Diabetic Macular EdemaPhase 2/3PHOTONNCT04429503
Study of a High-Dose Aflibercept in Participants With Diabetic Eye Disease
A Phase 2/3 study testing aflibercept and High-dose aflibercept in people with Diabetic Macular Edema and Type 1 Diabetes Mellitus, run by Regeneron Pharmaceuticals at 138 sites in 8 countries.
Trial summary
The primary objective of the study is to determine if treatment with high-dose aflibercept (HD) at intervals of 12 or 16 weeks provides non-inferior best corrected visual acuity (BCVA) compared to aflibercept dosed every 8 weeks. The secondary objectives of the study are as follows: To determine the effect of HD vs. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Diabetic Macular Edema, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus
- What is being tested?
- aflibercept and High-dose aflibercept
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 660 participants
- Where
- 138 sitesin 8 countries
- Study dates
- 29 Jun 2020to 18 Jun 2024
- Phase
- Phase 2/3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Diabetic macular edema (DME) with central involvement in the study eye
- Best corrected visual acuity (BCVA) early treatment diabetic retinopathy study (ETDRS) letter score of 78 to 24 (approximate Snellen equivalent of 20/32 to 20/320) in the study eye with decreased vision determined to be primarily the result of DME
- Willing and able to comply with clinic visits and study-related procedures
- Provide informed consent signed by study participant or legally acceptable representative
- Extension Phase: All randomized patients that complete visit 26, week 96, as long as the patient 1) provides informed consent and 2) no treatment for DME has been given in the study eye other than the randomized study treatment.
Who cannot join
- Evidence of macular edema due to any cause other than diabetes mellitus in either eye
- Active proliferative diabetic retinopathy in the study eye
- IVT anti-VEGF treatment (aflibercept, ranibizumab, bevacizumab, brolucizumab, pegaptanib sodium) or panretinal laser photocoagulation (PRP) /macular laser photocoagulation within 12 weeks (84 days) or intraocular or periocular corticosteroids within 16 weeks (112 days) of the screening visit in the study eye
- Prior IVT investigational agents in either eye (eg, anti-ang-2/anti-VEGF bispecific monoclonal antibodies, gene therapy, etc.) at any time
- Treatment with ocriplasmin (JETREA®) in the study eye at any time
- NOTE: Other Protocol Defined Inclusion/Exclusion Criteria Apply
Trial locations and contacts
138 sites in 8 countries.
138 sites in 8 countries
United States84 sites
Regeneron Study Site
‘Aiea, Hawaii, 96701
Regeneron Study Site
Abilene, Texas, 79606
Regeneron Study Site
Arcadia, California, 91006
Regeneron Study Site
Asheville, North Carolina, 28803
Regeneron Study Site
Augusta, Georgia, 30909
Regeneron Study Site
Baltimore, Maryland, 21209
Regeneron Study Site
Beachwood, Ohio, 44122
Regeneron Study Site
Beaufort, South Carolina, 29902
Regeneron Study Site
Bellaire, Texas, 77401
Regeneron Study Site
Bethlehem, Pennsylvania, 18017
Regeneron Study Site
Beverly Hills, California, 90211
Regeneron Study Site
Bloomfield, New Jersey, 07003
Regeneron Study Site
Boston, Massachusetts, 02114
Regeneron Study Site
Campbell, California, 95008
Regeneron Study Site
Carmel, Indiana, 46290
Regeneron Study Site
Charlotte, North Carolina, 28210
Regeneron Study Site
Cincinnati, Ohio, 45202
Regeneron Study Site
Cincinnati, Ohio, 45242
Regeneron Study Site
Clearwater, Florida, 33761
Regeneron Study Site
Cleveland, Ohio, 44130
Regeneron Study Site
Colorado Springs, Colorado, 80909
