Lucentis Drug Information
Generic name: RANIBIZUMAB
Vascular Endothelial Growth Factor Inhibitor [EPC]
Uses of Lucentis
Neovascular (Wet) Age-Related Macular Degeneration (AMD) 1.2 Macular Edema Following Retinal Vein
Occlusion (RVO)
Diabetic Macular Edema (DME) 1.4 Diabetic Retinopathy (DR) 1.5 Myopic Choroidal Neovascularization
(mCNV)
Dosage & Administration of Lucentis
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Side Effects of Lucentis
Injection Procedure Serious adverse reactions related to the injection procedure have occurred
in < 0.1% of intravitreal injections, including endophthalmitis , rhegmatogenous retinal detachment, and iatrogenic traumatic cataract.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The data below reflect exposure to 0.5 mg LUCENTIS in 440 patients with neovascular AMD in Studies AMD-1, AMD-2, and AMD-3; in 259 patients with macular edema following RVO. The data also reflect exposure to 0.3 mg LUCENTIS in 250 patients with DME and DR at baseline . Safety data observed in 224 patients with mCNV, as well as Studies AMD-4 and D-3, were consistent with these results. On average, the rates and types of adverse reactions in patients were not significantly affected by dosing regimen.
Ocular Reactions Table 1 shows frequently reported ocular adverse reactions in LUCENTIS-treated patients compared with the control group. Table 1 Ocular Reactions in the DME and DR, AMD, and RVO Studies DME and DR 2-year AMD 2-year AMD 1-year RVO 6-month Adverse Reaction LUCENTIS 0.3 mg Control LUCENTIS 0.5 mg Control LUCENTIS 0.5 mg Control LUCENTIS 0.5 mg Control n=250 n=250 n=379 n=379 n=440 n=441 n=259 n=260 Conjunctival hemorrhage 47% 32% 74% 60% 64% 50% 48% 37% Eye pain 17% 13% 35% 30% 26% 20% 17% 12% Vitreous floaters 10% 4% 27% 8% 19% 5% 7% 2% Intraocular pressure increased 18% 7% 24% 7% 17% 5% 7% 2% Vitreous detachment 11% 15% 21% 19% 15% 15% 4% 2% Intraocular inflammation 4% 3% 18% 8% 13% 7% 1% 3% Cataract 28% 32% 17% 14% 11% 9% 2% 2% Foreign body sensation in eyes 10% 5% 16% 14% 13% 10% 7% 5% Eye irritation 8% 5% 15% 15% 13% 12% 7% 6% Lacrimation increased 5% 4% 14% 12% 8% 8% 2% 3% Blepharitis 3% 2% 12% 8% 8% 5% 0% 1% Dry eye 5% 3% 12% 7% 7% 7% 3% 3% Visual disturbance or vision blurred 8% 4% 18% 15% 13% 10% 5% 3% Eye pruritis 4% 4% 12% 11% 9% 7% 1% 2% Ocular hyperemia 9% 9% 11% 8% 7% 4% 5% 3% Retinal disorder 2% 2% 10% 7% 8% 4% 2% 1% Maculopathy 5% 7% 9% 9% 6% 6% 11% 7% Retinal degeneration 1% 0% 8% 6% 5% 3% 1% 0% Ocular discomfort 2% 1% 7% 4% 5% 2% 2% 2% Conjunctival hyperemia 1% 2% 7% 6% 5% 4% 0% 0% Posterior capsule opacification 4% 3% 7% 4% 2% 2% 0% 1% Injection site hemorrhage 1% 0% 5% 2% 3% 1% 0% 0% Non-Ocular Reactions Non-ocular adverse reactions with an incidence of ≥ 5% in patients receiving LUCENTIS for DR, DME, AMD, and/or RVO and which occurred at a ≥ 1% higher frequency in patients treated with LUCENTIS compared to control are shown in Table 2. Though less common, wound healing complications were also observed in some studies. Table 2 Non-Ocular Reactions in the DME and DR, AMD, and RVO Studies DME and DR 2-year AMD 2-year AMD 1-year RVO 6-month Adverse Reaction LUCENTIS 0.3 mg Control LUCENTIS 0.5 mg Control LUCENTIS 0.5 mg Control LUCENTIS 0.5 mg Control n=250 n=250 n=379 n=379 n=440 n=441 n=259 n=260 Nasopharyngitis 12% 6% 16% 13% 8% 9% 5% 4% Anemia 11% 10% 8% 7% 4% 3% 1% 1% Nausea 10% 9% 9% 6% 5% 5% 1% 2% Cough 9% 4% 9% 8% 5% 4% 1% 2% Constipation 8% 4% 5% 7% 3% 4% 0% 1% Seasonal allergy 8% 4% 4% 4% 2% 2% 0% 2% Hypercholesterolemia 7% 5% 5% 5% 3% 2% 1% 1% Influenza 7% 3% 7% 5% 3% 2% 3% 2% Renal failure 7% 6% 1% 1% 0% 0% 0% 0% Upper respiratory tract infection 7% 7% 9% 8% 5% 5% 2% 2% Gastroesophageal reflux disease 6% 4% 4% 6% 3% 4% 1% 0% Headache 6% 8% 12% 9% 6% 5% 3% 3% Edema peripheral 6% 4% 3% 5% 2% 3% 0% 1% Renal failure chronic 6% 2% 0% 1% 0% 0% 0% 0% Neuropathy peripheral 5% 3% 1% 1% 1% 0% 0% 0% Sinusitis 5% 8% 8% 7% 5% 5% 3% 2% Bronchitis 4% 4% 11% 9% 6% 5% 0% 2% Atrial fibrillation 3% 3% 5% 4% 2% 2% 1% 0% Arthralgia 3% 3% 11% 9% 5% 5% 2% 1% Chronic obstructive pulmonary disease 1% 1% 6% 3% 3% 1% 0% 0% Wound healing complications 1% 0% 1% 1% 1% 0% 0% 0%
