Aflibercept 8 mg Late-breaking Data Presented at Retina Society in Diabetic Macular Edema and Wet Age-related Macular Degeneration
Presentations reinforce that aflibercept 8 mg demonstrated non-inferior vision gains to EYLEA at 48 weeks, with 93% and 83% of patients in PHOTON and PULSAR, respectively, maintaining dosing intervals of 12 weeks or longer after initial monthly doses
Additional new pre-specified and exploratory analyses showed aflibercept 8 mg led to sustained improvements in certain anatomical measures during the 48-week treatment period for both 12- and 16-week dosing regimens in PHOTON and PULSAR
"Investigational aflibercept 8 mg allowed the vast majority of patients to be maintained on extended dosing intervals with outcomes that were generally consistent with EYLEA across time points during the 48-week treatment period," said
As previously announced, the presentations at
In addition to data recently shared at the
- Among wAMD patients, 71% (n=332) and 67% (n=334) had no retinal fluid in the center subfield, compared to 59% for EYLEA (n=335), per a pre-specified analysis of PULSAR. The median time to a fluid-free subfield was 4 weeks for aflibercept 8 mg, compared to 8 weeks for EYLEA.
- Among DME patients, there was a mean reduction of 14 mm2 (n= 328) and 9 mm2 (n=163) in the total area of fluorescein leakage from baseline, compared to 9 mm2 for EYLEA (n=167), per an exploratory analysis of PHOTON. Reductions in fluorescein leakage, a measure of disease activity, are associated with disease improvement.
The safety of aflibercept 8 mg was similar to EYLEA in both trials, and consistent with the known safety profile of EYLEA from previous clinical trials. The most frequent ocular adverse events that occurred more commonly in aflibercept 8 mg versus EYLEA patients in PHOTON (aflibercept 8 mg n=491; EYLEA n=167) were cataract (3% vs. 1%), conjunctival hemorrhage (4% vs. 4%), punctate keratitis (2% vs. <1%), retinal hemorrhage (1% vs. <1%) and vitreous floaters (4% vs. 2%). In PULSAR (aflibercept 8 mg n=673; EYLEA n=336), they were cataract (4% vs. 3%) and intraocular pressure increased (3% vs. 2%). There were no cases of retinal vasculitis, occlusive retinitis or endophthalmitis in either trial.
"These data show unprecedented durability of aflibercept 8 mg in patients living with age-related macular degeneration and diabetic macular edema, who also experienced significant anatomical improvements at week 48," said Jean-François Korobelnik, Professor of Ophthalmology and Head of the Department of Ophthalmology at University Hospital of
Aflibercept 8 mg is being jointly developed by
Aflibercept 8 mg is investigational, and its safety and efficacy have not been evaluated by any regulatory authority.
PHOTON in DME and PULSAR in wAMD are double-masked, active-controlled pivotal trials that are being conducted in multiple centers globally. In both trials, patients were randomized into 3 treatment groups to receive either: aflibercept 8 mg every 12 weeks, aflibercept 8 mg every 16 weeks, or EYLEA every 8 weeks.
Patients treated with aflibercept 8 mg in both trials had 3 initial monthly doses, and patients treated with EYLEA received 5 initial monthly doses in PHOTON and 3 in PULSAR. In the first year, patients in the aflibercept 8 mg groups could have their dosing intervals shortened down to an every 8-week interval if protocol-defined criteria for disease progression were observed. Intervals could not be extended until the second year of the study, with those results still to be assessed. Patients in all EYLEA groups maintained a fixed 8-week dosing regimen throughout their participation in the trials.
The lead sponsors of the trials were Regeneron for PHOTON and Bayer for PULSAR.
DME is a common complication in eyes of people living with diabetes. DME occurs when high levels of blood sugar lead to damaged blood vessels in the eye that leak fluid into the macula. This can lead to vision loss and, in some cases, blindness. Of the nearly 28 million American adults living with diabetes, an estimated 1.2 million have DME.
wAMD is a retinal disease that may affect people as they age. It occurs when abnormal blood vessels grow and leak fluid under the macula, the part of the eye responsible for sharp central vision and seeing fine detail. This fluid can damage and scar the macula, which can cause vision loss. An estimated 1.1 million Americans have wAMD, and this number is expected to double by 2050.
EYLEA® (aflibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).
- EYLEA is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.
- Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.
- Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.
- There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA compared with 1.5% (9 out of 595) in patients treated with ranibizumab; through 96 weeks, the incidence was 3.3% (60 out of 1824) in the EYLEA group compared with 3.2% (19 out of 595) in the ranibizumab group. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.
- Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.
- The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and intraocular pressure increased.
- Patients may experience temporary visual disturbances after an intravitreal injection with EYLEA and the associated eye examinations. Advise patients not to drive or use machinery until visual function has recovered sufficiently.
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