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Sadda S, Sarraf D, Khanani AM, Tadayoni R, Chang AA, Saffar I, Gedif K, Wong DT. Comparative assessment of subretinal hyper-reflective material in patients treated with brolucizumab versus aflibercept in HAWK and HARRIER. Br J Ophthalmol 2023:bjo-2023-323577. [PMID: 37669850 DOI: 10.1136/bjo-2023-323577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Post hoc analysis of the phase III HAWK and HARRIER studies to compare the reductions in subretinal hyper-reflective material (SHRM) thickness following brolucizumab 6 mg or aflibercept 2 mg treatment and to assess SHRM thickness and thickness variability as a potential biomarker of visual outcomes in patients with neovascular age-related macular degeneration (nAMD). METHODS Optical coherence tomography images from the brolucizumab (n=700) and aflibercept (n=696) arms were analysed for the maximum SHRM thickness across the macula over 96 weeks. In a pooled treatment-agnostic analysis, the effect of week 12 SHRM thickness and SHRM thickness variability on best-corrected visual acuity (BCVA) through week 96 were also assessed. RESULTS Brolucizumab was associated with numerically higher percentage reductions from baseline in SHRM thickness versus aflibercept in all patients (week 96: 54.4% vs 47.6%, respectively) and also in the matched subgroups with disease activity at week 16 (week 96: 51.6% vs 33.8%, respectively). In eyes with lower SHRM measurements at week 12, mean BCVA gains from baseline were higher at week 96 (<200 µm, +6.47 Early Treatment Diabetic Retinopathy Study letters; ≥200 µm, +3.10 letters). Eyes with the lowest SHRM thickness variability from week 12 to week 96 showed the greatest mean BCVA gains from baseline (week 96: <12 µm, +7.42 letters; >71 µm, -2.95 letters). CONCLUSIONS In HAWK and HARRIER, greater reductions in maximum SHRM thickness from baseline were observed with brolucizumab compared with aflibercept. Furthermore, the data suggest that SHRM thickness postloading and SHRM thickness variability over time are biomarkers for visual outcomes in patients with nAMD.
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Affiliation(s)
- SriniVas Sadda
- Doheny Eye Institute, University of California, Los Angeles, California, USA
| | - David Sarraf
- Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
| | - Arshad M Khanani
- Sierra Eye Associates and University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Ramin Tadayoni
- Department of Ophthalmology, Université Paris Cité, AP-HP, Lariboisière, Saint Louis and Rothschild Foundation Hospitals, Paris, France
| | - Andrew A Chang
- Sydney Retina Clinic, Sydney Eye Hospital, Sydney University, Sydney, New South Wales, Australia
| | | | | | - David T Wong
- Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
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Tadayoni R, Jaffe GJ, Holz FG, Schmidt-Erfurth U, Takahashi K, Cheung CMG, Hariprasad SM, Gedif K, Olsen R, Best C, Igwe F, Kaiser PK. Potential for Treatment Interval Extension in Eyes with nAMD Disease Activity Post Loading Phase in HAWK and HARRIER. Ophthalmol Ther 2023; 12:2209-2216. [PMID: 37294524 PMCID: PMC10287590 DOI: 10.1007/s40123-023-00735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The HAWK and HARRIER studies evaluated the efficacy and safety of brolucizumab versus aflibercept in treatment-naïve eyes with neovascular age-related macular degeneration. Based on the study design, brolucizumab-treated eyes adjusted to a q8w regimen because the presence of disease activity (DA) at the end of the matched loading phase (Week 16) could not subsequently extend to a q12w interval. The aim of this post hoc analysis was to assess subsequent DA in this subgroup to determine the potential for interval extensions during the first year of treatment. METHODS Pooled data from the brolucizumab 6 mg arms and aflibercept arms of HAWK and HARRIER were included. Presence of DA was determined by the masked investigator based on their assessment of functional and anatomical parameters measured by optical coherence tomography. DA was compared at DA assessments, conducted at Weeks 16, 20, 32, and 44; fluid was also assessed at the primary analysis at Week 48. RESULTS Fewer brolucizumab- (22.8%) than aflibercept-treated (32.2%) eyes had DA at the first DA assessment at Week 16. In eyes with investigator-identified DA at Week 16, BCVA change from baseline to Week 96 was comparable between treatment arms. Fewer brolucizumab- than aflibercept-treated eyes had DA at each subsequent DA assessment in Year 1: 31.8% vs 39.1% (Week 20), 27.3% vs 43.5% (Week 32), and 17.3% vs 31.2% (Week 44). Fewer eyes treated with brolucizumab than aflibercept had intraretinal and/or subretinal fluid: 35.3% vs 43.5% (Week 20), 55.8% vs 69.6% (Week 32), 30.0% vs 43.1% (Week 44), and 48.6% vs 68.6% (Week 48). CONCLUSION These findings indicate that, in eyes that still had DA 8 weeks after the final dose of loading phase, brolucizumab-treated eyes had improved fluid resolution and higher potential for treatment interval extension than aflibercept-treated eyes during the first year of treatment.
