PHASE 2 STUDY OF THE SAFETY AND EFFICACY OF BRIMONIDINE DRUG DELIVERY SYSTEM (BRIMO DDS) GENERATION 1 IN PATIENTS WITH GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

PURPOSE To evaluate the safety and efficacy of Brimonidine Drug Delivery System (Brimo DDS), a biodegradable intravitreal implant, in the treatment of geographic atrophy (GA) secondary to age-related macular degeneration. METHODS Phase 2, randomized, multicenter, double-masked, 24-month study. Study eyes were treated (Day 1; Month 6 retreatment) with Brimo DDS 132 µg (n = 49), Brimo DDS 264 µg (n = 41), or sham procedure (n = 23). The primary timepoint for efficacy analysis was Month 12. RESULTS Mean GA area growth at Month 12 was 1.78 mm, 1.59 mm, and 2.19 mm in the Brimo DDS 132 µg, 264 µg, and sham groups, respectively. Geographic atrophy area growth was consistently smaller with Brimo DDS 132 and 264 µg than sham; between-group differences were significant (P ≤ 0.032) at Month 3. In patients with baseline lesion area ≥6 mm (two-thirds of patients), GA lesion area and effective radius growth was reduced with Brimo DDS 132 and 264 µg at Month 12 (P ≤ 0.050 vs. sham). Treatment-related adverse events were usually injection procedure-related. CONCLUSION Brimo DDS demonstrated a favorable safety profile and reduced GA lesion area growth at Month 3. Lesion growth at Month 12 was reduced in patients with baseline GA lesion area ≥6 mm. The results support Phase 3 development.

[1]  T. Ciulla,et al.  Complement inhibition as a therapeutic strategy in retinal disorders , 2019, Expert opinion on biological therapy.

[2]  P. Rosenfeld,et al.  A Randomized Phase 2 Study of an Anti-Amyloid β Monoclonal Antibody in Geographic Atrophy Secondary to Age-Related Macular Degeneration. , 2018, Ophthalmology. Retina.

[3]  Srinivas R. Sadda,et al.  Efficacy and Safety of Lampalizumab for Geographic Atrophy Due to Age-Related Macular Degeneration: Chroma and Spectri Phase 3 Randomized Clinical Trials , 2018, JAMA ophthalmology.

[4]  Frank G. Holz,et al.  Emixustat Hydrochloride for Geographic Atrophy Secondary to Age-Related Macular Degeneration: A Randomized Clinical Trial. , 2018, Ophthalmology.

[5]  Steve Lenier APL-2 slows growth of GA in phase II safety and efficacy trial , 2018 .

[6]  Hans Limburg,et al.  Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. , 2017, The Lancet. Global health.

[7]  F. Ferris,et al.  Report From the NEI/FDA Endpoints Workshop on Age-Related Macular Degeneration and Inherited Retinal Diseases , 2017, Investigative ophthalmology & visual science.

[8]  Ursula Schmidt-Erfurth,et al.  THE PATHOPHYSIOLOGY OF GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION AND THE COMPLEMENT PATHWAY AS A THERAPEUTIC TARGET , 2017, Retina.

[9]  R. Klein,et al.  Incidence of Age-Related Macular Degeneration in a Multi-Ethnic United States Population: The Multi-Ethnic Study of Atherosclerosis. , 2016, Ophthalmology.

[10]  G. A. Limb,et al.  Brimonidine Can Prevent In Vitro Hydroquinone Damage on Retinal Pigment Epithelium Cells and Retinal Müller Cells. , 2016, Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics.

[11]  Glenn J Jaffe,et al.  Natural History of Geographic Atrophy Progression Secondary to Age-Related Macular Degeneration (Geographic Atrophy Progression Study). , 2016, Ophthalmology.

[12]  J. Monés,et al.  Increased Fundus Autofluorescence and Progression of Geographic Atrophy Secondary to Age-Related Macular Degeneration: The GAIN Study. , 2015, American journal of ophthalmology.

[13]  D. Cook,et al.  Incidence of Late-Stage Age-Related Macular Degeneration in American Whites: Systematic Review and Meta-analysis. , 2015, American journal of ophthalmology.

[14]  L. Wheeler,et al.  A Novel In Vivo Model of Focal Light Emitting Diode-Induced Cone-Photoreceptor Phototoxicity: Neuroprotection Afforded by Brimonidine, BDNF, PEDF or bFGF , 2014, PloS one.

[15]  Kang Zhang,et al.  Systemic complement inhibition with eculizumab for geographic atrophy in age-related macular degeneration: the COMPLETE study. , 2014, Ophthalmology.

[16]  Robert N. Weinreb,et al.  Ophthalmic drug discovery: novel targets and mechanisms for retinal diseases and glaucoma , 2012, Nature Reviews Drug Discovery.

[17]  R. Ritch,et al.  A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. , 2011, American journal of ophthalmology.

[18]  Frederick L Ferris,et al.  Change in area of geographic atrophy in the Age-Related Eye Disease Study: AREDS report number 26. , 2009, Archives of ophthalmology.

[19]  L. McLoon,et al.  Experimental and clinical evidence for brimonidine as an optic nerve and retinal neuroprotective agent: an evidence-based review. , 2009, Archives of ophthalmology.

[20]  A. Tufail,et al.  Age-related macular degeneration: diagnosis and management. , 2008, British medical bulletin.

[21]  P. Jong Prevalence of age-related macular degeneration in the United States. , 2004 .

[22]  George A. Williams,et al.  The Age-Related Eye Disease Study (AREDS): design implications. AREDS report no. 1. , 1999, Controlled clinical trials.

[23]  J S Sunness,et al.  The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration. , 1999, Molecular vision.

[24]  J S Sunness,et al.  Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration. , 1999, Ophthalmology.

[25]  G. Ying,et al.  Incidence and Growth of Geographic Atrophy during 5 Years of Comparison of Age-Related Macular Degeneration Treatments Trials. , 2017, Ophthalmology.

[26]  G. Ying,et al.  Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials. , 2015, Ophthalmology.

[27]  William J Feuer,et al.  Square root transformation of geographic atrophy area measurements to eliminate dependence of growth rates on baseline lesion measurements: a reanalysis of age-related eye disease study report no. 26. , 2013, JAMA ophthalmology.

[28]  J. Myers A Randomized Trial of Brimonidine Versus Timolol in Preserving Visual Function: Results From the Low-pressure Glaucoma Treatment Study , 2012 .