1. Academic Validation
  2. Simultaneous Inhibition of Angiopoietin-2 and Vascular Endothelial Growth Factor-A with Faricimab in Diabetic Macular Edema: BOULEVARD Phase 2 Randomized Trial

Simultaneous Inhibition of Angiopoietin-2 and Vascular Endothelial Growth Factor-A with Faricimab in Diabetic Macular Edema: BOULEVARD Phase 2 Randomized Trial

  • Ophthalmology. 2019 Aug;126(8):1155-1170. doi: 10.1016/j.ophtha.2019.03.023.
Jayashree Sahni 1 Sunil S Patel 2 Pravin U Dugel 3 Arshad M Khanani 4 Chirag D Jhaveri 5 Charles C Wykoff 6 Vrinda S Hershberger 7 Meike Pauly-Evers 8 Shamil Sadikhov 9 Piotr Szczesny 8 Dietmar Schwab 8 Everson Nogoceke 8 Aaron Osborne 10 Robert Weikert 8 Sascha Fauser 8
Affiliations

Affiliations

  • 1 Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland. Electronic address: jayashree.sahni@roche.com.
  • 2 West Texas Retina Consultants, Abilene, Texas.
  • 3 Retinal Consultants of Arizona, Phoenix, Arizona; USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
  • 4 Sierra Eye Associates, Reno, Nevada; Reno School of Medicine, The University of Nevada, Reno, Nevada.
  • 5 Retina Consultants of Austin and Retina Research Center, Austin, Texas; Dell Medical School, The University of Texas at Austin, Austin, Texas.
  • 6 Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas.
  • 7 Florida Eye Associates, Melbourne, Florida.
  • 8 Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland.
  • 9 Roche Product Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland.
  • 10 Genentech, Inc., South San Francisco, California.
Abstract

Purpose: The phase 2 BOULEVARD trial compared safety and efficacy of faricimab, a novel bispecific antibody targeting angiopoietin-2 and vascular endothelial growth factor-A (VEGF-A), with ranibizumab in patients with diabetic macular edema (DME).

Design: The BOULEVARD trial (ClinicalTrials.gov identifier, NCT02699450) was a prospective, randomized, active comparator-controlled, double-masked, multicenter, phase 2 study conducted at 59 sites in the United States.

Participants: The trial enrolled patients 18 years of age or older with center-involving DME, best-corrected visual acuity (BCVA) of 73 to 24 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and central subfield thickness (CST) of 325 μm or more.

Methods: Anti-VEGF treatment-naïve patients were randomized 1:1:1 to intravitreal 6.0 mg faricimab, 1.5 mg faricimab, or 0.3 mg ranibizumab, and patients previously treated with anti-VEGF were randomized 1:1 to 6.0 mg faricimab or 0.3 mg ranibizumab. Patients were dosed monthly for 20 weeks, followed by an observation period up to week 36 to assess durability.

Main outcome measures: The prespecified primary outcome measure was mean change in BCVA from baseline at week 24 for faricimab versus ranibizumab in treatment-naïve patients. Key secondary and exploratory outcome measures included CST, Diabetic Retinopathy Severity Scale (DRSS) score, and durability as assessed by time to re-treatment.

Results: The trial enrolled 229 patients (168 treatment-naïve and 61 previously treated with anti-VEGF). In treatment-naïve patients, 6.0 mg faricimab, 1.5 mg faricimab, and 0.3 mg ranibizumab resulted in mean improvements of 13.9, 11.7, and 10.3 ETDRS letters from baseline, respectively. The 6.0-mg faricimab dose demonstrated a statistically significant gain of 3.6 letters over ranibizumab (P = 0.03). In both patient populations, faricimab resulted in dose-dependent reductions in CST, improvements in DRSS score, and longer time to re-treatment during the observation period compared with ranibizumab. Faricimab showed no new or unexpected safety signals.

Conclusions: The BOULEVARD trial met its primary end point; faricimab demonstrated statistically superior visual acuity gains versus ranibizumab at week 24 in treatment-naïve patients. Central subfield thickness reduction, DRSS score improvement, and extended durability outcomes support the primary outcome. These findings suggest the benefit of simultaneous inhibition of angiopoietin-2 and VEGF-A with faricimab for patients with DME.

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