Regeneron Study Site
Dublin, Ohio, 43016
Regeneron Study Site
Durango, Colorado, 81301
Regeneron Study Site
Edison, New Jersey, 08820
Regeneron Study Site
Edmond, Oklahoma, 73013
Regeneron Study Site
Encino, California, 91436
Regeneron Study Site
Fairfax, Virginia, 22031
Regeneron Study Site
Fort Lauderdale, Florida, 33308
Regeneron Study Site
Fort Myers, Florida, 33912
Regeneron Study Site
Fullerton, California, 92835
Regeneron Study Site
Germantown, Tennessee, 38138
Regeneron Study Site
Great Neck, New York, 11021
Regeneron Study Site
Hagerstown, Maryland, 21740
Regeneron Study Site
Henderson, Nevada, 89052
Regeneron Study Site
Huntington Beach, California, 92647
Regeneron Study Site
Jacksonville, Florida, 32216
Regeneron Study Site
Kingston, Pennsylvania, 18704
Regeneron Study Site
Knoxville, Tennessee, 37922
Regeneron Study Site
Ladson, South Carolina, 29456
Regeneron Study Site
Lakeland, Florida, 33805
Regeneron Study Site
Lakewood, Colorado, 80228
Regeneron Study Site
Largo, Florida, 33770
Regeneron Study Site
Liverpool, New York, 13088
Regeneron Study Site
Long Beach, California, 90807
Regeneron Study Site 1
Marietta, Georgia, 30060
Regeneron Study Site 2
Marietta, Georgia, 30060
Regeneron Study Site
Melbourne, Florida, 32901
Regeneron Study Site
Miami, Florida, 33126
Regeneron Study Site
Monroeville, Pennsylvania, 15146
Regeneron Study Site
Morgantown, West Virginia, 26506
Regeneron Study Site
Nashville, Tennessee, 37203
Regeneron Study Site
New York, New York, 11221
Regeneron Study Site
Norfolk, Virginia, 23502
Regeneron Study Site
Oak Forest, Illinois, 60452
Regeneron Study Site
Oceanside, New York, 11572
Regeneron Study Site
Orlando, Florida, 32806
Regeneron Study Site
Palo Alto, California, 94303
Regeneron Study Site
Pasadena, California, 91107
Regeneron Study Site
Phoenix, Arizona, 85021
Regeneron Study Site
Pinellas Park, Florida, 33782
Regeneron Study Site
Plantation, Florida, 33324
Regeneron Study Site
Portland, Oregon, 97225
Regeneron Study Site
Poway, California, 92064
Regeneron Study Site
Rancho Cordova, California, 95670
Regeneron Study Site
Rapid City, South Dakota, 57701
Regeneron Study Site
Riverside, California, 92505
Regeneron Study Site
Royal Oak, Michigan, 48073
Regeneron Study Site 1
Salt Lake City, Utah, 84107
Regeneron Study Site 2
San Antonio, Texas, 78240
Regeneron Study Site
Shawnee Mission, Kansas, 66204
Regeneron Study Site
Shirley, New York, 02114
Regeneron Study Site
Southaven, Mississippi, 38671
Regeneron Study Site
Springfield, Illinois, 62703
Regeneron Study Site
Springfield, Illinois, 62704
Regeneron Study Site
St. Petersburg, Florida, 33711
Regeneron Study Site
Stuart, Florida, 34994
Regeneron Study Site
Teaneck, New Jersey, 07666
Regeneron Study Site
The Woodlands, Texas, 77384
Regeneron Study Site
Torrance, California, 90509
Regeneron Study Site
Tulsa, Oklahoma, 74114
Regeneron Study Site
Waterford, Connecticut, 06385
Regeneron Study Site
West Columbia, South Carolina, 29169
Regeneron Study Site
Willow Park, Texas, 76087
Regeneron Study Site
Winter Haven, Florida, 33880
Japan31 sites
Regeneron Study Site
Chiyoda-ku, Tokyo, 101-8309
Regeneron Study Site
Fukuoka, 812-0011
Regeneron Study Site
Fukuoka, 819-8585
Regeneron Study Site
Hachiōji, Tokyo, 193-0998
Regeneron Study Site
Hakodate, Hokkaido, 041-0851
Regeneron Study Site
Hirakata, Osaka, 573-1191
Regeneron Study Site
Itabashi-ku, Tokyo, 173-0015
Regeneron Study Site
Kagoshima, 890-8520
Regeneron Study Site
Kashihara, Nara, 634-8522
Regeneron Study Site
Kawasaki, Kanagawa, 216-8511
Regeneron Study Site
Kita-gun, Kagawa-ken, 761-0793
Regeneron Study Site
Kobe, Hyōgo, 650-0017
Regeneron Study Site
