Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY), today announced positive results from the Phase II STAIRWAY study which explored the extended durability of faricimab (RG7716) in the treatment of wet age-related macular degeneration (AMD), a leading cause of blindness in people aged 60 and over in the United States.3 At 52 weeks, faricimab patients dosed either every 16 weeks or every 12 weeks demonstrated sustained vision outcomes comparable to ranibizumab dosed every four weeks. Results of the study were presented as a late-breaking oral presentation during the 2018 American Academy of Ophthalmology’s (AAO) 122nd Annual Meeting in Chicago, Illinois.1
“Because current anti-VEGF monotherapies for wet AMD are burdensome, requiring frequent clinic visits for eye injections, some people are under-treated and experience subsequent declining vision over time,” said Sandra Horning, M.D., chief medical officer and head of Global Product Development. “The STAIRWAY data show the potential of faricimab to allow fewer injections while achieving and sustaining the same visual gains seen with a current standard of care. Based on these data, we will be initiating a global Phase III program for faricimab in wet AMD.”
STAIRWAY is a 52-week study that assessed two extended dosing regimens of faricimab 6.0 mg given every 16 weeks or every 12 weeks, compared to ranibizumab 0.5 mg every four weeks. At week 24 (three months after the last of four loading doses), patients randomized to faricimab every 16 weeks were switched to 12-week dosing if they were shown to have active disease, per pre-defined criteria. At week 24, 65 percent (n=36/55) of people treated with faricimab had no active disease, highlighting the potential of 16-week dosing in nearly two-thirds of patients. Initial vision gains, as measured by Best Corrected Visual Acuity (BCVA), were fully maintained through to week 52 with 16- and 12-week dosing regimens. People treated with faricimab dosed every 16 weeks experienced a mean improvement of 11.4 chart letters from baseline, compared to 10.1 letters in patients treated with faricimab dosed every 12 weeks and 9.6 letters in patients treated with ranibizumab 0.5 mg dosed every four weeks. The three treatment regimens were similar in both the proportion of patients gaining more than 15 letters and avoiding a loss of more than 15 letters. Comparable reductions in central retina thickness were also observed in people treated with both dosing intervals of faricimab and those treated with ranibizumab.1 In STAIRWAY, the rates of ocular and systemic adverse events observed with faricimab were similar to the rates observed with ranibizumab. No new safety signals were observed. The overall safety profile of faricimab appears consistent with the safety profile reported in patients with wet AMD who receive intravitreal anti-VEGF therapies.1
In addition, data on the investigational Port Delivery System with ranibizumab (PDS) in patients with wet AMD were also presented at the AAO Annual Meeting, comprising further data from the Phase II Ladder study, and the trial design of the Phase III Archway study.2 The small, refillable eye implant, which is slightly longer than a grain of rice, is designed to allow most people with wet AMD to go six months without needing a refill.
Top line results presented earlier this year showed the majority of PDS patients – including approximately 80 percent of patients in the high-dose PDS group – went six months or longer between the implantation and the first required refill of the device. Importantly, patients in the high-dose PDS group achieved similar visual outcomes as ranibizumab 0.5 mg dosed every four weeks.4 Based on the data of the Phase II Ladder program, the pivotal Phase III Archway clinical trial and the Portal label extension study were initiated in September 2018. These studies will evaluate the efficacy and safety of the PDS 100 mg/mL concentration in patients with wet AMD at a fixed dosing interval of 24 weeks.5,6
Faricimab and the PDS are the two most advanced investigational treatments in Genentech and Roche’s robust ophthalmology pipeline. In addition to Archway, two pivotal Phase III studies for faricimab are currently open and enrolling: RHINE (NCT03622593) and YOSEMITE (NCT03622580). These two studies are designed to investigate the efficacy and safety of faricimab compared with aflibercept in people with diabetic macular edema (DME).7,8 Based on STAIRWAY, a global Phase III program for faricimab in wet AMD is anticipated to commence in 2019.
