Shashikant Sharma1, Vishali Gupta2, Aniruddha Maiti3, Sribhargava Natesh4, Sandeep Saxena5, Vivek Dave6, Vimal Parmar7, Raju Sampangi8, Hemanth Murthy9, Sandhya Dharwadkar10, Naresh Kumar Yadav11, Shrinivas Joshi12, Rahul Mayor13, Dhanashree Ratra14, Soumyava Basu15, Neha Goel16,17, Alok Chaturvedi18, Ronak Patel19, Vinu Jose20. 1. Medical Affairs, Intas Pharmaceuticals Ltd, Ahmedabad, Gujarat, India. shashikant_sharma@intaspharma.com. 2. Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 3. Susrut Eye Foundation & Research Centre, Kolkata, West Bengal, India. 4. Nethra Eye Hospital, Bangalore, Karnataka, India. 5. Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India. 6. L V Prasad Eye Institute, Hyderabad, Telangana, India. 7. PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India. 8. Gurushree Hi-Tech Multi Speciality Hospital, Bangalore, Karnataka, India. 9. Retina Institute of Karnataka, Bangalore, Karnataka, India. 10. K.R. Hospital, Mysore Medical College & Research Institute, Mysore, India. 11. Narayana Nethralaya, Bangalore, Karnataka, India. 12. M M Joshi Eye Institute, Hubli, Karnataka, India. 13. Dr. Shroff's Charity Eye Hospital, New Delhi, India. 14. Sankara Nethralaya, Chennai, Tamil Nadu, India. 15. L V Prasad Eye Institute, Bhubaneswar, Odisha, India. 16. ICARE Eye Hospital & Post Graduate Institute, Noida, Uttar Pradesh, India. 17. Eye7 Chaudhary Eye Centre, New Delhi, India. 18. Medical Affairs, Intas Pharmaceuticals Ltd, Ahmedabad, Gujarat, India. 19. Department of Biostatistics and Programming, Lambda Therapeutic Research Ltd., Ahmedabad, Gujarat, India. 20. Clinical Development & Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma), Ahmedabad, Gujarat, India.
Abstract
BACKGROUND: Razumab™ (world's first biosimilar ranibizumab) is approved for several macular disorders including wet age-related macular degeneration (AMD). We evaluated the safety and efficacy of biosimilar ranibizumab in wet AMD. METHODS: This prospective, multicentre, rAnibizumab bioSimilar Safety Efficacy postmarkeTing (ASSET) study enrolled patients aged ≥ 50 years with wet AMD having best-corrected visual acuity (BCVA) between 20/40 and 20/320. The patients received intravitreal biosimilar ranibizumab 0.5 mg every 4 weeks for 24 weeks. Safety endpoints included the incidence of adverse events (AEs), serious AEs (SAEs), and immunoreactivity after 6 months. The efficacy endpoints were the proportion of patients who lose fewer than 15 letters, increase in BCVA, change in central retinal thickness (CRT), and change in Visual Function Questionnaire-25 (VFQ-25) score, from baseline to 24 weeks. RESULTS: Of the 126 enrolled patients, majority (95.24%) of the patients received all 6 doses of biosimilar ranibizumab (total 3 mg). Nineteen AEs were reported (n = 16; 12.7%); majority (78.9%) were mild. There were no serious AEs reported, except one AE of death which was unrelated to the study drug. None of the patients discontinued the study due to an AE. The most common ocular AE was increase in intraocular pressure (4 events) and non-ocular AE was pyrexia (5 events). A total of 7.9% (10/126) patients prior to dosing and 7.1% (9/126) patients post-treatment were positive for anti-ranibizumab antibodies. No AEs suggestive of immunogenicity were noted. At 24-weeks, 97.60% patients in the intent-to-treat (ITT) population (N = 125) and 97.41% patients in the per-protocol (PP) population (N = 116) lost < 15 letters from baseline visual acuity. In the ITT and PP populations, 31.20% and 32.76% patients, respectively, showed improved visual acuity by ≥ 15 letters. Significant improvements in BCVA (mean difference: 8.8, 9.2, p < 0.001 for ITT, PP) and VFQ-25 (8.5, 9.2, p < 0.001 for ITT, PP) were seen; CRT reduced significantly (125 µm, 119.3 µm, p < 0.001 for ITT, PP). CONCLUSION: Razumab™ (world's first biosimilar ranibizumab) was well-tolerated without new safety concerns and significantly improved visual acuity in wet AMD patients. Trial registration CTRI/2016/03/006739. Registered 18 March 2016-Prospectively registered, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=13141&EncHid=&userName=2016/03/006739.
BACKGROUND:Razumab™ (world's first biosimilar ranibizumab) is approved for several macular disorders including wet age-related macular degeneration (AMD). We evaluated the safety and efficacy of biosimilar ranibizumab in wet AMD. METHODS: This prospective, multicentre, rAnibizumab bioSimilar Safety Efficacy postmarkeTing (ASSET) study enrolled patients aged ≥ 50 years with wet AMD having best-corrected visual acuity (BCVA) between 20/40 and 20/320. The patients received intravitreal biosimilar ranibizumab 0.5 mg every 4 weeks for 24 weeks. Safety endpoints included the incidence of adverse events (AEs), serious AEs (SAEs), and immunoreactivity after 6 months. The efficacy endpoints were the proportion of patients who lose fewer than 15 letters, increase in BCVA, change in central retinal thickness (CRT), and change in Visual Function Questionnaire-25 (VFQ-25) score, from baseline to 24 weeks. RESULTS: Of the 126 enrolled patients, majority (95.24%) of the patients received all 6 doses of biosimilar ranibizumab (total 3 mg). Nineteen AEs were reported (n = 16; 12.7%); majority (78.9%) were mild. There were no serious AEs reported, except one AE of death which was unrelated to the study drug. None of the patients discontinued the study due to an AE. The most common ocular AE was increase in intraocular pressure (4 events) and non-ocular AE was pyrexia (5 events). A total of 7.9% (10/126) patients prior to dosing and 7.1% (9/126) patients post-treatment were positive for anti-ranibizumab antibodies. No AEs suggestive of immunogenicity were noted. At 24-weeks, 97.60% patients in the intent-to-treat (ITT) population (N = 125) and 97.41% patients in the per-protocol (PP) population (N = 116) lost < 15 letters from baseline visual acuity. In the ITT and PP populations, 31.20% and 32.76% patients, respectively, showed improved visual acuity by ≥ 15 letters. Significant improvements in BCVA (mean difference: 8.8, 9.2, p < 0.001 for ITT, PP) and VFQ-25 (8.5, 9.2, p < 0.001 for ITT, PP) were seen; CRT reduced significantly (125 µm, 119.3 µm, p < 0.001 for ITT, PP). CONCLUSION:Razumab™ (world's first biosimilar ranibizumab) was well-tolerated without new safety concerns and significantly improved visual acuity in wet AMDpatients. Trial registration CTRI/2016/03/006739. Registered 18 March 2016-Prospectively registered, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=13141&EncHid=&userName=2016/03/006739.