Kōriyama, Fukushima, 963-8052
Regeneron Study Site
Kurume, Fukuoka, 830-0011
Regeneron Study Site
Matsumoto, Nagano, 390-8621
Regeneron Study Site
Meguro-ku, Tokyo, 152-8902
Regeneron Study Site
Mito, Ibaraki, 310-0845
Regeneron Study Site
Nagakute, Aichi-ken, 480-1195
Regeneron Study Site
Nagasaki, Nagasaki, 852-8501
Regeneron Study Site
Nagoya, Aichi-ken, 466-8560
Regeneron Study Site
Nagoya, Aichi-ken, 467-8602
Regeneron Study Site
Osaka, 545-8586
Regeneron Study Site
Saitama, 330-8553
Regeneron Study Site
Shimotsuke-shi, Tochigi, 329-0498
Regeneron Study Site
Susono, Shizuoka, 410-1102
Regeneron Study Site
Tokorozawa, Saitama, 359-8513
Regeneron Study Site
Tokushima, 770-8503
Regeneron Study Site
Toride, Ibaraki, 302-0014
Regeneron Study Site
Tsuchiura-shi, Ibaraki, 300-0817
Regeneron Study Site
Ube, Yamaguchi, 755-8505
Regeneron Study Site
Yoshida-Gun, Fukui, 910-1193
Hungary9 sites
Regeneron Study Site
Budapest, H-1085
Regeneron Study Site
Budapest, H-1106
Regeneron Study Site
Budapest, H-1133
Regeneron Study Site
Budapest, H-1145
Regeneron Study Site
Debrecen, H-4032
Regeneron Study Site 1
Pécs, Baranya, H-7621
Regeneron Study Site
Szeged, H-6720
Regeneron Study Site
Szombathely, Vas County, H-9700
Regeneron Study Site
Zalaegerszeg, Zala County, H-8900
Canada4 sites
Regeneron Study Site
Calgary, Alberta, T2H 0C8
Regeneron Study Site
Mississauga, Ontario, L4W 1W9
Regeneron Study Site
North York, Ontario, M3C 0G9
Regeneron Study Site
Sherbrooke, Quebec, J1G 2V4
Czechia4 sites
Regeneron Study Site
Pardubice, 530 02
Regeneron Study Site
Prague, 100 34
Regeneron Study Site
Prague, 128 08
Regeneron Study Site
Prague, 150 00
Germany3 sites
Regeneron Study Site
Göttingen, North Rhine-Westphalia, 37075
Regeneron Study Site
Münster, North Rhine-Westphalia, 48145
Regeneron Study Site
Neubrandenburg, Mecklenburg-Westfalen, 17036
United Kingdom2 sites
Regeneron Study Site
London, EC1V 2PD
Regeneron Study Site
Sunderland, Tyne and Wear, SR2 9HP
About this study
Official title: A Randomized, Double-Masked, Active-Controlled Phase 2/3 Study of the Efficacy and Safety of High-Dose Aflibercept in Patients With Diabetic Macular Edema
The primary objective of the study is to determine if treatment with high-dose aflibercept (HD) at intervals of 12 or 16 weeks provides non-inferior best corrected visual acuity (BCVA) compared to aflibercept dosed every 8 weeks.
The secondary objectives of the study are as follows:
- To determine the effect of HD vs. aflibercept on anatomic and other visual measures of response
- To evaluate the safety, immunogenicity, and pharmacokinetics (PK) of aflibercept
- Being tested
- aflibercept, High-dose aflibercept
- Medical subject headings
- Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
afliberceptDrug
Also called EYLEA®, BAY86-5321
Intravitreally (IVT) administered as a liquid formulation in a vial
High-dose afliberceptDrug
Intravitreally (IVT) administered as a liquid formulation in a vial
| Study group | Role | What they receive |
|---|---|---|
| aflibercept Q8 | Active comparator | Administered every 8 weeks after a loading phase Receives: Drug: aflibercept |
| High-Dose aflibercept Q12 | Experimental | Administered every 12 weeks after a loading phase Receives: Drug: High-dose aflibercept |
| High-Dose aflibercept Q16 | Experimental | Administered every 16 weeks after a loading phase Receives: Drug: High-dose aflibercept |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change From Baseline in Best Corrected Visual Acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] Letter Score) in the Study Eye at Week 48
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best).