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Affiliation(s)
- Ramin Tadayoni
- Ophthalmology Department, Université Paris Cité, AP-HP, Lariboisière, Saint Louis and Fondation Adolphe de Rothschild Hospitals, 2 Rue Ambroise Paré, 75010, Paris, France.
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Center & Duke-NUS Medical School, Singapore, Singapore
| | - Seenu M Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA
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Abrishamian L, Bonten M, Chandra R, Elango DS, Fustier P, Gedif K, Goncalves S, Igbinadolor A, Kingsley J, Knutson CG, Kukkaro P, Kumarasamy N, Legenne P, Mekebeb-Reuter M, Ramanathan K, Reshetnyak E, Robinson M, Rosa J, Soergel M, Stavropoulou V, Stojcheva N, Stumpp MT, Tietz A, Zhao X, Zhang Z. 1130. Ensovibep antiviral activity in ambulatory patients with COVID-19 is independent of baseline anti-SARS-CoV-2 antibodies and exhibits minimal selective pressure – Results from the placebo-controlled EMPATHY trial. Open Forum Infect Dis 2022. [PMCID: PMC9752393 DOI: 10.1093/ofid/ofac492.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Ensovibep is a multi-specific DARPin (designed ankyrin repeat protein) antiviral in clinical development for treatment of COVID-19. In the Phase 2 EMPATHY study, ensovibep demonstrated greater viral load decline versus placebo. Here we report (1) the efficacy of ensovibep in patients with and without anti-SARS-CoV-2 antibodies at baseline and (2) SARS-CoV-2 mutation emergence data with treatment. Methods Eligible ambulatory patients with ≥2 COVID-19 symptoms (onset within 7 days) and positive SARS-CoV-2 rapid antigen test on day of dosing, were randomized (1:1:1:1) to ensovibep (600, 225 or 75 mg) or placebo as single, IV infusion. Chemiluminescent immunoassays were used for antibody detection (SARS-CoV-2 S1/S2 IgG and SARS-CoV-2 IgM). A pre-specified subgroup analysis was performed based on baseline anti-SARS-CoV-2 antibody status. Analysis of changes in viral genome from baseline to post baseline was performed to evaluate treatment-emergent mutations. Results Of the patients analyzed, 48.5% had anti-SARS-CoV-2 antibodies at baseline. Baseline log10 SARS-CoV-2 viral load (mean ±SD) was similar across groups [ensovibep (all doses) 6.5 ±1.5, placebo 6.2 ±1.5]; > 90% were infected with the Delta (B.1.617.2) variant. SARS-CoV-2 viral load reduction up to Day 8 showed similar effects in favor of ensovibep compared with placebo regardless of the presence of anti-SARS-CoV-2 antibodies (Figure 1). Patients in ensovibep 75 mg, 600 mg, and placebo groups had comparable incidences of emergent mutations, with a higher incidence in the 225 mg group. Based on analysis of 70% of the expected viral sequencing data, two mutations in the key binding residues of ensovibep were observed (Y489H and F486L) in a total of three patients treated with ensovibep. These patients either cleared virus by Day 8 or mutations were transient (occurred at a single time point but not later in the course of infection).
