A 3 Stage Ph 2 Study: St 1: Single SubQ D-4517.2 Dose Safety and PD in Wet wAMD or DME. Stage 1A: Multiple SubQ D-4517.2 Dose Safety, PK and PD in wAMD and DME. Stage 2: Safety, Tolerability, PK and Efficacy of SubQ D-4517.2 in wAMD
A Study to Evaluate the Safety, Tolerability and Pharmacokinetics of D-4517.2 After Subcutaneous Administration in subjects with Neovascular (wet) Age-Related Macular Degeneration (AMD) or subjects with Diabetic Macular Edema (DME)
⁃ Overall Study Inclusion Criteria-For All Subjects:
• Willing and able to give informed consent, comply with all study procedures, and be likely to complete the study.
• Demonstrated response to prior anti-VEGF treatment as defined by one or more of the following and as assessed by the Investigator for Stages 1 and 1A and confirmed by the Central Reader for Stage 2:
∙ Complete resolution or partial reduction of foveal intra- and/or subretinal fluid ≥ 30% from initial diagnosis as measured by SD-OCT.
‣ Increase in BCVA ≥ 2 lines from initial diagnosis using Snellen scale.
• Female subjects may be enrolled if they are:
∙ Not pregnant, lactating, or breastfeeding
‣ Documented in medical records or subject self-reported to be surgically sterile or postmenopausal.
‣ Female subjects of childbearing potential must practice true abstinence for at least 28 days prior to investigational product (IP) administration until 30 days after the last IP administration and have a negative serum and urine pregnancy test at Screening and Baseline Day 1, respectively, or
‣ Using 2 forms of highly effective contraception, including 1 physical barrier (condom or diaphragm) plus another method, such as adequate hormonal method (eg, contraceptive implants, injectables, or oral contraceptives) or nonhormonal methods (eg, intrauterine device or spermicidals) from Screening or at least 2 weeks prior to IP administration (whichever is earlier) until 30 days after the last IP administration and having a negative serum and urine pregnancy test at Screening and Baseline Day 1, respectively.
• Male subjects with female partners of childbearing potential may be enrolled if they are:
∙ Documented to be surgically sterile (vasectomy) in medical records or subject self-reported, or
‣ Agree to practice true abstinence during the study and for 30 days after the last IP administration, or
‣ Agree to use 2 adequate forms of highly effective contraception during the study, 1 of which should be a physical barrier for 30 days after the last IP administration.
‣ Must agree not to donate sperm during study and for 30 days following administration of the last dose of IP.
• Subjects who complete the Aflibercept Treatment Period in Stage 1 are eligible to enroll in Stage 1A if they meet all eligibility requirements. These subjects will enter the study in the D-4517.2 Treatment Period.
• Subjects who complete Stage 1 and/or Stage 1A are eligible to enroll in Stage 2 if they meet all eligibility requirements.
• Ocular media clarity, pupillary dilation and individual cooperation sufficient for adequate fundus imaging in the opinion of the Investigator.
• Recurrence of intra- or subretinal fluid at study Baseline. This inclusion criterion will be confirmed by the Sponsor or Central Reader in Stages 1 and 1A and by the Central Reader in Stage 2.
• For subjects with bilateral disease, only one eye per subject can participate in the study. In cases where both eyes are eligible, the eye with the worse BCVA at the Screening Visit will be selected as the study eye. If both eyes have the same BCVA, the eye with the largest CST will be selected as the study eye.
• Subjects With wAMD (For all Stages):
⁃ Male or nonpregnant female adults aged ≥50 years at time of signing the informed consent form (ICF).
⁃ BCVA letter score between 75 and 23 letters (ETDRS chart) (20/32 to 20/320 Snellen equivalents) inclusive in the study eye at Baseline and BCVA letter score of at least 35 letters (ETDRS chart) (20/200 Snellen equivalent) in the non-study eye.
⁃ Previously treated subjects with at least 3 prior IVT injections with an anti-VEGF agent (aflibercept, bevacizumab, faricimab, ranibizumab, or any other approved anti-VEGF agent) with last treatment administered between 4 and 12 weeks prior to Screening. Administration of IVT anti-VEGF agents prior to enrollment must not be more than 12 weeks apart. This inclusion criterion will be assessed by the Investigator.
⁃ For Stage 2, presence of a choroidal neovascular (CNV) lesion secondary to wAMD confirmed by the Central Reader.
⁃ The Investigator attributes the cause of the decreased vision in the study eye primarily to wAMD.
⁃ Subjects With DME (For Stages 1 and 1A only):
⁃ Male or nonpregnant female adults aged ≥18 years at time of signing the ICF.
⁃ Diagnosis of diabetes mellitus (Type 1 or Type 2). Any of the following will be considered to be sufficient evidence that diabetes is present:
• Current regular use of oral anti-hyperglycemic agents for the treatment of diabetes.
∙ Current regular use of insulin or other injectable drugs (eg, dulaglutide and liraglutide) for the treatment of diabetes.
∙ Documented diabetes by American Diabetic Association (ADA) and/or World Health Organization (WHO) criteria.
⁃ Hemoglobin A1c (HbA1c) ≤12% at Screening.
⁃ DME defined as macular thickening involving the center of the macula with CST of ≥325 μm using Spectralis® (Heidelberg Engineering, Heidelberg, Germany) SD-OCT at Screening. These inclusion criteria will be assessed by the Central Reader.
⁃ BCVA letter score between 75 and 23 letters (ETDRS chart) (20/32 to 20/320 Snellen equivalents) inclusive in the study eye at Baseline.
⁃ Previously treated subjects with at least 5 prior IVT injections with an anti-VEGF agent (aflibercept, bevacizumab, faricimab, ranibizumab, or any other approved anti-VEGF agent) with last treatment administered between 4 and 12 weeks prior to Screening. Administration of IVT anti-VEGF agents prior to enrollment must not be more than 12 weeks apart. This inclusion criterion will be assessed by the Investigator.
⁃ The Investigator attributes the cause of the decreased vision in the study eye primarily to DME.