Immunogenicity As with all therapeutic proteins, there is the potential for an
immune response in patients treated with LUCENTIS. The immunogenicity data reflect the percentage of patients whose test results were considered positive for antibodies to LUCENTIS in immunoassays and are highly dependent on the sensitivity and specificity of the assays. The pre-treatment incidence of immunoreactivity to LUCENTIS was 0%-5% across treatment groups. After monthly dosing with LUCENTIS for 6 to 24 months, antibodies to LUCENTIS were detected in approximately 1%-9% of patients.
The clinical significance of immunoreactivity to LUCENTIS is unclear at this time. Among neovascular AMD patients with the highest levels of immunoreactivity, some were noted to have iritis or vitritis. Intraocular inflammation was not observed in patients with DME and DR at baseline, or RVO patients with the highest levels of immunoreactivity.
Postmarketing Experience
The following adverse reaction has been identified during post-approval use of LUCENTIS. Because this reaction was reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate the frequency or establish a causal relationship to drug exposure. Ocular: Tear of retinal pigment epithelium among patients with neovascular AMD
Warnings & Cautions for Lucentis
Endophthalmitis and Retinal Detachments Intravitreal injections, including those with
LUCENTIS, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique should always be used when administering LUCENTIS. In addition, patients should be monitored following the injection to permit early treatment should an infection occur .
Increases in Intraocular Pressure Increases in intraocular pressure have been noted both
pre-injection and post-injection (at 60 minutes) while being treated with LUCENTIS. Monitor intraocular pressure prior to and following intravitreal injection with LUCENTIS and manage appropriately.
Thromboembolic Events
Although there was a low rate of arterial thromboembolic events (ATEs) observed in the LUCENTIS clinical trials, there is a potential risk of ATEs following intravitreal use of VEGF inhibitors. Arterial thromboembolic events are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). Neovascular (Wet) Age-Related Macular Degeneration The ATE rate in the three controlled neovascular AMD studies (AMD-1, AMD-2, AMD-3) during the first year was 1.9% (17 of 874) in the combined group of patients treated with 0.3 mg or 0.5 mg LUCENTIS compared with 1.1% (5 of 441) in patients from the control arms . In the second year of Studies AMD-1 and AMD-2, the ATE rate was 2.6% (19 of 721) in the combined group of LUCENTIS-treated patients compared with 2.9% (10 of 344) in patients from the control arms. In Study AMD-4, the ATE rates observed in the 0.5 mg arms during the first and second year were similar to rates observed in Studies AMD-1, AMD-2, and AMD-3. In a pooled analysis of 2-year controlled studies, the stroke rate (including both ischemic and hemorrhagic stroke) was 2.7% (13 of 484) in patients treated with 0.5 mg LUCENTIS compared to 1.1% (5 of 435) in patients in the control arms.
