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Positive Phase 3 Trial Results of Ranibizumab in Macular Degeneration Reported
An analysis of the one-year data showed that adverse events were similar to those seen in earlier trials of Lucentis. Common side effects occurring more frequently in the Lucentis arms than in the control group were mild to moderate and included conjunctival hemorrhage, eye pain and vitreous floaters. Serious ocular adverse events occurring more frequently in Lucentis-treated patients were uncommon ( Additional key study findings include:
- 95 percent (452/478) of Lucentis-treated patients lost fewer than 15 letters compared to baseline, the primary endpoint of the study, compared with 62 percent (148/238) for the sham injection control group.
- 25 percent (59/238) of patients treated with 0.3 mg of Lucentis and 34 percent (81/240) treated with 0.5 mg of Lucentis improved vision by a gain of 15 letters or more compared to approximately 5 percent (11/238) of patients in the control group.
- Nearly 40 percent (188/478) of Lucentis-treated patients achieved a visual acuity score of 20/40 or better at 12 months compared to 11 percent (26/238) in the control group.
"We are very excited that Lucentis has improved vision in patients with wet AMD and look forward to results of a second Phase III trial," said Hal Barron, M.D., Genentech senior vice president, development and chief medical officer. "The magnitude of the treatment effect in this study suggests that Lucentis could have a major impact on the lives of patients with wet AMD."
Lucentis is a humanized antibody fragment developed at Genentech and designed to bind and inhibit Vascular Endothelial Growth Factor A (VEGF-A), a protein that is believed to play a critical role in angiogenesis (the formation of new blood vessels). Earlier this month, Genentech announced it has requested a fast-track designation for the Lucentis development program in wet AMD. If granted by the U.S. Food and Drug Administration (FDA), this could enable Genentech to begin a rolling Biologics License Application filing by the end of 2005.
About the Study
Minimally classic/occult trial of the Anti-VEGF antibody Ranibizumab (formerly, RhuFab) In the treatment of Neovascular AMD (MARINA) is a Phase III study of 716 patients in the United States with minimally classic or occult wet AMD who were randomized 2:1 to receive intravitreal Lucentis injections or a control regimen. The control regimen consisted of a sham injection, meaning the treating physician prepares and anesthetizes the patient’s eye but does not perform an injection. Patients treated with Lucentis were further randomized to receive either a 0.3 mg or 0.5 mg dose of Lucentis once a month for two years.
Exclusion criteria included prior subfoveal laser treatment, verteporfin photodynamic therapy (PDT) or experimental treatments for wet AMD. Patients participating in the MARINA study could receive PDT therapy if they converted to predominantly classic disease while on the study or if they had small, active minimally classic or occult lesions and lost 20 letters or more in visual acuity on two consecutive physician evaluations. As a result, 11 percent (25/238) of patients in the control group, 0.4 percent (1/238) of patients in the Lucentis 0.3 mg group and no patients in the 0.5 mg group received PDT in the first year of study.
Ongoing Phase III Studies
Genentech and Novartis Pharma AG are conducting an additional Phase III study of Lucentis, ANCHOR (ANti-VEGF Antibody for the Treatment of Predominantly Classic CHORoidal Neovascularization in AMD). This is a randomized, multi-center, double-masked, active treatment controlled study comparing two different doses of Lucentis to PDT in 423 patients. The trial is ongoing in the United States, Europe and Australia in patients with predominantly classic wet AMD. Results from this study are expected in the fourth quarter of 2005.
Genentech is conducting an additional Phase IIIb study, PIER (A Phase IIIb, Multicenter, Randomized, Double-Masked, Sham Injection-Controlled Study of the Efficacy and Safety of Ranibizumab in Subjects with Subfoveal Choroidal Neovascularization with or without Classic CNV Secondary to Age-Related Macular Degeneration), a randomized, double-masked, sham injection-controlled study comparing one of two doses of Lucentis to sham injections in 184 patients in the United States with wet AMD. In this trial, Lucentis is administered once per month for the first three doses followed thereafter by doses once every three months for two years. Results from this study are expected in the first quarter of 2006.
Genentech recently began enrollment in the HORIZON Phase III open-label extension study, which allows eligible patients who have completed participation in certain other Lucentis clinical studies to continue to receive the investigational drug.
Lucentis™ (ranibizumab) is a humanized therapeutic antibody fragment developed at Genentech and designed to bind and inhibit VEGF-A, a protein that is believed to play a critical role in angiogenesis (the formation of new blood vessels). Lucentis is designed to block new blood vessel growth and leakiness, which lead to wet AMD disease progression and vision loss.
AMD is a major cause of painless central visual loss and is the leading cause of blindness for people over the age of 60 in the United States and Canada. The National Eye Institute estimates that there are 1.6 million people with AMD in the United States alone and that this prevalence will grow to 2.95 million by 2020. In Canada, the Foundation Fighting Blindness estimates that more than 800,000 people are affected by the disease.
AMD occurs in two forms: dry and wet. The dry form is associated with atrophic cell death of the central retina or macula, which is required for fine vision used for activities such as reading, driving or recognizing faces. The wet form is caused by growth of abnormal blood vessels also known as choroidal neovascularization (CNV) or ocular angiogenesis under the macula. These vessels leak fluid and blood and cause scar tissue that destroys the central retina. This results in a deterioration of sight over a period of months to years.