Measured: Baseline, Week 48
Secondary outcomes (16)
Percentage of Participants With a ≥2 Step Improvement From Baseline in Diabetic Retinopathy Severity Scale (DRSS) Score at Week 48
The DRSS was assessed according to the following scale: 10 = Diabetic retinopathy (DR) absent, 14 = DR questionable, 15 = DR questionable, 20 = Micro-aneurysms only, 35 = Mild Non-proliferative diabetic retinopathy (NPDR), 43 = Moderate NPDR, 47 = Moderately severe NPDR, 53 = Severe NPDR, 61 = Mild Proliferative diabetic retinopathy (PDR), 65 = Moderate PDR, 71 = High-risk PDR, 75 = High-risk PDR, 81 = Advanced PDR: fundus partially obscured, center of macula attached, 85 = Advanced PDR: posterior fundus obscured, or center of macula detached, 90 = cannot grade, even sufficiently for level 81 or 85.
Measured: Baseline, Week 48
Percentage of Participants Gaining ≥15 Letters in BCVA From Baseline at Week 48
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best). Only one study eye per participant was analyzed within the study
Measured: Baseline, Week 48
Percentage of Participants With BCVA ≥69 Letters at Week 48
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best).
Measured: At Week 48
Percentage of Participants Without Fluid at Foveal Center at Week 48
Retinal fluid status was evaluated using spectral domain optical coherence tomography (SD-OCT) on the study eye.
Measured: At Week 48
Change From Baseline in Central Retinal Thickness (CRT) in the Study Eye at Week 48
Central Retinal Thickness (CRT) was measured in the study eye by spectral domain optical coherence tomography (SD-OCT).
Measured: Baseline, Week 48
Percentage of Participants Without Leakage on Fluorescein Angiography (FA) at Week 48
Leakage is the release of fluorescein dye from diseased retinal vessels.
Measured: At Week 48
Change From Baseline in National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) Total Score at Week 48
Vision-specific quality of life is assessed with the NEI VFQ-25 (National Eye Institute Visual Function Questionnaire), i.e. a 25-item questionnaire that gives a score on a scale from 0 (worst) to 100 (best = no vision problems).
Measured: Baseline, Week 48
Systemic Pharmacokinetics (PK) of Aflibercept as Assessed by Plasma Concentrations Through Week 48
Concentrations of Free Aflibercept in Plasma by Time and Treatment Group
Measured: Through Week 48
Change From Baseline in BCVA in the Study Eye in Participants With Both Baseline and Week 48 BCVA
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best). (Per Statistical Analysis Plan (SAP) Version 2.0 Appendix 10.9 for US Only)
Measured: Baseline, Week 48
Change From 8-weeks Post Initial Treatment Phase in BCVA in the Study Eye in Participants With Both 8-weeks Post Initial Treatment Phase BCVA and Week 48 BCVA
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best). (Per SAP Version 2.0 Appendix 10.9 for US Only)
Measured: Baseline, Week 48
Change From Baseline in BCVA (Region-specific Analysis) in the Study Eye at Week 60
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best).
Measured: Baseline, Week 60
Assessment of Immunogenicity to Aflibercept by Measuring the Incidence of Treatment-emergent Anti-drug Antibodies (ADA) Response Through Week 96
Number of participants with pre-existing immunoreactivity and treatment-emergent ADA response reported
Measured: Through Week 96
Number of Participants With Any Treatment-emergent Adverse Event (TEAE) Through Week 96
A TEAE is an AE starting after the first dose of study drug to the last dose of study drug (active or sham) plus 30 days. Additionally, for patients who are still participating in the study (ie, have not been withdrawn and are continuing in the extension phase of the study) as of the week 96 visit all AEs up through the date of the week 96 visit were considered treatment-emergent.
Measured: Through Week 96
Number of Participants With Any Serious TEAE Through Week 96
A TEAE is an AE starting after the first dose of study drug to the last dose of study drug (active or sham) plus 30 days. Additionally, for patients who are still participating in the study (ie, have not been withdrawn and are continuing in the extension phase of the study) as of the week 96 visit all AEs up through the date of the week 96 visit were considered treatment-emergent.
Measured: Through Week 96
Number of Participants With Any TEAE Through Week 156
TEAEs are defined as AEs starting after the first dose of study drug to the last dose of study drug (active or sham) plus 30 days or week 156 visit, whichever was later.
Measured: Through Week 156
Number of Participants With Any Serious TEAE Through Week 156
Measured: Through Week 156
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Jun 2020
- Study start29 Jun 2020
- Primary completion30 May 2022
- Study completion18 Jun 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Diabetic Macular EdemaStudies of the same condition, open and under way.