Forest plot of estimated treatment differences and associated 95% confidence intervals in time-weighted change from baseline in log10 SARS-CoV-2 viral load through Day 8 by subgroups for the presence of anti-SARS-CoV-2 antibodies (SARS-CoV-2 S1/S2 IgG and/or SARS-CoV-2 IgM) at baseline. ![]() Conclusion Ensovibep effectively reduces SARS-CoV-2 viral load regardless of the presence of anti-SARS-CoV-2 antibodies at baseline. Furthermore, there were no emerging mutations of concern, indicating that a single dose administration of ensovibep is associated with minimal selective pressure. Disclosures Marc Bonten, MD, PhD, Astra-Zeneca: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Novartis: Advisor/Consultant Richa Chandra, MD, Novartis Pharmaceuticals Corporation: Employee Damodaran Solai Elango, MD, Novartis Healthcare Pvt Ltd: Employee Pierre Fustier, PhD, Molecular Partners AG: Employee Kinfemichael Gedif, PhD, Novartis Pharmaceuticals Corporation: Employee Susana Goncalves, MD, Novartis Pharma AG: Employee Awawu Igbinadolor, MD, Novartis: Awawu Igbinadolor reports financial support from different pharmaceutical companies and organizations Jeff Kingsley, DO, MBA, CPI, FACRP, Centricity Research: Other Charles G. Knutson, PhD, Novartis Institutes for BioMedical Research: Employee Petra Kukkaro, PhD, Novartis Pharma AG: Employee Nagalingeswaran Kumarasamy, MD, Novartis: Nagalingeswaran Kumarasamy reports financial support from different pharmaceutical companies and organizations Philippe Legenne, MD, Molecular Partners AG: Employee Martha Mekebeb-Reuter, MD, Novartis: Martha Mekebeb-Reuter reports financial support from different pharmaceutical companies and organizations Krishnan Ramanathan, MD, Novartis Pharma AG: Employee Evgeniya Reshetnyak, PhD, Novartis Pharmaceuticals Corporation: Employee Michael Robinson, PhD, Novartis Institute for Tropical Disease: Employee Jennifer Rosa, MD, Novartis: Jennifer Rosa reports financial support from different pharmaceutical companies and organizations Marianne Soergel, MD, Molecular Partners AG: Employee Vaia Stavropoulou, PhD, Molecular Partners AG: Employee Nina Stojcheva, PhD, Molecular Partners AG: Employee Michael T. Stumpp, PhD, Molecular Partners AG: Employee Andreas Tietz, MD, Novartis Pharma AG: Employee Xiaojun Zhao, PhD, Novartis Institutes for BioMedical Research: Employee Zhaojie Zhang, PhD, 8. Novartis Institutes for BioMedical Research: Employee.
