May 2020

Results of the IVAN Follow-up trial have been published

The results of the IVAN Follow-up study have recently been published in the Ophthalmology journal. The IVAN Follow-up study was, as it’s name suggests, the follow-up study to the original IVAN trial which was published in The Lancet back in 2013.

Participants in the IVAN Trial were randomised to receive one of two anti-VEGF treatments, Lucentis or Avastin, directly into their affected eye to treat ‘wet’ age-related macular degeneration (AMD), one of the biggest causes of sight loss in the UK. The IVAN Follow-up trial, managed by Dawn Phillips, collected data from the majority of the original IVAN participants from the time between their exit from the IVAN Trial up to seven years later.

The results of the IVAN Follow-up trial showed:

  • Distance visual acuity (letters read on a letter chart) worsened by more than four letters per year;
  • Approximately one third of eyes with AMD treated with anti-VEGF treatments retained a level of vision that was sufficient for driving;
  • The anti-VEGF injection rate (i.e. how frequently patients had injections) did not influence the rate of change in distance visual acuity.

A major strength of IVAN Follow Up was the exceptional data completeness, much of which was extracted from medical records spanning up to seven years. Research staff commented on the strong bonds they had formed with patients over the course of the original IVAN trial, whilst many patients reported a strong desire to contribute to IVAN Follow Up. Undoubtedly, this sense of belonging that staff and patients developed during the IVAN trial led to excellent adherence during IVAN Follow Up. The results that staff and patients contributed to have important implications for clinicians with regards to patient counselling and treatment planning, as well as for healthcare providers with regards to planning and resource allocation.

A brief history

The IVAN trial was the first multi-centre CTIMP led by what was formerly the CTEU Bristol (now the Bristol Trials Centre). It had a huge impact on ophthalmology research in the NHS. Many new collaborations have been formed and countless papers have come out of this work and the work that stemmed from it. The IVAN Trial also put the CTEU in an excellent position to take on and manage many more ophthalmology studies since. The IVAN Follow-up study was funded by the NIHR HTA Programme (project number 07/36/501). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR HTA or the Department of Health and Social Care.

BTC collaborator COVID-19 projects

The Bristol Trials Centre has many collaborators who work with us on our studies, providing specific support and guidance. We have highlighted below some of the great research that BTC collaborators are carrying out into COVID-19.

The DECIDE study – DEcision making about Cancer treatment during the covID 19 pandEmic

Led by Daisy Elliott

The overall aim of this project is to investigate formulation and delivery of cancer treatment recommendations in the context of the COVID-19 pandemic, with a view to producing evidence-informed resources to support communication in clinician-patient encounters.

Specific objectives are to:

  • Investigate processes for organising and prioritising cancer treatment during the COVID-19 pandemic in NHS Trusts across the UK, including clinical professionals’ experiences of implementing national and specialty-specific guidance;
  • Examine cancer treatment discussions conducted between clinical professionals and patients through audio-recording clinical consultations;
  • Explore patients’ and clinical professionals’ experiences of the above clinical encounters and their perceptions of how these can be improved;
  • Use the evidence generated from the above to produce resources designed to support communication around cancer treatment in the context of the COVID-19 pandemic.

The Lotus C19 Study – Understanding perceptions of risks, mitigation and innovation for surgery in a COVID-19 world

Led by Leila Rooshenas

We will conduct in-depth, semi-structured interviews to understand the perceived risks in surgery in the context of COVID-19 and explore strategies to overcome these. We will examine present experiences in the NHS and the international response by surgical teams.

COVID-19 rapid evidence reviews – co-ordinated by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West)

The Bristol Trials Centre is one of several research centres from across the University of Bristol, University of the West of England and University of Bath to be collaborating with NIHR ARC West to provide rapid evidence reviews for COVID-19 response planning. These reviews offer expertise across various settings and topics to inform decision-making for NHS clinical commissioning groups (CCGs), local authority public health departments and the Department of Health and Social Care in their response to the COVID-19 pandemic. Settings include mental health, primary care, care homes, acute trusts and community, with a range of topics covered across those settings. Dr Peter Brindle, Medical Director at the Bristol, North Somerset and South Gloucestershire CCG, said: “These rapid reviews are just one example of how the academic community has rallied to support the health and care system in the COVID-19 crisis. It is incredible how responsive university colleagues have been in providing evidence and evaluation support.” The rapid evidence reviews are available on the NIHR ARC West website