A Study of PRL3-zumab in Neovascular Age-related Macular Degeneration (nAMD)

Study Design This is a Single-center, Phase I/II placebo-controlled study to assess the safety and efficacy of PRL3-zumab in patients with Neovascular Age-related Macular Degeneration (nAMD).

PRL3-zumab will be administered intravenously in 2-week interval for 3 doses. Normal saline (0.9% Sodium Chloride w/v) will be used in placebo treatment. The study will consist of 3 arms.

Arm-1: PRL3-zumab 3mg/kg intravenously will be administered in 2 week interval followed by 20 weeks of monitoring (n=6) Arm-2: PRL3-zumab 6mg/kg intravenously will be administered in 2 week interval followed by 20 weeks of monitoring (n=6) Arm-3: Placebo (normal saline 0.9% sodium chloride w/v) intravenously will be administered in 2 week interval followed by 20 weeks of monitoring (n=3)

Initial 3 arms will be conducted on patients who failed Standard-of-Care (SOC) therapy. Response assessment will be done at every 4 weeks from last dose of treatment till 24-week.

Randomization:

Randomization will be done in 2:2:1 manner on PRL3-zumab (Arm 1), 3mg/kg (n=6); PRL3-zumab (Arm 2), 6mg/kg (n=6); and placebo group (Arm 3) (n=3). Randomization can be achieved using random number table which will be prepared before the commencement of clinical trial.

The allocation of participants will be done by Investigator and will be concealed from the participants.

Blinding:

Single blinding will be done for this trial in which all participants are unaware of their treatment assignment. No blinding will be done on Investigator.

Primary Endpoints:

1. Safety:

• Adverse Events: Frequency and severity of adverse events throughout the primary outcome assessment period will be assessed by the Investigator for severity according to Common Terminology Criteria for Adverse Events (CTCAE) version 5 or later

1. RP2D:

• This study will confirm Recommended Phase 2 DOse (RP2D) established from Phase I Clinical Trial in Cancer patients conducted in National University Hospital Singapore (MC/03/0616).

1. Efficacy:

• Change From Baseline in Best Corrected Visual Acuity (BCVA) Measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) Letter Score. Change in BCVA letter gain of 0-4 will be considered as primary end point.
• Change From Baseline in Central Subfield Retinal Thickness (CST) measured by Optical Coherence Tomography (OCT).

[Assessment Time Frame: 4 weekly through 24 weeks]

Secondary endpoints:

• Change in visual Acuity (Best Corrected Visual Acuity) of 5 or more letters.
• Proportion of patients gaining ≥15, ≥10, ≥5, or ≥0 ETDRS letters in BCVA from baseline over time
• Proportion of patients avoiding a loss of ≥15, ≥10, or ≥5 ETDRS letters in BCVA from baseline over time
• Proportion of patients with absence of intraretinal fluid measured by OCT
• Proportion of patients with absence of subretinal fluid measured by OCT [Assessment Time Frame: 4 weekly through 24 weeks]

Criteria for additional Therapy:

Once the treatment is stopped after the third dose, patients from all groups are eligible for additional therapy as open-label treatment if there is recurrence of disease activity, as defined by presence of any of the following criteria:

1. Decrease of ≥5 letters in BCVA compared with average BCVA value over the previous two scheduled visits, owing to nAMD disease activity (as determined by the investigator).
2. Increase of >50 µm in OCT-measured CST compared with the average CST value over the previous two scheduled visits.
3. Recurrence of intra-retinal or sub-retinal fluid (if resolved previously)
4. New macular hemorrhage

Patients in the placebo group will be given PRL3-zumab (6mg/kg) if they fulfil the criteria for additional therapy. Additional therapy will be continued in subsequent monitoring visit until the progression of disease, or end of the trial. If patients show clinical benefit from the treatment, additional doses could be given based on investigators' judgment.

Criteria for progression of disease:

1. BCVA decreases by 15 letters or more from best recorded BCVA because of nAMD disease activity.
2. an increase in OCT central retinal thickness 150 µm or more from lowest recorded measurement after 2 consecutive additional therapy occurring 1 month apart.