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Affiliation(s)
- Luis Abrishamian
- South Bay Clinical Research Institute, Redondo Beach, CA, USA, Redonda Beach, California
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht, Netherlands
| | - Richa Chandra
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, East Hanover, New Jersey
| | | | - Pierre Fustier
- Molecular Partners AG, Zurich-Schlieren, Switzerland, Zurich-Schlieren, Zurich, Switzerland
| | - Kinfemichael Gedif
- Novartis Pharmaceuticals Corporation, Fort Worth, TX, USA, Fort Worth, Texas
| | - Susana Goncalves
- Novartis Pharma AG, Basel, Switzerland, Basel, Basel-Stadt, Switzerland
| | | | - Jeff Kingsley
- Centricity Research, Columbus, GA, USA, Columbus, Georgia
| | - Charles G Knutson
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA, Cambridge, Massachusetts
| | - Petra Kukkaro
- Novartis Pharma AG, Basel, Switzerland, Basel, Basel-Stadt, Switzerland
| | - Nagalingeswaran Kumarasamy
- VHS Infectious Diseases Medical Centre, Chennai Antiviral Research and Treatment Clinical Research Site, Chennai, India, Chennai, Tamil Nadu, India
| | - Philippe Legenne
- Molecular Partners AG, Zurich-Schlieren, Switzerland, Zurich-Schlieren, Zurich, Switzerland
| | - Martha Mekebeb-Reuter
- Excellentis Clinical Trial Consultants, George, South Africa, George, Western Cape, South Africa
| | | | - Evgeniya Reshetnyak
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, East Hanover, New Jersey
| | - Michael Robinson
- Novartis Institute for Tropical Disease (NITD), Emeryville, CA, USA, Emeryville, California
| | - Jennifer Rosa
- Clinresco Centres, Gauteng, South Africa, Gauteng, Gauteng, South Africa
| | - Marianne Soergel
- Molecular Partners AG, Zurich-Schlieren, Switzerland, Zurich-Schlieren, Zurich, Switzerland
| | - Vaia Stavropoulou
- Molecular Partners AG, Zurich-Schlieren, Switzerland, Zurich-Schlieren, Zurich, Switzerland
| | - Nina Stojcheva
- Molecular Partners AG, Zurich-Schlieren, Switzerland, Zurich-Schlieren, Zurich, Switzerland
| | - Michael T Stumpp
- Molecular Partners AG, Zurich-Schlieren, Switzerland, Zurich-Schlieren, Zurich, Switzerland
| | - Andreas Tietz
- Novartis Pharma AG, Basel, Switzerland, Basel, Basel-Stadt, Switzerland
| | - Xiaojun Zhao
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA, Cambridge, Massachusetts
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Poor SH, Weissgerber G, Adams CM, Bhatt H, Browning DJ, Chastain J, Ciulla TA, Ferriere M, Gedif K, Glazer LC, Joondeph BC, Normand G, Sheth V, Watters C, Grosskreutz CL. A Randomized, Double-Masked, Multicenter Trial of Topical Acrizanib (LHA510), a Tyrosine Kinase VEGF-Receptor Inhibitor, in Treatment-Experienced Subjects With Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2022; 239:180-189. [PMID: 35247334 DOI: 10.1016/j.ajo.2022.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether topical acrizanib (LHA510), a small-molecule vascular endothelial growth factor receptor inhibitor, could suppress the need for anti-vascular endothelial growth factor therapy over a 12-week period in patients with neovascular age-related macular degeneration. DESIGN A phase 2 multicenter randomized double-masked, vehicle-controlled proof-of-concept study. METHODS Trial includes n = 90 patients with active choroidal neovascularization due to neovascular age-related macular degeneration and under anti-vascular endothelial growth factor treatment. All patients received an intravitreal injection of ranibizumab at baseline and were retreated when there was evidence of disease recurrence (rescue). Patients were randomized 1:1 to receive topical LHA510 or vehicle for 12 weeks. Drops were administered twice a day for 8 weeks and then 3 times a day for the last 4 weeks. MAIN OUTCOME MEASURE The primary outcome was the number of patients requiring rescue over 84 days of topical dosing. Key secondary outcome measures were time to first rescue, total number of ranibizumab injections, changes in central subfield thickness, and changes of visual acuity from baseline to day 84. RESULTS The extended per protocol set included 70 patients of whom 25 of 33 patients in the LHA510 group (75.8%) and 25 of 37 patients in the placebo group (67.6%) required rescue by day 84 (P = .8466). Secondary and subgroup analysis did not support evidence of efficacy. Twenty-one of 46 patients administered LHA510 developed a reversible corneal haze that resolved with cessation of treatment and did not recur in patients restarted at once daily frequency. CONCLUSION In spite of extensive optimization for topical efficacy, LHA510 failed to demonstrate clinical efficacy.
