Gene Polymorphisms of Corticosteroid-induced Ocular Hypertension

NCT ID: NCT03250819

Last Updated: 2020-06-01

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 370 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2017-09-13
• Study Completion Date: 2020-05-01

Brief Summary

Glaucoma is one of the most prevalent eye diseases and the second most common cause of blindness worldwide. The most common form is primary open angle glaucoma (POAG). Glaucoma is a slowly progressing neuropathy of the optic nerve that causes loss of visual field and eventually blindness. Elevated intra-ocular pressure (IOP) is the most important risk factor.

Corticosteroids, which are often used for the treatment of many diseases in ophthalmology and other specialities, may cause an elevation of the IOP. It is estimated that corticosteroids induce ocular hypertension in approximately 18%-36% of the general population and in patients with POAG this percentage can be as high as 92%. When the treatment is sustained, this can cause a glaucomatous neuropathy of the optic nerve (corticosteroid-induced glaucoma).

The precise pathogenic mechanism isn't clear yet. Genetic factors are likely to affect the susceptibility to corticosteroid response. Therefore, an overview of the genetic mechanisms of corticosteroid-induced glaucoma can give more insight in the pathogenesis. In this study the researchers investigate the occurrence of SNPs (single nucleotide polymorphisms) in 150 cases with a steroid-response in comparison with 300 controls exposed to corticosteroids without a steroid-response.

Up to now, one small GWAS has been conducted comparing 32 patients with and without corticosteroid-induced ocular hypertension after treatment with intravitreal triamcinolone. In this study, two SNPs proximal of the transcriptional start site (near the 5') of HCG22 on chromosome 6 were identified. However, this is a rather small sample population and the investigators didn't match for the underlying disease. Further, in another small study, Hogewind et al. performed SNP analysis in multiple genes (SFRS3, FKBP4, FKBP5, and NR3C1) in corticosteroid-induced ocular hypertension.

This study enables the investigators to identify patients at risk for developing corticosteroid-induced glaucoma and to gain a better insight in the pathogenesis. This may also lead to the discovery of biomarkers that indicate an increased risk of developing a steroid-induced glaucoma and new prevention and treatment strategies, which are necessary as the treatment of corticosteroid induced-glaucoma now only focuses at lowering the IOP and can still be challenging.

Conditions

Corticosteroid Induced Ocular Hypertension/Glaucoma

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: OTHER

Study Groups

Corticosteroid responders

Patients who develop an increase in eye pressure after the use of corticosteroids

SNP analysis

Intervention Type: OTHER

The collected blood samples will be used to investigate the occurrence of SNPs (single nucleotide polymorphisms) in both study groups

Non-corticosteroid responders

Patients who use/used corticosteroids but didn't develop an increase in eye pressure

SNP analysis

Intervention Type: OTHER

The collected blood samples will be used to investigate the occurrence of SNPs (single nucleotide polymorphisms) in both study groups

Interventions

SNP analysis

The collected blood samples will be used to investigate the occurrence of SNPs (single nucleotide polymorphisms) in both study groups

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Use of corticosteroids:
• Patients treated with Ozurdex (an intravitreal dexamethasone implant
• Patients treated with subconjunctival Triamcinolone/ Celestone injections
• Patients treated with corticosteroids after a corneal surgery
• Patients treated with corticosteroids after a refractive surgery
• Patients treated with corticosteroids after a cataract surgery
• Patients treated with corticosteroids for macular edema
• Patients exposed to corticosteroids for other diseases such as uveitis
• When using topical corticosteroids, time of use > 3 months
• Age > 18 year and mentally competent
• Patient from the Maastricht University Medical Centre+ (MUMC+), the Netherlands

Exclusion Criteria

• Age < 18 year
• Mentally not able to participate or give permission
• Not able to communicate in Dutch
• Patients with a type of uveitis that might cause a decrease of the IOP
• When using topical corticosteroids, time of use < 3 months.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Maastricht University Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Johannes SA Schouten, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Maastricht University Medical Center

Locations

University Eye Clinic Maastricht, Maastricht UMC+

Maastricht, Limburg, Netherlands

Countries

Netherlands

References

Jeong S, Patel N, Edlund CK, Hartiala J, Hazelett DJ, Itakura T, Wu PC, Avery RL, Davis JL, Flynn HW, Lalwani G, Puliafito CA, Wafapoor H, Hijikata M, Keicho N, Gao X, Argueso P, Allayee H, Coetzee GA, Pletcher MT, Conti DV, Schwartz SG, Eaton AM, Fini ME. Identification of a Novel Mucin Gene HCG22 Associated With Steroid-Induced Ocular Hypertension. Invest Ophthalmol Vis Sci. 2015 Apr;56(4):2737-48. doi: 10.1167/iovs.14-14803.

Reference Type: BACKGROUND

PMID: 25813999 (View on PubMed)

Fini ME, Schwartz SG, Gao X, Jeong S, Patel N, Itakura T, Price MO, Price FW Jr, Varma R, Stamer WD. Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine. Prog Retin Eye Res. 2017 Jan;56:58-83. doi: 10.1016/j.preteyeres.2016.09.003. Epub 2016 Sep 22.

Reference Type: BACKGROUND

PMID: 27666015 (View on PubMed)

Other Identifiers

NL58992.068.17

Identifier Type: -

Identifier Source: org_study_id