Novartis Brolucizumab Meets Endpoints in Two Phase 3 Studies

Novartis reported that RTH258 (brolucizumab) 6 mg met the primary and key secondary endpoints in two Phase III studies, HAWK and HARRIER. RTH258 3 mg, evaluated in HAWK, also met these endpoints. These pivotal studies enrolled more than 1,800 patients with neovascular age-related macular degeneration (nAMD) across 400 centers worldwide. The primary and key secondary efficacy endpoints were non-inferiority of RTH258 to aflibercept in mean change in best-corrected visual acuity (BCVA) from baseline to week 48, and average mean change over the period of week 36-48, respectively. Both were met with highly significant p values. RTH258 was generally well tolerated with overall ocular and non-ocular (systemic) adverse event rates comparable to aflibercept.

RTH258 demonstrated long-lasting efficacy versus aflibercept dosed every eight weeks. A majority of patients, 57% (HAWK) and 52% (HARRIER), were maintained exclusively on a q12w (every 12 week) interval immediately following the loading phase through week 48.

“These results clearly and convincingly demonstrate RTH258 has the potential to reduce injection burden while providing excellent visual outcomes. Given our legacy in developing medicines to preserve vision, we are pleased that RTH258 carries the promise of being the next major advancement for patients with nAMD” said Vas Narasimhan, Global Head, Drug Development and Chief Medical Officer, Novartis. “Based on these robust data, we are looking forward to working with regulatory agencies to bring this pioneering treatment to patients.”

Detailed analysis of the data is ongoing and will be presented at an upcoming medical congress. RTH258 is a highly innovative single chain antibody that enables much higher concentrations of antibody in the eye than approved therapies. Given the complexity of the formulation, Novartis has invested to ensure a competitive, low cost of goods formulation over the past 18 months to maximize the long term value of RTH258. Novartis expects to complete the pharmacokinetic study with the final manufacturing process to enable filing in 2018.

RTH258 has the potential to address the needs of patients with nAMD who would benefit from a long-lasting, efficacious treatment with a less frequent dosing regimen.

About RTH258 (brolucizumab)
Designed specifically for the eye, RTH258 is the most clinically advanced, humanized single chain anti-body fragment in development. The proprietary innovative architecture results in a small molecule (26 kDa) with potent inhibition of, and high affinity to all VEGF-A isoforms.[6],[7] Potential benefits of the small size include better tissue penetration and rapid clearance from the systemic circulation.[6],[8],[9]

In preclinical studies,[6],[7],[8],[9] RTH258 inhibited activation of VEGF receptors through prevention of the ligand-receptor interaction. Increased signalling through the VEGF pathway is associated with pathologic ocular angiogenesis and retinal edema[10]. Inhibition of the VEGF pathway has been shown to inhibit the growth of neovascular lesions, resolve retinal edema and improve vision in patients with chorioretinal vascular diseases.[11]