Macular Edema Following Retinal Vein Occlusion The ATE rate in the two controlled RVO studies during the first 6 months was 0.8% in both the LUCENTIS and control arms of the studies (4 of 525 in the combined group of patients treated with 0.3 mg or 0.5 mg LUCENTIS and 2 of 260 in the control arms) . The stroke rate was 0.2% (1 of 525) in the combined group of LUCENTIS-treated patients compared to 0.4% (1 of 260) in the control arms. Diabetic Macular Edema and Diabetic Retinopathy Safety data are derived from studies D-1 and D-2. All enrolled patients had DME and DR at baseline . In a pooled analysis of Studies D-1 and D-2 , the ATE rate at 2 years was 7.2% (18 of 250) with 0.5 mg LUCENTIS, 5.6% (14 of 250) with 0.3 mg LUCENTIS, and 5.2% (13 of 250) with control. The stroke rate at 2 years was 3.2% (8 of 250) with 0.5 mg LUCENTIS, 1.2% (3 of 250) with 0.3 mg LUCENTIS, and 1.6% (4 of 250) with control.
At 3 years, the ATE rate was 10.4% (26 of 249) with 0.5 mg LUCENTIS and 10.8% (27 of 250) with 0.3 mg LUCENTIS; the stroke rate was 4.8% (12 of 249) with 0.5 mg LUCENTIS and 2.0% (5 of 250) with 0.3 mg LUCENTIS.
Fatal Events in Patients with Diabetic Macular Edema and Diabetic Retinopathy at
Baseline Diabetic Macular Edema and Diabetic Retinopathy Safety data are derived from studies D-1 and D-2. All enrolled patients had DME and DR at baseline . A pooled analysis of Studies D-1 and D-2 , showed that fatalities in the first 2 years occurred in 4.4% (11 of 250) of patients treated with 0.5 mg LUCENTIS, in 2.8% (7 of 250) of patients treated with 0.3 mg LUCENTIS, and in 1.2% (3 of 250) of control patients. Over 3 years, fatalities occurred in 6.4% (16 of 249) of patients treated with 0.5 mg LUCENTIS and in 4.4% (11 of 250) of patients treated with 0.3 mg LUCENTIS. Although the rate of fatal events was low and included causes of death typical of patients with advanced diabetic complications, a potential relationship between these events and intravitreal use of VEGF inhibitors cannot be excluded.
Retinal Vasculitis with or without Occlusion Retinal vasculitis with or without occlusion
typically in the presence of preexisting intraocular inflammation or post-treatment with other intravitreal agents, have been reported with the use of LUCENTIS. Discontinue treatment with LUCENTIS in patients who develop these events. Patients should be instructed to report any change in vision without delay .
Drug Interactions with Lucentis
Drug interaction studies have not been conducted with LUCENTIS. LUCENTIS intravitreal injection has been used adjunctively with PDT. Twelve of 105 (11%) patients with neovascular AMD developed serious intraocular inflammation; in 10 of the 12 patients, this occurred when LUCENTIS was administered 7 days (± 2 days) after PDT.
Pregnancy Safety for Lucentis
Pregnancy Risk Summary There are no adequate and well-controlled studies of LUCENTIS administration in pregnant women. Administration of ranibizumab to pregnant monkeys throughout the period of organogenesis resulted in a low incidence of skeletal abnormalities at intravitreal doses 13-times the predicted human exposure (based on maximal serum trough levels ) after a single eye treatment at the recommended clinical dose. No skeletal abnormalities were observed at serum trough levels equivalent to the predicted human exposure after a single eye treatment at the recommended clinical dose . Animal reproduction studies are not always predictive of human response, and it is not known whether ranibizumab can cause fetal harm when administered to a pregnant woman.