- More trials run by Regeneron PharmaceuticalsThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2/3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 660 participants (actual)
Sponsor and investigators
- Lead sponsor
- Regeneron Pharmaceuticals
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- Bayer
- Responsible party
- Sponsor
- Investigators
- Clinical Trial Management, Study director, Regeneron Pharmaceuticals
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04429503
- Sponsor's protocol ID
- VGFTe-HD-DME-1934
- Other IDs
- 2019-003643-30, 2019
- Acronym
- PHOTON
- Status last verified
- Jul 2025
- First submitted
- 26 May 2020
- Last updated
- 8 Aug 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: All IPD that underlie results in a publication.
Publications
Loewenstein A, Schmidt-Ott U, Do DV, Lanzetta P, Leal S, Berliner AJ, Chu KW, Barakat MR, Ghorayeb G, Stewart MW, Spitzer MS, Zhang X, McCullough A, Tueckmantel C, Avila D, Morgan-Warren P, Brunck L, Dupljak A, Hymowitz M, Portnoy A, Gale R. Intraocular Pressure Outcomes with Intravitreal Aflibercept 8 mg: A 96-Week Pooled Analysis from PULSAR and PHOTON. Ophthalmol Ther. 2026 Jul;15(7):2441-2456. doi: 10.1007/s40123-026-01424-y. Epub 2026 Jun 13.
PubMed 42287526Suzuma K, Murata T, Shimura M, Yoshida S, Kishino G, Berliner AJ, Chu KW, Reed K, Vitti R, Cheng Y, Voronca D, Bhore R, Leal S, Morgan-Warren P, Schulze A, Schmidt-Ott U, Kobayashi M, Sakamoto T; PHOTON Investigators. Intravitreal aflibercept 8 mg in patients from Japan with diabetic macular edema: 48-week subgroup analysis of the PHOTON trial. Jpn J Ophthalmol. 2026 Jan;70(1):123-138. doi: 10.1007/s10384-025-01271-7. Epub 2025 Dec 26.
PubMed 41452566Do DV, Wykoff CC, Sivaprasad S, Brown DM, Boyer DS, Sakamoto T, Win P, Joshi S, Salehi-Had H, Seres A, Berliner AJ, Leal S, Vitti R, Chu KW, Reed K, Cheng Y, Bhore R, Bai Z, Schmidt-Ott U, Schmelter T, Schulze A, Hasanbasic Z, Morgan-Warren PJ, Zhang X, Hirshberg B, Yancopoulos GD; PHOTON Investigators. Intravitreal Aflibercept 8 mg for Diabetic Macular Edema: Ninety-Six-Week Results from the Randomized Phase 2/3 PHOTON Trial. Ophthalmology. 2026 May;133(5):577-588. doi: 10.1016/j.ophtha.2025.10.028. Epub 2025 Nov 10.
PubMed 41223900Brown DM, Boyer DS, Do DV, Wykoff CC, Sakamoto T, Win P, Joshi S, Salehi-Had H, Seres A, Berliner AJ, Leal S, Vitti R, Chu KW, Reed K, Rao R, Cheng Y, Sun W, Voronca D, Bhore R, Schmidt-Ott U, Schmelter T, Schulze A, Zhang X, Hirshberg B, Yancopoulos GD, Sivaprasad S; PHOTON Investigators. Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial. Lancet. 2024 Mar 23;403(10432):1153-1163. doi: 10.1016/S0140-6736(23)02577-1. Epub 2024 Mar 7.
PubMed 38461843
Study at a glance
From the registry record, last updated by the sponsor on 8 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-Masked, Active-Controlled Phase 2/3 Study of the Efficacy and Safety of High-Dose Aflibercept in Patients With Diabetic Macular Edema
- ClinicalTrials.gov ID
- NCT04429503
- Acronym / sponsor ID
- PHOTON / VGFTe-HD-DME-1934
- Phase
- Phase 2/3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 660 participants (actual)
- Lead sponsor
- Regeneron PharmaceuticalsIndustry (pharma, biotech, devices)
- Collaborators
- Bayer
- Study start
- 29 Jun 2020 (actual)
- Primary completion
- 30 May 2022 (actual)
- Study completion
- 18 Jun 2024 (actual)
- First posted
- 12 Jun 2020 (actual)
- Results
- Posted 21 Nov 2023
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The primary objective of the study is to determine if treatment with high-dose aflibercept (HD) at intervals of 12 or 16 weeks provides non-inferior best corrected visual acuity (BCVA) compared to aflibercept dosed every 8 weeks.
