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NCT03654885: XEN GPS

XEN-45 Gel Stent Versus Trabeculectomy in Glaucoma: Gold-Standard Pathway Study (GPS)

Completed Phase 4 Results posted Last updated 21 July 2022
What this trial tests

Phase 4 trial testing XEN-45 Gel Stent in Glaucoma in 158 participants. Completed in 13 May 2021.

Timeline
1 October 2018
Primary endpoint
13 May 2021
13 May 2021

Quick facts

Lead sponsorAllergan
PhasePhase 4
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment158
Start date1 October 2018
Primary completion13 May 2021
Estimated completion13 May 2021
Sites35 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Allergan — full company profile →

Who can join

18 and older, any sex, with Glaucoma. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Percentage of Participants Achieving at Least 20% Intraocular Pressure (IOP) Reduction (Improvement) From Baseline at Month 12 With Prespecified Caveats Primary · Baseline (Preoperative) to Month 12

IOP is a measure of the fluid pressure inside the eye. In addition to achieving a 20% reduction of IOP from Baseline, the participants had to meet all of the following prespecified caveats at Month 12: no increase in the number of topical IOP-lowering medications compared to Baseline, no clinical hypotony, no loss of vision to count fingers or worse, and no secondary glaucoma surgical intervention.

GroupValue95% CI
XEN-45 Gel Stent62.1
Trabeculectomy68.2
Mean IOP Over Time Secondary · Baseline and Day 1, Weeks 1 and 2, Months 1, 3, 6, 9, and 12

IOP is a measurement of the fluid pressure inside the eye.

Day 1
GroupValue95% CI
XEN-45 Gel Stent9.25± 4.710
Trabeculectomy15.00± 13.025
Week 1
GroupValue95% CI
XEN-45 Gel Stent11.27± 6.864
Trabeculectomy11.48± 7.323
Week 2
GroupValue95% CI
XEN-45 Gel Stent13.64± 8.363
Trabeculectomy11.53± 5.503
Month 1
GroupValue95% CI
XEN-45 Gel Stent13.72± 6.315
Trabeculectomy11.45± 5.645
Month 3
GroupValue95% CI
XEN-45 Gel Stent16.46± 7.407
Trabeculectomy11.59± 4.672
Month 6
GroupValue95% CI
XEN-45 Gel Stent14.86± 4.228
Trabeculectomy11.72± 5.242
Month 9
GroupValue95% CI
XEN-45 Gel Stent14.57± 4.221
Trabeculectomy11.02± 3.535
Month 12
GroupValue95% CI
XEN-45 Gel Stent14.43± 4.060
Trabeculectomy11.83± 3.525
Change From Baseline in Mean IOP Over Time Secondary · Baseline and Day 1, Weeks 1 and 2, Months 1, 3, 6, 9, and 12

IOP is a measurement of the fluid pressure inside the eye.

Change From Baseline at Day 1
GroupValue95% CI
XEN-45 Gel Stent-13.63± 0.645
Trabeculectomy-7.82± 0.958
Change From Baseline at Week 1
GroupValue95% CI
XEN-45 Gel Stent-11.56± 0.660
Trabeculectomy-11.34± 0.958
Change From Baseline at Week 2
GroupValue95% CI
XEN-45 Gel Stent-9.26± 0.657
Trabeculectomy-11.29± 0.958
Change From Baseline at Month 1
GroupValue95% CI
XEN-45 Gel Stent-9.15± 0.648
Trabeculectomy-11.37± 0.958
Change From Baseline at Month 3
GroupValue95% CI
XEN-45 Gel Stent-6.35± 0.663
Trabeculectomy-11.09± 0.977
Change From Baseline at Month 6
GroupValue95% CI
XEN-45 Gel Stent-7.94± 0.690
Trabeculectomy-10.95± 0.978
Change From Baseline at Month 9
GroupValue95% CI
XEN-45 Gel Stent-8.19± 0.690
Trabeculectomy-11.72± 0.978
Change From Baseline at Month 12
GroupValue95% CI
XEN-45 Gel Stent-8.25± 0.701
Trabeculectomy-11.02± 1.009
Mean Number of Topical IOP-Lowering Medications Over Time Secondary · Baseline and Day 1, Weeks 1 and 2, Months 1, 3, 6, 9, and 12

IOP is a measurement of the fluid pressure inside the eye. Topical IOP-lowering medication classes included: prostaglandin analogues, beta adrenergic antagonists, carbonic anhydrase inhibitors,alpha adrenergic agonists, pilocarpine, and combinations of these treatments.