Based on the anti-VEGF mechanism of action for ranibizumab , treatment with LUCENTIS may pose a risk to human embryofetal development. LUCENTIS should be given to a pregnant woman only if clearly needed. Data Animal Data An embryo-fetal developmental toxicity study was performed on pregnant cynomolgus monkeys.
Pregnant animals received intravitreal injections of ranibizumab every 14 days starting on Day 20 of gestation, until Day 62 at doses of 0, 0.125, and 1 mg/eye. Skeletal abnormalities including incomplete and/or irregular ossification of bones in the skull, vertebral column, and hindlimbs and shortened supernumerary ribs were seen at a low incidence in fetuses from animals treated with 1 mg/eye of ranibizumab. The 1 mg/eye dose resulted in trough serum ranibizumab levels up to 13 times higher than predicted C max levels with single eye treatment in humans.
No skeletal abnormalities were seen at the lower dose of 0.125 mg/eye, a dose which resulted in trough exposures equivalent to single eye treatment in humans. No effect on the weight or structure of the placenta, maternal toxicity, or embryotoxicity was observed.
Pediatric Use of Lucentis
Pediatric Use The safety and effectiveness of LUCENTIS in pediatric patients have not been established.
Contraindications for Lucentis
Ocular or Periocular Infections
LUCENTIS is contraindicated in patients with ocular or periocular infections.
Hypersensitivity
LUCENTIS is contraindicated in patients with known hypersensitivity to ranibizumab or any of the excipients in LUCENTIS. Hypersensitivity reactions may manifest as severe intraocular inflammation.
Overdosage Information for Lucentis
More concentrated doses as high as 2 mg ranibizumab in 0.05 mL have been administered to patients. No additional unexpected adverse reactions were seen.
Clinical Studies of Lucentis
Neovascular (Wet) Age-Related Macular Degeneration (AMD)
The safety and efficacy of LUCENTIS were assessed in three randomized, double-masked, sham- or active-controlled studies in patients with neovascular AMD. A total of 1323 patients (LUCENTIS 879, control 444) were enrolled in the three studies. Studies AMD-1 and AMD-2 In Study AMD-1, patients with minimally classic or occult (without classic) CNV lesions received monthly LUCENTIS 0.3 mg or 0.5 mg intravitreal injections or monthly sham injections. Data are available through Month 24. Patients treated with LUCENTIS in Study AMD-1 received a mean of 22 total treatments out of a possible 24 from Day 0 to Month 24. In Study AMD-2, patients with predominantly classic CNV lesions received one of the following: 1) monthly LUCENTIS 0.3 mg intravitreal injections and sham PDT; 2) monthly LUCENTIS 0.5 mg intravitreal injections and sham PDT; or 3) sham intravitreal injections and active PDT. Sham PDT (or active PDT) was given with the initial LUCENTIS (or sham) intravitreal injection and every 3 months thereafter if FA showed persistence or recurrence of leakage.
Data are available through Month 24. Patients treated with LUCENTIS in Study AMD-2 received a mean of 21 total treatments out of a possible 24 from Day 0 through Month 24. In both studies, the primary efficacy endpoint was the proportion of patients who maintained vision, defined as losing fewer than 15 letters of visual acuity at 12 months compared with baseline. Almost all LUCENTIS-treated patients (approximately 95%) maintained their visual acuity. Among LUCENTIS-treated patients, 31% to 37% experienced a clinically significant improvement in vision, defined as gaining 15 or more letters at 12 months.
