to or during IVT will be considered treatment failures.

Secondary endpoints include individual and cumulative pain scores, change from baseline in SPEED questionnaire score, and ocular safety assessments including best-corrected visual acuity, intraocular pressure, corneal fluorescein staining (Oxford scale), and treatment-emergent adverse events through Day 7 (±2 days). Participants will be followed for approximately 7 days after injection.

Interventions

• Drug Chloroprocaine Ophthalmic Gel 3% (IHEEZO)
  Preservative-free chloroprocaine hydrochloride ophthalmic gel 3% administered as 3 topical drops to the study eye prior to intravitreal injection.
• Procedure Sham Subconjunctival Injection
  Sham procedure performed using a syringe with a blunt-tipped cannula that does not contact the conjunctiva, performed to maintain masking prior to intravitreal injection.
• Drug Proparacaine Hydrochloride Ophthalmic Solution 0.5%
  Topical proparacaine hydrochloride ophthalmic solution 0.5% administered as 3 drops to the study eye prior to intravitreal injection.
• Drug Lidocaine Hydrochloride Injection 2%
  Subconjunctival injection of lidocaine hydrochloride 2% administered after topical proparacaine and prior to intravitreal injection.

Primary outcome measures

• Proportion of Participants Achieving Successful Ocular Surface Anesthesia [Time frame: Immediately before and immediately after intravitreal injection (Day 1)]

Secondary outcome measures (10)

• Pain Score Immediately Before Intravitreal Injection [Time frame: Immediately before intravitreal injection (Day 1)]
• Pain Score Immediately After Intravitreal Injection [Time frame: Immediately after intravitreal injection (Day 1)]
• Pain Score at Evening Follow-Up [Time frame: Evening of Day 1 (3-12 hours post-injection)]
• Pain Score at 24 Hours Post-Injection [Time frame: Day 2 (20-28 hours post-injection)]
• Cumulative 24-Hour Pain Score [Time frame: Day 1 through 24 hours post-injection]
• Change From Baseline in SPEED Questionnaire Score [Time frame: Baseline, Evening Day 1, and Day 2 (20-28 hours)]
• Change in Best-Corrected Visual Acuity [Time frame: Time Frame: Baseline and Day 7 ± 2 days]
• Change in Intraocular Pressure [Time frame: Time Frame: Baseline and Day 7 ± 2 days]
• Corneal Fluorescein Staining Score [Time frame: Time Frame: Baseline, post-injection Day 1, and Day 7 ± 2 days]
• Incidence of Treatment-Emergent Adverse Events [Time frame: Time Frame: Day 1 through Day 7 ± 2 days Unit: Number of participants with ≥1 TEA]

Eligibility criteria

Inclusion criteria

• Able to understand and voluntarily provide written informed consent prior to initiation of any study-specific procedures
• Male or female, age ≥ 18 years
• Scheduled to undergo unilateral, uncomplicated intravitreal injection of an FDA-approved, non-biosimilar anti-VEGF agent in the study eye
• Diagnosis requiring anti-vascular endothelial growth factor (anti-VEGF) treatment, including macular edema (cystoid or diabetic), retinal vein occlusion, diabetic retinopathy, or neovascular age-related macular degeneration
• At least three prior intravitreal anti-VEGF injections in the study eye
• Fewer than 13 intravitreal anti-VEGF injections in the study eye within the last 365 days
• Willing and able to comply with study procedures and follow-up assessments

Exclusion criteria

• Scheduled to undergo simultaneous bilateral intravitreal injection
• Pre-existing eye pain in the study eye
• Fewer than three prior intravitreal anti-VEGF injections in the study eye within 365 days prior to enrollment
• Mental disability or cognitive impairment that prevents reliable pain assessment
• Prisoner
• Pregnant or breastfeeding
• Woman of childbearing potential not using an acceptable method of contraception
• Inability to comply with study procedures or follow-up assessments
• Known sensitivity or allergy to any study medications or related drug classes
• History of resistance to local anesthetics
• History of Ehlers-Danlos syndrome
• Participation in another investigational drug or device study within 30 days prior to screening (unless previously randomized to a control group receiving Eylea, Eylea HD, Lucentis, or Vabysmo)
• Use of pain medication, opioids, analgesics, or NSAIDs (any route) within 24 hours prior to Visit 1
• Clinically significant systemic disease or condition that, in the Investigator's judgment, may compromise safety or study integrity
• Cataract extraction, intraocular surgery, or extraocular surgery within 60 days prior to enrollment that may affect ocular pain
• History of autoimmune disease, graft-versus-host disease, fibromyalgia, uveitis, neurotrophic corneal disease, keratitis or corneal ulceration, uncontrolled glaucoma, or herpetic ocular disease
• History of endophthalmitis or ocular trauma within 3 months prior to enrollment
• Pre-existing subconjunctival hemorrhage or bulbar conjunctival hyperemia
• Chronic ocular pain rated moderate to severe within 1 week prior to Visit 1
• Active bacterial or viral infection in either eye

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Prevention

Study locations

United States · 1 center

• Tyler Retina Research Institute — Tyler

Identifiers

NCT: NCT07456826 · IZ-4-002

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