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Lally DR, Loewenstein A, Arnold JJ, Yang YC, Gedif K, Best C, Patel H, Tadayoni R, Heier JS. Efficacy and safety of brolucizumab versus aflibercept in eyes with early persistent retinal fluid: 96-week outcomes from the HAWK and HARRIER studies. Eye (Lond) 2022; 37:1242-1248. [PMID: 35597816 PMCID: PMC10102125 DOI: 10.1038/s41433-022-02092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Post-hoc analysis to compare the outcomes of brolucizumab 6 mg vs. aflibercept 2 mg in neovascular age-related macular degeneration (nAMD) patients with early persistent retinal fluid in HAWK and HARRIER. METHODS After 3 monthly loading doses, brolucizumab-treated eyes (N = 730) received injections every 12 weeks (q12w) or q8w if disease activity was detected. Aflibercept-treated eyes (N = 729) received fixed q8w dosing. Early persistent fluid was defined as the presence of subretinal fluid and/or intraretinal fluid up to Week 12. RESULTS A lower proportion of brolucizumab patients had early persistent retinal fluid compared with aflibercept (11.2% (n = 82) vs. 19.2% (n = 140)). In these patients, 34.1% of the brolucizumab-treated group achieved a ≥ 15 ETDRS letter gain in best corrected visual acuity (BCVA) from baseline at Week 96 compared with 20.7% of the aflibercept-treated group. Brolucizumab achieved numerically better BCVA outcomes (Week 96: brolucizumab, +6.4 letters; aflibercept, +3.7 letters) and significantly greater central subfield thickness reductions versus aflibercept from baseline through Week 96 (Week 96: -202 µm vs. -145 µm; p = 0.0206). Brolucizumab demonstrated an overall favourable benefit/risk profile in this patient cohort. In their unmasked, post-hoc review, the Safety Review Committee identified two cases of retinal vasculitis and no cases of retinal vascular occlusion in the brolucizumab arm; no cases of retinal vasculitis or retinal vascular occlusion were identified in the aflibercept arm. CONCLUSION In this analysis, anatomical and visual outcomes were better with brolucizumab compared with aflibercept. Brolucizumab may therefore achieve greater disease control than aflibercept in nAMD patients with early persistent retinal fluid.
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Affiliation(s)
- David R Lally
- New England Retina Consultants, Springfield, MA, USA. .,Department of Surgery, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
| | - Anat Loewenstein
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yit C Yang
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | | | - Hersh Patel
- Novartis Pharmaceuticals Corporation, East Hannover, NJ, USA.,IVERIC bio, Inc., New York, NY, USA
| | - Ramin Tadayoni
- Department of Ophthalmology, Université de Paris, AP-HP, Lariboisière, Saint Louis and Rothschild Foundation Hospitals, Paris, France
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Regillo C, Singh R, Hamilton R, Gedif K, Best C, Koh A, Holz FG. Fluid control in neovascular age-related macular degeneration with brolucizumab: an analysis of the HAWK and HARRIER phase 3 trials. Ophthalmologica 2022; 245:403-412. [PMID: 35468601 DOI: 10.1159/000524096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neovascular age-related macular degeneration (nAMD) is characterised by exudation of fluid from abnormally growing blood vessels in the macula. Anti-vascular endothelial growth factor (VEGF) therapy is standard treatment for nAMD. Fluid resolution is used both as an indicator of disease control and to guide the frequency of treatment because of anti-VEGF therapy effectiveness in reducing neovascularization-related exudation. Herein reports a post-hoc assessment of the HAWK and HARRIER trials comparing efficacy and safety of brolucizumab with aflibercept in patients with nAMD. MATERIALS AND METHODS HAWK randomized 1078 patients with untreated, active choroidal neovascularization due to AMD in the study eye to receive brolucizumab 3mg, 6mg or aflibercept 2mg. In HARRIER, 739 patients received brolucizumab 6mg or aflibercept 2mg. Brolucizumab was injected at weeks 0, 4 and 8, and