The size of the lesion did not significantly affect the results. Detailed results are shown in Table 3, Table 4, and Figure 1 below. Table 3 Visual Acuity Outcomes at Month 12 and Month 24 in Study AMD-1 Outcome Measure Month Sham n=229 LUCENTIS 0.5 mg n=230 Estimated Difference (95% CI) Adjusted estimate based on the stratified model; p < 0.01 Loss of <15 letters in visual acuity (%) 12 60% 91% 30% (23%, 37%) 24 56% 89% 33% (26%, 41%) Gain of ≥15 letters in visual acuity (%) 12 6% 31% 25% (18%, 31%) 24 4% 30% 25% (18%, 31%) Mean change in visual acuity (letters) (SD) 12 -11.0 +6.3 17.1 24 -15.0 +5.5
Table 4 Visual Acuity Outcomes at Month 12 and Month 24 in
Study AMD-2 Outcome Measure Month PDT n=141 LUCENTIS 0.5 mg n=139 Estimated Difference (95% CI) Adjusted estimate based on the stratified model; p < 0.01 Loss of <15 letters in visual acuity (%) 12 66% 98% 32% (24%, 40%) 24 65% 93% 28% (19%, 37%) Gain of ≥15 letters in visual acuity (%) 12 11% 37% 26% (17%, 36%) 24 9% 37% 29% (20%, 39%) Mean change in visual acuity (letters) (SD) 12 -8.5 +11.0 19.8 24 -9.1 +10.9 20 Figure 1 Mean Change in Visual Acuity Visual acuity was measured at a distance of 2 meters from Baseline to Month 24 in Study AMD-1 and Study AMD-2 Patients in the group treated with LUCENTIS had minimal observable CNV lesion growth, on average. At Month 12, the mean change in the total area of the CNV lesion was 0.1-0.3 disc areas (DA) for LUCENTIS versus 2.3-
DA for the control arms. At Month 24, the mean change in
the total area of the CNV lesion was 0.3-
DA for
LUCENTIS versus 2.9-
DA for the control arms. Figure 1 Study
AMD-3 Study AMD-3 was a randomized, double-masked, sham-controlled, 2-year study designed to assess the safety and efficacy of LUCENTIS in patients with neovascular AMD (with or without a classic CNV component). Data are available through Month 12. Patients received LUCENTIS 0.3 mg or 0.5 mg intravitreal injections or sham injections once a month for three consecutive doses, followed by a dose administered once every 3 months for 9 months. A total of 184 patients were enrolled in this study (LUCENTIS 0.3 mg, 60; LUCENTIS 0.5 mg, 61; sham, 63); 171 (93%) completed 12 months of this study. Patients treated with LUCENTIS in Study AMD-3 received a mean of six total treatments out of a possible 6 from Day 0 through Month 12. In Study AMD-3, the primary efficacy endpoint was the mean change in visual acuity at 12 months compared with baseline (see Figure 2 ). After an initial increase in visual acuity (following monthly dosing), on average, patients dosed once every 3 months with LUCENTIS lost visual acuity, returning to baseline at Month 12. In Study AMD-3, almost all LUCENTIS-treated patients (90%) lost fewer than 15 letters of visual acuity at Month 12. Figure 2 Mean Change in Visual Acuity from Baseline to Month 12 in Study AMD-3 Figure 2 Study AMD-4 Study AMD-4 was a randomized, double-masked, active treatment-controlled, two-year study designed to assess the safety and efficacy of LUCENTIS 0.5 mg administered monthly or less frequently than monthly in patients with neovascular AMD. Patients randomized to the LUCENTIS 0.5 mg less frequent dosing arm received three monthly doses followed by monthly assessments where patients were eligible to receive LUCENTIS injections guided by pre-specified re-treatment criteria.
A total of 550 patients were enrolled in the two 0.5 mg treatment groups with 467 (85%) completing through Month 24. Data are available through Month 24. Clinical results at Month 24 remain similar to that observed at Month 12. From Month 3 through Month 24, visual acuity decreased by 0.3 letters in the 0.5 mg less frequent dosing arm and increased by 0.7 letters in the 0.5 mg monthly arm (see Figure 3 ). Over this 21-month period, patients in the 0.5 mg less frequent dosing and the 0.5 mg monthly arms averaged 10.3 and 18.5 injections, respectively. The distribution of injections received in the less frequent dosing arm is shown in Figure 4. Figure 3 Mean Change in Visual Acuity from Baseline to Month 24 in Study AMD-4 Figure 4 Distribution of Injections from Month 3 to Month 24 in the Less Frequent Dosing Arm in Study AMD-4 Figure 3 Figure 4
Macular Edema Following Retinal Vein Occlusion (RVO)
The safety and efficacy of LUCENTIS were assessed in two randomized, double-masked, 1-year studies in patients with macular edema following RVO. Sham controlled data are available through Month 6. Patient age ranged from 20 to 91 years, with a mean age of 67 years. A total of 789 patients (LUCENTIS 0.3 mg, 266 patients; LUCENTIS 0.5 mg, 261 patients; sham, 262 patients) were enrolled, with 739 (94%) patients completing through Month 6. All patients completing Month 6 were eligible to receive LUCENTIS injections guided by pre-specified re-treatment criteria until the end of the studies at Month 12. In Study RVO-1, patients with macular edema following branch or hemi-RVO, received monthly LUCENTIS 0.3 mg or 0.5 mg intravitreal injections or monthly sham injections for 6 months. All patients were eligible for macular focal/grid laser treatment beginning at Month 3 of the 6-month treatment period.