About Wet Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a disease that impacts the part of the eye that provides sharp, central vision needed for activities like reading, and is a leading cause of blindness for people age 60 and over in the U.S.3 Wet AMD is an advanced form of the disease that can cause rapid and severe vision loss.9 Approximately 11 million people in the United States have some form of AMD and of those about 1.1 million have wet AMD.9
Wet AMD is caused by growth of abnormal blood vessels, also referred to as choroidal neovascularization (CNV), into the macula. These vessels leak fluid and blood and cause scar tissue that destroys the central retina. This process results in a deterioration of sight over a period of months to years.
Current standards of care for wet AMD target vascular endothelial growth factor (VEGF) alone, which effectively addresses blood vessel leakage, but only partially addresses the inflammation associated with the condition. In addition, people receiving anti-VEGF therapy may need as often as monthly eye injections. This high treatment burden can lead to under-treatment of wet AMD and, potentially, less than optimal vision outcomes.10,11 There is a significant unmet need for efficacious, longer-lasting therapies for people with this condition.
About STAIRWAY and faricimab
Faricimab is the first bispecific antibody designed specifically for intravitreal use to simultaneously bind to and neutralize both Angiopoietin-2 (Ang-2) and vascular endothelial growth factor A (VEGF-A) with high potency and specificity. In wet age-related macular degeneration (AMD), Ang-2 works synergistically with VEGF to drive pathologic blood vessel permeability and destabilization, abnormal blood vessel growth and fluid leakage, which contribute to vision loss. Ang-2 also plays an important role in multiple aspects of inflammation in wet AMD.12,13
STAIRWAY (NCT03038880) is a Phase II, multicenter, randomized, comparator-controlled, parallel group clinical trial, investigating the efficacy, safety and pharmacokinetics of faricimab administered with extended dosing regimens in 76 treatment-naïve people with wet AMD.1
About Ladder, Archway and the Investigational Port Delivery System with ranibizumab (PDS)
The investigational Port Delivery System with ranibizumab (PDS) is a small, refillable device, slightly longer than a grain of rice, surgically implanted in the eye during a procedure performed under local anesthesia. The PDS is uniquely designed to continuously deliver a specialized formulation of ranibizumab over time. The PDS contains a special formulation of ranibizumab not approved by the U.S. Food and Drug Administration (FDA). It is different from the ranibizumab intravitreal injection, a medicine marketed as Lucentis® (ranibizumab injection) and FDA-approved to treat wet AMD and other retinal diseases.
Ladder (NCT02510794) is a Phase II, multicenter, randomized, interventional, active treatment-controlled study designed to evaluate the efficacy and safety of the PDS in people with wet age-related macular degeneration (AMD) who have previously responded to treatment with anti-vascular endothelial growth factor (VEGF) therapies.4 Additional data analyses of the Ladder study are ongoing and will be presented at future medical meetings.
Archway (NCT03677934) will evaluate the efficacy and safety of the PDS 100 mg/mL in patients with wet AMD with a fixed dosing interval of 24 weeks.5 In the trial, patients will be randomized into one of two arms: Arm A will receive the PDS 100 mg/mL and refills at fixed 24-week intervals and Arm B will receive monthly intravitreal injections of ranibizumab 0.5 mg. The primary endpoint of Archway is the change from baseline in Best Corrected Visual Acuity (BCVA) at weeks 36 and 40.
About Genentech in Ophthalmology
Genentech is researching and developing new treatments for people living with a range of eye diseases that cause significant visual impairment and blindness, including wet age-related macular degeneration (AMD), diabetic macular edema (DME), diabetic retinopathy (DR), geographic atrophy (GA) and other retinal diseases. The company is also investigating platforms for sustained ocular drug delivery, including the Port Delivery System with ranibizumab (PDS).
Genentech’s parent company, Roche, is investigating a bispecific antibody for the treatment of retinal eye diseases.
Founded more than 40 years ago, Genentech is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious and life-threatening medical conditions. The company, a member of the Roche Group, has headquarters in South San Francisco, California. For additional information about the company, please visit http://www.gene.com.