thereafter q12w unless disease activity was identified (injection interval: q8w). Aflibercept was injected q8w after the loading phase; aligned with approved dosing at study initiation. The objective of this analysis was to assess effects of brolucizumab versus aflibercept on retinal fluid resolution during two phase 3 trials (HAWK and HARRIER) in patients with nAMD. Anatomical assessments for intraretinal fluid (IRF) and subretinal fluid (SRF) were performed every 4 weeks by spectral domain optical coherence tomography. Sustained dryness was defined as a patient being fluid-free (SRF and IRF) on ≥3 consecutive visits. Time to sustained dryness was determined by Kaplan-Meier estimates. RESULTS At week 96, fluid resolution (absence of IRF and SRF) was achieved by more brolucizumab- (6mg; 76.1%) versus aflibercept-treated patients (63.1%; p=0.0002, HAWK); 75.4% versus 61.8% (p<0.0001, HARRIER). More patients achieved sustained dryness with brolucizumab versus aflibercept: at 96 weeks, 87.9% (brolucizumab 3mg) and 86.1% (brolucizumab 6mg) versus 82.0% (aflibercept) in HAWK and 91.2% (brolucizumab) versus 78.0% (aflibercept) in HARRIER. Sustained dryness was achieved faster and hence with fewer brolucizumab injections. DISCUSSION/CONCLUSION Brolucizumab dried the macula in patients with nAMD faster and to a greater degree than aflibercept. Achieving sustained dryness faster, and therefore with fewer injections, provides an opportunity for earlier decisions relating to treatment interval extension potentially reducing treatment burden.
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Affiliation(s)
- Carl Regillo
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Rishi Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland, Ohio, USA
| | - Robin Hamilton
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | | | | | - Adrian Koh
- Camden Medical Center, Singapore, Singapore
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Singer M, Khanani AM, Wolf A, Flores R, Chhablani J, B G, Clemens A, Gedif K, Liu X, Mulyukov Z, Querques G. Brolucizumab 12- and 16-Week Fixed Dosing Potential in Neovascular AMD: A post hoc Evaluation of Data from the HAWK and HARRIER Trials. Ophthalmologica 2022; 245:315-322. [PMID: 35344964 DOI: 10.1159/000524245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This post hoc analysis applies a fixed dosing stratification approach to patient-level brolucizumab data from the phase III HAWK and HARRIER trials to determine the proportion of patients who would have been assigned to fixed dosing regimens with treatment intervals of 8, 12, or 16 weeks (q8w, q12w, or q16w) based on the presence/absence of disease activity (DA) following the loading phase. The analysis also simulates central subfield thickness (CSFT) data to estimate the anatomical outcomes if the patients had been thus assigned. Of note, the limitations of this analysis include the post hoc nature of the work and the inability to directly compare HAWK and HARRIER with TENAYA and LUCERNE due to the differences in design. DESIGN This study was a post hoc modelling analysis of patient-level data. METHODS Using patient-level data from HAWK and HARRIER, patients (n = 730) were allocated to a fixed q16w, q12w, or q8w regimen based on assessment of DA at weeks 16 and 20. Two definitions of DA were used: DA 1, based on a phase II study of faricimab, and DA 2, a definition derived from common clinical consideration including visual acuity and anatomical changes. CSFT simulations were performed using a pharmacokinetic/pharmacodynamic model describing CSFT response to anti-VEGF treatment. Outcome measures were modelled patient allocation to fixed regimens and mean CSFT reduction. RESULTS Using DA definitions 1 and 2, respectively, 78% and 76% of patients in the brolucizumab arm were allocated to a greater than or equal to q12w regimen, and 56% and 52% were allocated to a q16w regimen. Mean reduction in CSFT was similar between the two study drugs with both DA definition assumptions. CONCLUSIONS This analysis demonstrates the potential durability of action and effectiveness of brolucizumab.
