TOPLINE:

An injection of 6 mg of intravitreal brolucizumab was at least as effective as — and potentially superior to — panretinal laser photocoagulation in preserving vision in patients with proliferative diabetic retinopathy through 54 weeks. At week 54, visual acuity remained essentially unchanged from baseline with brolucizumab, while patients treated with panretinal laser photocoagulation lost an average of about four letters.

METHODOLOGY:

• Researchers evaluated the efficacy and safety of intravitreal brolucizumab vs panretinal laser photocoagulation in adults with diabetes and proliferative diabetic retinopathy using data from CONDOR, a 96-week, multicenter, phase 3 randomized clinical trial.
• A total of 689 participants who had not previously received panretinal laser photocoagulation in the study eye were randomly assigned to receive either 6 mg of brolucizumab (n = 347; mean age, 53.2 years; 58.5% men) or panretinal laser photocoagulation (n = 342; mean age, 54.7 years; 61.4% men), with 572 participants completing the week 54 visit.
• Participants assigned to brolucizumab received three loading injections every 6 weeks, followed by maintenance injections every 12 weeks, with an option from week 48 to extend the treatment intervals in 6-week steps up to 24 weeks based on disease activity; participants assigned to panretinal laser received one to four laser sessions through week 12 and additional laser treatment as needed.
• The primary endpoint was the change in best-corrected visual acuity from baseline at week 54.

TAKEAWAY:

• Brolucizumab was superior to panretinal laser photocoagulation for change in visual acuity at week 54, with a least-squares mean change in letter score of 0.2 in the brolucizumab arm compared with -4.2 in the panretinal laser photocoagulation arm (difference, 4.4; P < .001).
• A higher proportion of patients receiving brolucizumab vs panretinal laser photocoagulation had no proliferative diabetic retinopathy at week 54 (63.6% vs 22.4%; P < .001).
• By week 54, fewer patients treated with brolucizumab vs panretinal laser photocoagulation had vision-threatening complications related to diabetic retinopathy (33.7% vs 75.4%; P < .001).
• About 34.3% of patients in the brolucizumab arm and 49.1% of those in the panretinal laser photocoagulation arm reported experiencing ocular adverse events in the study eye.

IN PRACTICE:

“These findings suggest that brolucizumab provides effective disease control in PDR [proliferative diabetic retinopathy] by reversing disease progression and maintaining functional vision,” the researchers reported.

SOURCE:

The study was led by Sebastian Wolf, MD, PhD, of the Department of Ophthalmology at University Hospital in Bern, Switzerland. It was published online on April 23 in JAMA Ophthalmology.

LIMITATIONS: 

The trial aimed to enroll patients with proliferative diabetic retinopathy who did not have diabetic macular edema, but many had a thicker central retina than expected (> 280 μm) at screening. While most enrolled participants had confirmed proliferative diabetic retinopathy, a meaningful minority did not. A subgroup analysis comparing participants with and without diabetic macular edema at baseline was beyond the scope of this study.

DISCLOSURES:

This study was funded by Novartis AG. Several authors reported financial relationships with Novartis and other companies, including grants during the study, consulting and personal fees, industry-sponsored research support, and ownership of stock or stock options.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.