Day 1
GroupValue95% CI
XEN-45 Gel Stent0.2± 0.51
Trabeculectomy0.3± 0.53
Week 1
GroupValue95% CI
XEN-45 Gel Stent0.3± 0.77
Trabeculectomy0.3± 0.73
Week 2
GroupValue95% CI
XEN-45 Gel Stent0.3± 0.64
Trabeculectomy0.2± 0.53
Month 1
GroupValue95% CI
XEN-45 Gel Stent0.3± 0.75
Trabeculectomy0.1± 0.52
Month 3
GroupValue95% CI
XEN-45 Gel Stent0.5± 0.89
Trabeculectomy0.1± 0.26
Month 6
GroupValue95% CI
XEN-45 Gel Stent0.6± 0.96
Trabeculectomy0.2± 0.58
Month 9
GroupValue95% CI
XEN-45 Gel Stent0.6± 1.09
Trabeculectomy0.2± 0.49
Month 12
GroupValue95% CI
XEN-45 Gel Stent0.6± 0.95
Trabeculectomy0.3± 0.50
Change From Baseline in Mean Number of Topical IOP-Lowering Medications Over Time Secondary · Baseline and Day 1, Weeks 1 and 2, Months 1, 3, 6, 9, and 12

IOP is a measurement of the fluid pressure inside the eye. Topical IOP-lowering medication classes included: prostaglandin analogues, beta adrenergic antagonists, carbonic anhydrase inhibitors,alpha adrenergic agonists, pilocarpine, and combinations of these treatments.

Change From Baseline at Day 1
GroupValue95% CI
XEN-45 Gel Stent-2.1± 0.08
Trabeculectomy-2.0± 0.11
Change From Baseline at Week 1
GroupValue95% CI
XEN-45 Gel Stent-2.0± 0.08
Trabeculectomy-2.0± 0.11
Change From Baseline at Week 2
GroupValue95% CI
XEN-45 Gel Stent-2.0± 0.08
Trabeculectomy-2.1± 0.11
Change From Baseline at Month 1
GroupValue95% CI
XEN-45 Gel Stent-2.0± 0.08
Trabeculectomy-2.1± 0.11
Change From Baseline at Month 3
GroupValue95% CI
XEN-45 Gel Stent-1.8± 0.08
Trabeculectomy-2.2± 0.11
Change From Baseline at Month 6
GroupValue95% CI
XEN-45 Gel Stent-1.7± 0.08
Trabeculectomy-2.0± 0.11
Change From Baseline at Month 9
GroupValue95% CI
XEN-45 Gel Stent-1.7± 0.08
Trabeculectomy-2.0± 0.11
Change From Baseline at Month 12
GroupValue95% CI
XEN-45 Gel Stent-1.7± 0.08
Trabeculectomy-2.0± 0.11
Change From Baseline in Mean IOP at Month 12 Secondary · Baseline (Preoperative) and Month 12

IOP is a measurement of the fluid pressure inside the eye.

GroupValue95% CI
XEN-45 Gel Stent-8.25± 0.701
Trabeculectomy-11.02± 1.009
Change From Baseline in Mean Number of Topical IOP-Lowering Medications at Month 12 Secondary · Baseline (Preoperative) and Month 12

IOP is a measurement of the fluid pressure inside the eye. Topical IOP-lowering medication classes included: prostaglandin analogues, beta adrenergic antagonists, carbonic anhydrase inhibitors, alpha adrenergic agonists, pilocarpine, and combinations of these treatments.