Macular focal/grid laser treatment was given to 26 of 131 (20%) patients treated with 0.5 mg LUCENTIS and 71 of 132 (54%) patients treated with sham. In Study RVO-2, patients with macular edema following central RVO received monthly LUCENTIS 0.3 mg or 0.5 mg intravitreal injections or monthly sham injections for 6 months. At Month 6, after monthly treatment with 0.5 mg LUCENTIS, the following clinical results were observed: Table 5 Visual Acuity Outcomes at Month 6 in Study RVO-1 and Study RVO-2 Outcome Measure Study RVO-1: Sham, n=131; LUCENTIS 0.5 mg, n=132 RVO-2: Sham, n=130; LUCENTIS 0.5 mg, n=130 Sham LUCENTIS 0.5 mg Estimated Difference (95% CI) Adjusted estimate based on stratified model; p < 0.01 Gain of ≥15 letters in visual acuity (%) RVO-1 29% 61% 31% (20%, 43%) Gain of ≥15 letters in visual acuity (%) RVO-2 17% 48% 30% (20%, 41%) p < 0.01 for all time points Figure 5 Mean Change in Visual Acuity from Baseline to Month 6 in Study RVO-1 and Study RVO-2 Figure 5
Diabetic Macular Edema (DME) Efficacy and safety data of
LUCENTIS are derived from studies D-1 and D-2 (See Section
Diabetic Retinopathy below). All enrolled patients had DR and
DME at baseline. The safety and efficacy of LUCENTIS were assessed in two randomized, double-masked, 3-year studies. The studies were sham-controlled through Month 24. Patient age ranged from 21 to 91 years, with a mean age of 62 years.
A total of 759 patients (LUCENTIS 0.3 mg, 250 patients; LUCENTIS 0.5 mg, 252 patients; sham, 257 patients) were enrolled, with 582 (77%) completing through Month 36. In Studies D-1 and D-2, patients received monthly LUCENTIS 0.3 mg or 0.5 mg intravitreal injections or monthly sham injections during the 24-month controlled treatment period. From Months 25 through 36, patients who previously received sham were eligible to receive monthly LUCENTIS 0.5 mg and patients originally randomized to monthly LUCENTIS 0.3 mg or 0.5 mg continued to receive their assigned dose. All patients were eligible for macular focal/grid laser treatment beginning at Month 3 of the 24-month treatment period or panretinal photocoagulation (PRP) as needed.
Through Month 24, macular focal/grid laser treatment was administered in 94 of 250 (38%) patients treated with LUCENTIS 0.3 mg and 185 of 257 (72%) patients treated with sham; PRP was administered in 2 of 250 (1%) patients treated with LUCENTIS 0.3 mg and 30 of 257 (12%) patients treated with sham. Compared to monthly LUCENTIS 0.3 mg, no additional benefit was observed with monthly treatment with LUCENTIS 0.5 mg. At Month 24, after monthly treatment with LUCENTIS 0.3 mg, the following clinical results were observed: Table 6 Visual Acuity Outcomes at Month 24 in Study D-1 and D-2 Outcome Measure Study D-1: Sham, n=130; LUCENTIS 0.3 mg, n=125 D-2: Sham, n=127; LUCENTIS 0.3 mg, n=125 Sham LUCENTIS 0.3 mg Estimated Difference (95% CI) Adjusted estimate based on stratified model; p ≤ 0.01 Gain of ≥15 letters in visual acuity (%) D-1 12% 34% 21% (11%, 30%) D-2 18% 45% 24% (14%, 35%) Loss of <15 letters in visual acuity (%) D-1 92% 98% 7% (2%, 13%) D-2 90% 98% 8% (2%, 14%) Mean change in visual acuity (letters) D-1 2.3 10.9
D-2 2.6 12.5 9.6 p < 0.01 for all time points comparing
LUCENTIS 0.3 mg to sham through Month 24 Figure 6 Mean Change in Visual Acuity from Baseline to Month 36 in Study D-1 and Study D-2 Visual acuity outcomes observed at Month 24 in patients treated with LUCENTIS 0.3 mg were maintained with continued treatment through Month 36 in both DME studies. Patients in the sham arms who received LUCENTIS 0.5 mg beginning at Month 25 achieved lesser VA gains compared to patients who began treatment with LUCENTIS at the beginning of the studies. In Studies D-1 and D-2, patients received monthly injections of LUCENTIS for 12 or 36 months, after which 500 patients opted to continue in the long-term follow-up study.
