Novartis has received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) for Lucentis (ranibizumab) to treat patients with visual impairment due to choroidal neovascularization (CNV) secondary to pathologic myopia (myopic CNV). CNV is the most common vision-threatening complication of high myopia [1].
Myopic CNV usually affects patients younger than 50 years old so any associated vision loss can have not only a significant impact on their quality of life but also on their productivity and to society [2]. In patients with untreated myopic CNV the long-term prognosis is poor with approximately 90 per cent of affected patients developing severe vision loss after five years [3].
Tim Wright, Global Head of Development, Novartis Pharmaceuticals said, “Lucentis has already transformed the management of wet AMD, and we are hopeful that if Lucentis receives approval in a fourth major ocular indication that patients with myopic CNV will benefit from this medicine. Currently, all we hope to do for these patients is to stabilise vision and prevent further vision loss, so a treatment with the long-term safety profile of Lucentis that actually improves and maintains vision with just a few injections would be of great benefit.”
The submission was supported by data from the Novartis-sponsored clinical trial, Radiance, that showed Lucentis provides superior improvement in visual acuity compared with the current licensed standard of care, Visudyne (verteporfin PDT), in patients with myopic CNV. These new data showed around 40 per cent of Lucentis treated patients compared with 15 per cent of Visudyne treated patients gained 15 or more letters of visual acuity at month three[4]. Mean visual acuity gains of approximately 14 letters at one year were demonstrated with Lucentis; this was with a median of 2.0 injections.
In this pivotal phase III study, patients were randomised to one of three treatment arms: Lucentis treatment based on visual acuity stability (group 1) or disease activity (group 2); or Visudyne treatment (group 3). Subjects randomised to Visudyne could be given Lucentis after three months based on persistent disease activity. The primary endpoint was Lucentis superiority to Visudyne based on the mean visual acuity change from baseline to month three. Patients were followed for twelve months.
Both the Lucentis treatment groups were statistically superior (p<0.00001) to the Visudyne treatment group. Mean letter gains at month three from baseline in the two Lucentis groups (groups 1 and 2) were 12.1 and 12.5 letters, respectively, compared to a 1.4 letter gain in the Visudyne treatment arm (group 3). At twelve months, the mean letter gains from baseline were 13.8 (group 1), 14.4 (group 2) and 9.3 (group 3).
The safety profile of Lucentis was consistent with that observed in other studies as well as real-world experience and no new ocular/non-ocular safety risks were identified. The most common adverse events occurring in more than 10 per cent of patients, at 12 months, were conjunctival haemorrhage (ocular) and nasopharyngitis (non-ocular).
EP News Bureau – Mumbai
References:
1. Neelam K et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012;31:495-525.
2. Rose K et al. Quality of life in myopia. Br J Ophthalmol 2000;84: 1031-1034.
3. Yoshida T et al. Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology 2003;110:1297-1305.
4. Wolf S et al. Ranibizumab vs verteporfin PDT for choroidal neovascularization secondary to pathologic myopia: a Phase III study. Asia Pacific Academy of Ophthalmology 2013.
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