The secondary objectives of the study are as follows:
- To determine the effect of HD vs. aflibercept on anatomic and other visual measures of response
- To evaluate the safety, immunogenicity, and pharmacokinetics (PK) of aflibercept
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| aflibercept Q8 | Active comparator | Drug: afliberceptAdministered every 8 weeks after a loading phase |
| High-Dose aflibercept Q12 | Experimental | Drug: High-dose afliberceptAdministered every 12 weeks after a loading phase |
| High-Dose aflibercept Q16 | Experimental | Drug: High-dose afliberceptAdministered every 16 weeks after a loading phase |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Diabetic macular edema (DME) with central involvement in the study eye
- Best corrected visual acuity (BCVA) early treatment diabetic retinopathy study (ETDRS) letter score of 78 to 24 (approximate Snellen equivalent of 20/32 to 20/320) in the study eye with decreased vision determined to be primarily the result of DME
- Willing and able to comply with clinic visits and study-related procedures
- Provide informed consent signed by study participant or legally acceptable representative
- Extension Phase: All randomized patients that complete visit 26, week 96, as long as the patient 1) provides informed consent and 2) no treatment for DME has been given in the study eye other than the randomized study treatment.
Key exclusion criteria (6 listed)
- Evidence of macular edema due to any cause other than diabetes mellitus in either eye
- Active proliferative diabetic retinopathy in the study eye
- IVT anti-VEGF treatment (aflibercept, ranibizumab, bevacizumab, brolucizumab, pegaptanib sodium) or panretinal laser photocoagulation (PRP) /macular laser photocoagulation within 12 weeks (84 days) or intraocular or periocular corticosteroids within 16 weeks (112 days) of the screening visit in the study eye
- Prior IVT investigational agents in either eye (eg, anti-ang-2/anti-VEGF bispecific monoclonal antibodies, gene therapy, etc.) at any time
- Treatment with ocriplasmin (JETREA®) in the study eye at any time
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| afliberceptAlso: EYLEA®, BAY86-5321Intravitreally (IVT) administered as a liquid formulation in a vial | Drug | aflibercept Q8 |
| High-dose afliberceptIntravitreally (IVT) administered as a liquid formulation in a vial | Drug | High-Dose aflibercept Q12, High-Dose aflibercept Q16 |
Primary outcome
Change From Baseline in Best Corrected Visual Acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] Letter Score) in the Study Eye at Week 48
Time frame: Baseline, Week 48
Visual function of the study eye was assessed at a distance of 4 meters at every study visit using the Early Treatment Diabetic Retinopathy Study (ETDRS) Best Corrected Visual Acuity (BCVA) letter score. BCVA scale range is 0 (worst) to 100 (best).
16 secondary outcomes
Percentage of Participants With a ≥2 Step Improvement From Baseline in Diabetic Retinopathy Severity Scale (DRSS) Score at Week 48
Time frame: Baseline, Week 48
Percentage of Participants Gaining ≥15 Letters in BCVA From Baseline at Week 48
Time frame: Baseline, Week 48
Percentage of Participants With BCVA ≥69 Letters at Week 48
Time frame: At Week 48
Percentage of Participants Without Fluid at Foveal Center at Week 48
Time frame: At Week 48
Change From Baseline in Central Retinal Thickness (CRT) in the Study Eye at Week 48
Time frame: Baseline, Week 48
Percentage of Participants Without Leakage on Fluorescein Angiography (FA) at Week 48
Time frame: At Week 48
Change From Baseline in National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) Total Score at Week 48
Time frame: Baseline, Week 48
Systemic Pharmacokinetics (PK) of Aflibercept as Assessed by Plasma Concentrations Through Week 48
Time frame: Through Week 48
Change From Baseline in BCVA in the Study Eye in Participants With Both Baseline and Week 48 BCVA
Time frame: Baseline, Week 48