Of 298 patients who had at least 12 months of follow-up from Month 36, 58 (19.5%) patients maintained vision with no further therapy. The remaining 202 patients were followed for less than 12 months. Figure 6
Diabetic Retinopathy (DR) Efficacy and safety data of
LUCENTIS are derived from Studies D-1 and D-2 and D-3. All enrolled patients in Studies D-1 and D-2 had DR and DME at baseline. Study D-3 enrolled DR patients both with and without DME at baseline. Of the 759 patients enrolled in Studies D-1 and D-2, 746 patients had a baseline assessment of fundus photography.
Patients had baseline Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scores (ETDRS-DRSS) ranging from 10 to 75. At baseline, 62% of patients had non-proliferative diabetic retinopathy (NPDR) (ETDRS-DRSS less than 60) and 31% had proliferative diabetic retinopathy (PDR) (ETDRS-DRSS greater than or equal to 60). The ETDRS-DRSS could not be graded in 5% of patients at baseline, and 2% of patients had absent or questionable DR at baseline. Approximately 20% of the overall population had prior PRP. After monthly treatment with LUCENTIS 0.3 mg, the following clinical results were observed ( Table 7 ; Figure 7 ): Table 7 ≥3-Step and ≥2-Step Improvement at Month 24 in Study D-1 and Study D-2 Outcome Measure Study D-1: Sham, n=124; LUCENTIS 0.3 mg, n=117 D-2: Sham, n=115; LUCENTIS 0.3 mg, n=117 Sham LUCENTIS 0.3 mg Estimated Difference (95% CI) Adjusted estimate based on stratified model ≥3-step improvement from baseline in ETDRS-DRSS p < 0.05 for all time points comparing LUCENTIS 0.3 mg to sham from Month 12 through Month 24 D-1 2% 17% 15% (7%, 22%) D-2 0% 9% 9% (4%, 14%) ≥2-step improvement from baseline in ETDRS-DRSS p < 0.05 for all time points comparing LUCENTIS 0.3 mg to sham from Month 3 through Month 24 D-1 4% 39% 35% (26%, 44%) D-2 7% 37% 31% (21%, 40%) At Month 24, DR improvement by ≥3-steps in ETDRS-DRSS from baseline in subgroups examined (e.g., age, gender, race, baseline visual acuity, baseline HbA1c, prior DME therapy at baseline, baseline DR severity (NPDR, PDR)) were generally consistent with the results in the overall population. The difference in the proportion of patients treated with LUCENTIS 0.3 mg compared to sham who achieved DR improvement based on the ETDRS-DRSS was observed as early as Month 3 for ≥2-step improvement or at Month 12 for ≥3-step improvement.
Figure 7 Proportion of Patients with ≥ 3-Step and ≥ 2-Step Improvement from Baseline in ETDRS Diabetic Retinopathy Severity Level over Time in Study D-1 and Study D-2 ≥3-Step Improvement from Baseline Over Time ≥2-Step Improvement from Baseline Over Time Study D-3 enrolled DR patients with and without DME; 88 (22%) eyes with baseline DME and 306 (78%) eyes without baseline DME and balanced across treatment groups. Study D-3 was a randomized, active-controlled study where patient age ranged from 20 to 83 with a mean age of 51 years. A total of 394 study eyes from 305 patients, including 89 who had both eyes randomized, were enrolled (LUCENTIS, 191 study eyes; pan-retinal photocoagulation; 203 study eyes). All eyes in the LUCENTIS group received a baseline 0.5 mg intravitreal injection followed by 3 monthly intravitreal injections, after which treatment was guided by pre-specified re-treatment criteria.