GroupValue95% CI
XEN-45 Gel Stent-1.7± 0.08
Trabeculectomy-2.0± 0.11
Change in Mean IOP From Preoperative Baseline Over Time in Participants With Eyes With Baseline IOP ≤18 mm Hg Secondary · Baseline (Preoperative) and Month 12

IOP is a measurement of the fluid pressure inside the eye.

GroupValue95% CI
XEN-45 Gel Stent-2.83± 1.281
Trabeculectomy-4.61± 1.801
Change in Number of Topical IOP-Lowering Medications From Preoperative Baseline to Month 12 in Participants With Eyes With Baseline IOP ≤18 mm Hg Secondary · Baseline (Preoperative) and Month 12

Topical IOP-lowering medication classes included: prostaglandin analogues, beta adrenergic antagonists, carbonic anhydrase inhibitors, alpha adrenergic agonists, pilocarpine, and combinations of these treatments.

GroupValue95% CI
XEN-45 Gel Stent-1.8± 0.15
Trabeculectomy-2.1± 0.20
Percentage of Participants Achieving Specific IOP Targets at Month 12 Secondary · Month 12

IOP is a measurement of the fluid pressure inside the eye. Specific IOP targets included following IOP values (in mm Hg): ≤18, ≤17, ≤16, ≤15, ≤14, ≤13, ≤12 mm Hg.

IOP Value of ≤18 mm Hg
GroupValue95% CI
XEN-45 Gel Stent68.4
Trabeculectomy84.1
IOP Value of ≤17 mm Hg
GroupValue95% CI
XEN-45 Gel Stent64.2
Trabeculectomy79.5
IOP Value of ≤16 mm Hg
GroupValue95% CI
XEN-45 Gel Stent62.1
Trabeculectomy79.5
IOP Value of ≤15 mm Hg
GroupValue95% CI
XEN-45 Gel Stent55.8
Trabeculectomy72.7
IOP Value of ≤14 mm Hg
GroupValue95% CI
XEN-45 Gel Stent50.5
Trabeculectomy63.6
IOP Value of ≤13 mm Hg
GroupValue95% CI
XEN-45 Gel Stent36.8
Trabeculectomy56.8
IOP Value of ≤12 mm Hg
GroupValue95% CI
XEN-45 Gel Stent30.5
Trabeculectomy43.2
Percentage of Participants Achieving Specific Percentage IOP Lower Targets From Baseline at Month 12 Secondary · Baseline (Preoperative) to Month 12

IOP is a measurement of fluid pressure inside the eye. Specific percentage IOP lower targets included ≥25%, ≥30%, ≥35%, ≥40% ≥45%, and ≥50% IOP reduction.

≥25% IOP Reduction
GroupValue95% CI
XEN-45 Gel Stent60.0
Trabeculectomy63.6
≥30% IOP Reduction
GroupValue95% CI
XEN-45 Gel Stent48.4
Trabeculectomy61.4
≥35% IOP Reduction
GroupValue95% CI
XEN-45 Gel Stent41.1
Trabeculectomy61.4
≥40% IOP Reduction
GroupValue95% CI
XEN-45 Gel Stent35.8
Trabeculectomy54.5
≥45% IOP Reduction
GroupValue95% CI
XEN-45 Gel Stent25.3
Trabeculectomy43.2
≥50% IOP Reduction
GroupValue95% CI
XEN-45 Gel Stent22.1
Trabeculectomy43.2
Percentage of Participants Achieving at Least a 20% IOP Reduction and Specific IOP Targets on Same or Lower Number of Topical IOP-Lowering Medications at Month 12 Secondary · Baseline (Preoperative) and Month 12

IOP is a measurement of fluid pressure inside the eye. Specific IOP targets included following IOP values (in mm Hg): ≤18, ≤17, ≤16, ≤15, ≤14, ≤13, ≤12 mm Hg.