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Affiliation(s)
- Michael Singer
- Medical Center of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Armin Wolf
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | - Rita Flores
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central EPE, Lisbon, Portugal
- CEDOC-Chronic Diseases Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Guruprasad B
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Xiaoxi Liu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ogura Y, Jaffe GJ, Cheung CMG, Kokame GT, Iida T, Takahashi K, Lee WK, Chang AA, Monés J, D'Souza D, Weissgerber G, Gedif K, Koh A. Efficacy and safety of brolucizumab versus aflibercept in eyes with polypoidal choroidal vasculopathy in Japanese participants of HAWK. Br J Ophthalmol 2021; 106:994-999. [PMID: 34301613 PMCID: PMC9234403 DOI: 10.1136/bjophthalmol-2021-319090] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose To compare the efficacy and safety of brolucizumab versus aflibercept in eyes with polypoidal choroidal vasculopathy (PCV) over 96 weeks in the HAWK study. Design HAWK was a global, 2-year, randomised, double-masked, multicentre phase III trial in participants with neovascular age-related macular degeneration. Methods Of the Japanese participants with PCV, 39 received brolucizumab 6 mg and 30 received aflibercept 2 mg. After 3 monthly loading doses, brolucizumab-treated eyes received an injection every 12 weeks (q12w) but were adjusted to q8w if disease activity was detected. Aflibercept-treated eyes received fixed q8w dosing. Mean change in best-corrected visual acuity (BCVA), the proportion of participants on q12w, retinal thickness, retinal fluid changes and safety were assessed to Week 96. Results Mean change in BCVA (early treatment diabetic retinopathy study (ETDRS) letters) from baseline to week 48/week 96 was+10.4/+11.4 for brolucizumab and +11.6/+11.1 for aflibercept. For brolucizumab-treated eyes, the probability of only q12w dosing after loading through week 48 was 76%, and 68% through week 96. Fluid resolution was greater with brolucizumab than aflibercept: respective proportions of eyes with intraretinal fluid and/or subretinal fluid were 7.7% and 30% at week 48% and 12.8% and 16.7% at week 96. Brolucizumab exhibited an overall well-tolerated safety profile despite a higher rate of intraocular inflammation compared with aflibercept. Conclusion In Japanese eyes with PCV, brolucizumab q12w/q8w monotherapy resulted in robust and consistent BCVA gains that were comparable to q8w aflibercept dosing. Anatomical outcomes favoured brolucizumab over aflibercept, with 76% of brolucizumab participants maintained on q12w dosing after loading to week 48.