Patients had baseline ETDRS-DRSS ranging from 20 to 85. At baseline, 11% of eyes had NPDR (ETDRS-DRSS less than 60), 50% had mild-to-moderate PDR (ETDRS-DRSS equal to 60, 61, or 65), and 37% had high-risk PDR (ETDRS-DRSS greater than or equal to 71). An analysis of data from Study D-3 demonstrated that at Year 2 in the LUCENTIS group, 31.7% and 28.4% of eyes in the subgroups with baseline DME and without baseline DME, respectively, had ≥ 3-step improvement from baseline in ETDRS-DRSS. Table 8 Proportion of Eyes with ≥ 3-Step and ≥ 2-Step Improvement from Baseline in ETDRS-DRSS at Year 2 in Study D-3 LUCENTIS group Outcome Measure (in ETDRS-DRSS) Eyes with Baseline DME n = 41 Eyes without Baseline DME n = 148 ≥ 3-step improvement from baseline 95% CI for percentage 13 (31.7%) (17.5%, 46.0%) 42 (28.4%) (21.1%, 35.6%) ≥ 2-step improvement from baseline 95% CI for percentage 24 (58.5%) (43.5%, 73.6%) 56 (37.8%) (30.0%, 45.7%) Figure 8 Proportion of Eyes in the LUCENTIS group with ≥ 3-Step and ≥ 2-Step Improvement from Baseline in ETDRS-DRSS at Year 1 and Year 2 in Study D-3 Figure 7 Figure 8
Myopic Choroidal Neovascularization (mCNV)
The efficacy and safety data of LUCENTIS were assessed in a randomized, double-masked, active-controlled 3-month study in patients with mCNV. Patients age ranged from 18 to 87 years, with a mean age of 55 years. A total of 276 patients (222 patients in the LUCENTIS treated Groups I and II; 55 patients in the active control PDT group) were enrolled. Patients randomized to the LUCENTIS groups received injections guided by pre-specified re-treatment criteria.
The retreatment criteria in Group I were vision stability guided, with the Best Corrected Visual Acuity (BCVA) at the current visit being assessed for changes compared with the two preceding monthly BCVA values. The retreatment criteria in Group II were disease activity guided, based on BCVA decrease from the previous visit that was attributable to intra- or sub-retinal fluid or active leakage secondary to mCNV as assessed by OCT and/or FA compared to the previous monthly visit. Visual gains for the two LUCENTIS 0.5 mg treatment arms were superior to the active control arm.
The mean change in BCVA from baseline at Month 3 was: +12.1 letters for Group I, +12.5 letters for Group II and +1.4 letters for the PDT group. ( Figure 9 ; Table 9 ). Efficacy was comparable between Group I and Group II. Table 9 Mean Change in Visual Acuity and Proportion of Patients who Gained ≥15 letters from Baseline at Month 3 Study Arms Mean change in BCVA from baseline (Letters) Proportion of patients who gained ≥15 letters from baseline Mean (SD) Estimated Difference (95% CI) Adjusted estimates based on stratified models; p < 0.01 Percent Estimated Difference (95% CI) Group I 12.1 10.9 37.1
Group II 12.5 11.4 40.5 26.0 Control (PDT) 1.4 14.5 Figure 9
Mean Change in Visual Acuity from Baseline to Month 3 in mCNV Study The proportion of patients who gained ≥15 letters (ETDRS) by Month 3 was 37.1% and 40.5% for LUCENTIS Groups I and II, respectively and 14.5% for the PDT group. The mean number of injections between baseline and Month 3 was 2.5 and 1.8 for Groups I and II, respectively. 41% of patients received 1, 2 or 3 injections between baseline and Month 3 with no injections afterwards. Figure 9
Drug information sourced from the FDA. This content is for informational purposes only and does not constitute medical advice. Consult a healthcare professional before making any medication decisions.
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