Vabysmo Results, Suprachoroidal Injections Top the Diabetic Retinopathy Smorgasbord | ASRS 2024

The multiple avenues for treating diabetic retinopathy were on full display today during a morning session at the American Society of Retina Specialists annual meeting. Smorgasbord is too-obvious of a reference for a meeting being held in Stockholm, Sweden, so it is also too apt to pass up.

The smorgasbord session included presentations of positive findings from a real-world study of Vabysmo (faricimab), a day after positive results from a four-year study of the drug were presented at the meeting.

Other presentations covered suprachoroidal injections, an investigational agent that its developers hope will treat leaky retinal blood vessel by influencing the Wnt signaling pathway, and results from another early-stage trial of a small-molecule tyrosine kinase with antiangiogenic properties.

Theodore Leng, M.D., M.S., director of clinical and translational research at the Byers Eye Institute at the Stanford University School of Medicine, presented findings from a one-year real-world, retrospective study of Vabysmo that used electronic health records data from U.S. ophthalmology clinics contributing to the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) database. The study included 6,343 patients with diabetic macular edema and 8,970 treated eyes, of which only a small percentage (about 13%) hadn’t been previously treated. Most (nearly 70%) of the previously treated eyes had treated with Eylea (aflibercept). After seven Vabysmo injections, the average change in best-documented visual acuity (BDVA), a standard measure of vision, was +3.8 letters in the eyes that hadn’t been treated and +0.7 in those that had been. The abstract of the study characterized that +0.7 improvement as indicative that Vabysmo had stabilized diabetic macular edema.

Spacing out injections to reduce the “treatment burden” of the intravitreal injections used to a range of retinal conditions has become a major concern for clinicians, patients and drug developers. According to Leng’s presentation, these study results showed that of the eyes with 12 months or more of follow-up approximately 70% extended the injection interval from six week or less to more six weeks within three initial injections.

The positive results for Vabysmo presented at Wednesday session of the meeting were from the RHONE-X trial, a two-year, open-label extension study of two, two-year trials. The results presented by Arshad Khanani M.D., M.A., a consultant to Genentech, showed that a 1.3% rate of intraocular inflammation and that no cases of retinal vasculitis or retinal occlusive vasculitis. Khanani reported that approximately 80% of patients had completed the trial and that by the end of the trial, approximately 80% were receiving injections 12 weeks apart or greater.

The suprachoroidal space is a potential space between the sclera, the white outer covering of the eye, and the choroid, a layer of the outer eye. Researchers and drug developers have been interested in delivering drugs there because they would be more bioavailable to the choroid, retinal pigment epithelium, and retina than those injected into the vitreous. Murat Oncel, M.D., a retina specialist at Liv Hospital Ulus in Istanbul, Turkey, presented results from a trial comparing suprachoroidal injection of triamcinolone acetonide, a synthetic corticosteroid, to intravitreal dexamethasone implants for injection as treatment for refractory diabetic macular edema. Oncel reported that they both were effective and improved best-corrected visual acuity but the dexamethasone implants had a higher complication rate and an increase in intraocular pressure and cataract progression.