IOP Target ≤18 mm Hg
GroupValue95% CI
XEN-45 Gel Stent61.1
Trabeculectomy72.7
IOP Target ≤17 mm Hg
GroupValue95% CI
XEN-45 Gel Stent58.9
Trabeculectomy70.5
IOP Target ≤16 mm Hg
GroupValue95% CI
XEN-45 Gel Stent56.8
Trabeculectomy70.5
IOP Target ≤15 mm Hg
GroupValue95% CI
XEN-45 Gel Stent55.8
Trabeculectomy70.5
IOP Target ≤14 mm Hg
GroupValue95% CI
XEN-45 Gel Stent50.5
Trabeculectomy61.4
IOP Target ≤13 mm Hg
GroupValue95% CI
XEN-45 Gel Stent36.8
Trabeculectomy54.5
IOP Target ≤12 mm Hg
GroupValue95% CI
XEN-45 Gel Stent30.5
Trabeculectomy43.2

Adverse events — posted to ClinicalTrials.gov

Time frame: Median follow-up of 366.0 days. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

XEN-45 Gel Stent
Serious: 9/95 (9%)
Deaths: 3/107
Trabeculectomy
Serious: 2/44 (5%)
Deaths: 1/51

Serious adverse events (12 terms)

ReactionSystemXEN-45 Gel StentTrabeculectomy
CORONA VIRUS INFECTIONInfections and infestations
CARDIAC ARRESTCardiac disorders
VISUAL ACUITY REDUCEDEye disorders
ENDOPHTHALMITISInfections and infestations
PERIORBITAL CELLULITISInfections and infestations
PNEUMONIAInfections and infestations
SEPSISInfections and infestations
FALLInjury, poisoning and procedural complications
INTRAOCULAR PRESSURE INCREASEDInvestigations
PARKINSON'S DISEASENervous system disorders
DEVICE EXTRUSIONProduct Issues
ACUTE RESPIRATORY DISTRESS SYNDROMERespiratory, thoracic and mediastinal disorders
Other adverse events (9 terms — click to expand)

ReactionSystemXEN-45 Gel StentTrabeculectomy
VISUAL ACUITY REDUCEDEye disorders
HYPOTONY OF EYEEye disorders
INTRAOCULAR PRESSURE INCREASEDInvestigations
CONJUNCTIVAL FILTERING BLEB LEAKInjury, poisoning and procedural complications
HYPHAEMAInjury, poisoning and procedural complications
CHOROIDAL EFFUSIONEye disorders
DRY EYEEye disorders
GLAUCOMAEye disorders
PUNCTATE KERATITISEye disorders

Most-reported serious reactions: CORONA VIRUS INFECTION, CARDIAC ARREST, VISUAL ACUITY REDUCED, ENDOPHTHALMITIS, PERIORBITAL CELLULITIS, PNEUMONIA, SEPSIS, FALL.

Data from ClinicalTrials.gov NCT03654885 adverse events section.

Sponsor's own description

The purpose of this study is to compare the safety and efficacy of XEN-45 to trabeculectomy in participants with open angle glaucoma refractory to topical medical therapy.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Safety reporting in trials on glaucoma interventions registered in ClinicalTrials.gov and corresponding publications.
    Krešo A, Grahovac M, Znaor L, Marušić A. · · 2024 · cited 6× · PMID 39533030 · DOI 10.1038/s41598-024-79394-z
  2. Effectiveness and safety of the XEN45 gel stent compared to trabeculectomy in primary open-angle glaucoma: the Gold-Standard Pathway Study.
    Ahmed IIK, Vera V, Stalmans I, Fea AM, et al · · 2025 · PMID 39915236 · DOI 10.1136/bmjophth-2024-001696
  3. Characteristics and publication status of minimally invasive glaucoma surgery trials registered in ClinicalTrials.gov, 2007-2024: a cross-sectional study.
    Peng C, Jia H, Hu J, Jiao Y. · · 2025 · PMID 39855651 · DOI 10.1136/bmjopen-2024-095854

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