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Affiliation(s)
- Yuichiro Ogura
- Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | | | - Gregg T Kokame
- University of Hawaii School of Medicine, Honolulu, Hawaii, USA
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Moriguchi, Japan
| | - Won Ki Lee
- Nune Eye Hospital, Seoul, Republic of Korea
| | - Andrew A Chang
- Sydney Retina Clinic, Sydney Eye Hospital, Sydney University, Sydney, New South Wales, Australia
| | - Jordi Monés
- Institut de la Màcula, Barcelona, Spain.,Barcelona Macula Foundation, Barcelona, Spain
| | | | | | | | - Adrian Koh
- Eye and Retina Surgeons, Camden Medical Centre, Singapore
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Dugel PU, Singh RP, Koh A, Ogura Y, Weissgerber G, Gedif K, Jaffe GJ, Tadayoni R, Schmidt-Erfurth U, Holz FG. HAWK and HARRIER: Ninety-Six-Week Outcomes from the Phase 3 Trials of Brolucizumab for Neovascular Age-Related Macular Degeneration. Ophthalmology 2021; 128:89-99. [PMID: 32574761 DOI: 10.1016/j.ophtha.2020.06.028] [Citation(s) in RCA: 191] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To report the 96-week outcomes from HAWK and HARRIER. DESIGN Phase 3, prospective, randomized, double-masked, multicenter studies comparing efficacy and safety of brolucizumab 3 mg (HAWK only) and 6 mg with aflibercept 2 mg in eyes with neovascular age-related macular degeneration (nAMD). PARTICIPANTS Treatment-naïve eyes with nAMD were randomized 1:1:1 to brolucizumab 3 mg (n = 358), brolucizumab 6 mg (n = 360), aflibercept 2 mg (n = 360; HAWK) or 1:1 to brolucizumab 6 mg (n = 370), aflibercept 2 mg (n = 369; HARRIER). METHODS After 3 monthly loading doses, brolucizumab patients received every (q)-12-week (w) dosing, possibly adjusting to q8w dosing if disease activity was present at predefined disease activity assessment (DAA) visits. Aflibercept was dosed in a fixed q8w regimen. Visual and anatomic parameters were assessed throughout. Primary end point was at week 48 (48w), confirmed at 96w. MAIN OUTCOME MEASURES Mean best-corrected visual acuity (BCVA) change from baseline, proportion of patients on an q12w regimen, retinal thickness, retinal fluid changes, and safety, all to 96w. RESULTS Mean change (least squares [LS] mean ± standard error) in BCVA from baseline to 96w in HAWK was 5.6±0.79 Early Treatment Diabetic Retinopathy Study (ETDRS) letters for brolucizumab 3 mg, 5.90±0.78 letters for brolucizumab 6 mg, and 5.3±0.78 letters for aflibercept and in HARRIER was 6.1±0.73 letters for brolucizumab 6 mg and 6.6 ± 0.73 letters for aflibercept. Greater central subfield thickness reductions were observed with brolucizumab 6 mg versus aflibercept in HAWK (LS mean, -174.8 μm vs. -148.7 μm; 95% confidence interval for treatment difference, -46.2 to -5.9 μm; P = 0.0115) and HARRIER (LS mean, -197.7 μm vs. -155.1 μm; 95% confidence interval for treatment difference, -62.0 to -23.3 μm; P < 0.0001). The proportions of eyes with intraretinal fluid and/or subretinal fluid (IRF/SRF) at 96w in HAWK were 31% (P = 0.0688) and 24% (P = 0.0002) for brolucizumab 3 mg and 6 mg and 37% for aflibercept, whereas in HARRIER, they were 24% for brolucizumab 6 mg (P < 0.0001) and 39% for aflibercept. At 92w (last DAA), a 45.4% and 38.6% probability was observed for brolucizumab 6 mg patients of maintaining an q12w treatment regimen in HAWK and HARRIER, respectively. Brolucizumab exhibited an overall well-tolerated safety profile. CONCLUSIONS Visual outcomes from 48w to 96w confirm the efficacy achieved at 48w. Brolucizumab demonstrated greater fluid resolution compared with aflibercept. The q12w potential for brolucizumab observed at 48w was maintained to 96w.
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Affiliation(s)
| | | | - Adrian Koh
- Eye & Retina Surgeons, Singapore, Republic of Singapore
| | - Yuichiro Ogura
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | - Ramin Tadayoni
- Lariboisiere & Saint Louis Hospitals, Universite de Paris, Paris, France
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Stahl E, Bremond-Gignac D, Landry T, Curtis M, Gedif K, Al Shahwan S, Dixon ER. Pharmacokinetics and Safety of Travoprost 0.004% Ophthalmic Solution Preserved with Polyquad in Pediatric Patients with Glaucoma. J Ocul Pharmacol Ther 2017; 33:361-365. [DOI: 10.1089/jop.2016.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Erin Stahl
- Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | | | - Sami Al Shahwan
- King Khaled Eye Specialists Hospital, Riyadh, Kingdom of Saudi Arabia
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