Change From 8-weeks Post Initial Treatment Phase in BCVA in the Study Eye in Participants With Both 8-weeks Post Initial Treatment Phase BCVA and Week 48 BCVA
Time frame: Baseline, Week 48
Change From Baseline in BCVA (Region-specific Analysis) in the Study Eye at Week 60
Time frame: Baseline, Week 60
Assessment of Immunogenicity to Aflibercept by Measuring the Incidence of Treatment-emergent Anti-drug Antibodies (ADA) Response Through Week 96
Time frame: Through Week 96
Number of Participants With Any Treatment-emergent Adverse Event (TEAE) Through Week 96
Time frame: Through Week 96
Number of Participants With Any Serious TEAE Through Week 96
Time frame: Through Week 96
Number of Participants With Any TEAE Through Week 156
Time frame: Through Week 156
Number of Participants With Any Serious TEAE Through Week 156
Time frame: Through Week 156
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Aug 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 42287526Loewenstein A, Schmidt-Ott U, Do DV, Lanzetta P, Leal S, Berliner AJ, Chu KW, Barakat MR, Ghorayeb G, Stewart MW, Spitzer MS, Zhang X, McCullough A, Tueckmantel C, Avila D, Morgan-Warren P, Brunck L, Dupljak A, Hymowitz M, Portnoy A, Gale R. Intraocular Pressure Outcomes with Intravitreal Aflibercept 8 mg: A 96-Week Pooled Analysis from PULSAR and PHOTON. Ophthalmol Ther. 2026 Jul;15(7):2441-2456. doi: 10.1007/s40123-026-01424-y. Epub 2026 Jun 13.
- Derived from this study: PubMed 41452566Suzuma K, Murata T, Shimura M, Yoshida S, Kishino G, Berliner AJ, Chu KW, Reed K, Vitti R, Cheng Y, Voronca D, Bhore R, Leal S, Morgan-Warren P, Schulze A, Schmidt-Ott U, Kobayashi M, Sakamoto T; PHOTON Investigators. Intravitreal aflibercept 8 mg in patients from Japan with diabetic macular edema: 48-week subgroup analysis of the PHOTON trial. Jpn J Ophthalmol. 2026 Jan;70(1):123-138. doi: 10.1007/s10384-025-01271-7. Epub 2025 Dec 26.
- Derived from this study: PubMed 41223900Do DV, Wykoff CC, Sivaprasad S, Brown DM, Boyer DS, Sakamoto T, Win P, Joshi S, Salehi-Had H, Seres A, Berliner AJ, Leal S, Vitti R, Chu KW, Reed K, Cheng Y, Bhore R, Bai Z, Schmidt-Ott U, Schmelter T, Schulze A, Hasanbasic Z, Morgan-Warren PJ, Zhang X, Hirshberg B, Yancopoulos GD; PHOTON Investigators. Intravitreal Aflibercept 8 mg for Diabetic Macular Edema: Ninety-Six-Week Results from the Randomized Phase 2/3 PHOTON Trial. Ophthalmology. 2026 May;133(5):577-588. doi: 10.1016/j.ophtha.2025.10.028. Epub 2025 Nov 10.
- Derived from this study: PubMed 38461843Brown DM, Boyer DS, Do DV, Wykoff CC, Sakamoto T, Win P, Joshi S, Salehi-Had H, Seres A, Berliner AJ, Leal S, Vitti R, Chu KW, Reed K, Rao R, Cheng Y, Sun W, Voronca D, Bhore R, Schmidt-Ott U, Schmelter T, Schulze A, Zhang X, Hirshberg B, Yancopoulos GD, Sivaprasad S; PHOTON Investigators. Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial. Lancet. 2024 Mar 23;403(10432):1153-1163. doi: 10.1016/S0140-6736(23)02577-1. Epub 2024 Mar 7.
- Individual participant dataSharing planned: Yes. All IPD that underlie results in a publication.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Clinical Trial Management study director
Regeneron Pharmaceuticals
138 sites in 8 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2/3 study testing aflibercept and High-dose aflibercept in people with Diabetic Macular Edema and Type 1 Diabetes Mellitus, run by Regeneron Pharmaceuticals at 138 sites in 8 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 8 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 138 sites in United States, Japan, Hungary, Canada, Czechia and 3 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 21 Nov 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change From Baseline in Best Corrected Visual Acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] Letter Score) in the Study Eye at Week 48 (time frame: Baseline, Week 48). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04429503, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Aug 2025; AzTrials last refreshed its copy on 7 Nov 2026.