Novartis Drug Lucentis Approved in EU as First Effective Anti-VEGF Treatment for Myopic Choroidal Neovascularization

The European Commission has granted Novartis a new indication for Lucentis (ranibizumab) to treat patients with visual impairment due to choroidal neovascularization (CNV) secondary to pathologic myopia (myopic CNV). This makes Lucentis, specifically designed for the eye and proven to save sight, the first anti-VEGF therapy licensed for four indications in the European Union (EU).

Pathologic myopia often affects working-age adults and is a major cause of vision loss worldwide, with 1–3% of the general population[1],[2]. CNV is the most common vision-threatening complication of high myopia[3]. In patients with untreated myopic CNV the long-term prognosis is poor with approximately 90% of affected patients developing severe vision loss after 5 years. The resulting visual loss from myopic CNV, which usually affects people younger than 50 years old, has a profound effect on productivity, financial status, career expectations, and quality of life in working-age individuals.

According to the European label, treatment of myopic CNV starts with a single injection. Any further injections are based on an individualized regimen. Retreatment is based on vision and anatomical changes, and monitoring is required monthly for the first two months and then at least quarterly up to one year; in the second year monitoring is at the discretion of the treating physician.

RADIANCE, the Novartis-sponsored clinical trial in patients with myopic CNV, shows that Lucentis provides rapid and superior improvement in visual acuity compared with the current licensed standard of care, Visudyne (verteporfin PDT). There is an average 14-letter visual acuity gain in the first year with a median of 2 injections and more than 60% of patients in RADIANCE did not need any further injections after 6 months[5].

"We are committed to fully understanding medical retina and to serving unmet patient needs. This fourth indication for our pioneering ophthalmology drug, Lucentis, shows how far we have come since it was first launched in 2006," said Tim Wright, Global Head of Development, Novartis Pharmaceuticals. "We expect that the use of Lucentis will significantly change the treatment of myopic CNV, as it is the first and only licensed treatment that has been proven to restore vision in patients with visual impairment due to myopic CNV."

Rapid visual acuity gains were achieved after only a single Lucentis injection and more than 70% of patients treated with Lucentis in RADIANCE experienced a reduction in CNV leakage and intraretinal edema, with central retinal thickness being significantly reduced from as early as month one.

Lucentis has a well-established safety profile and its safety profile in RADIANCE was consistent with that observed in other studies, as well as in real-world experience, and no new ocular/non-ocular safety risks were identified.

References
[1] Silva R et al., Myopic maculopathy: A review. Ophthalmologica 2012;228:197-–13.
[2] Shi Y et al., Exome sequencing identifies ZNF644 mutations in high myopia. PLOS Genet 2011;7: e1002084.
[3] Neelam K et al., Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012;31:495–525.
[4] Yoshida T et al., Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology 2003;110:1297–1305.
[5] Bandello F. Twelve-month efficacy and safety of ranibizumab 0.5 mg versus verteporfin photodynamic therapy in the treatment of visual impairment due to choroidal neovascularization secondary to pathologic myopia. Association for Research in Vision and Ophthalmology 2013.