Adverum Biotechnologies shares positive 52-week LUNA and 4-year OPTIC results
LUNA is an ongoing double-masked, randomized Phase 2 trial. OPTIC is an ongoing, open-label, dose-ranging first-in-human trial.
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Adverum Biotechnologies, Inc. announced topline 52-week results from the LUNA Phase 2 trial, new 4-year OPTIC long-term follow-up data, and key pivotal program design elements.
Reaction to the data
Laurent Fischer, MD, president and chief executive officer of Adverum Biotechnologies shared his thoughts in the press release.1 He is quoted saying, “We are thrilled to report 52-week LUNA data and 4-year OPTIC data that continue to support Ixo-vec as a transformative and potential best-in-class therapy, which may provide patients who have wet AMD with potentially life-long benefit and a predictable safety profile. Both OPTIC 2E11 results and LUNA efficacy data at 52 weeks show maintenance of visual and anatomic endpoints with over 80% reduction in injection burden and greater than 50% injection freedom. These consistent results are bolstered by our OPTIC long-term data where we have demonstrated stable therapeutic aflibercept levels through 5 years. The data across both studies support a reliable long-term benefit and a predictable safety profile. Ultimately, Ixo-vec is a potential paradigm-shifting solution for patients with wet AMD, where real-world evidence suggests that up to 57% of patients stop anti-VEGF treatment within 5 years, and the vast majority of patients end up losing vision. Designed as a single, one-time intravitreal injection, Ixo-vec has the potential to extend therapeutic benefit from weeks to years. Today’s 4-year OPTIC data suggest that Ixo-vec may preserve vision for the life of wet AMD patients.”
Rabia Gurses Ozden, MD, chief medical sfficer at Adverum also spoke to the design and the results of this study, saying, “We have designed our Ixo-vec Phase 3 pivotal program to establish gene therapy as a standard of care for all wet AMD patients. Our ARTEMIS trial design considers feedback from key stakeholders, including global regulatory authorities, key opinion leaders, and patients, thereby optimizing for Ixo-vec’s potential clinical, regulatory and commercial success. Today’s LUNA 52-week data support our decision to advance the 6E10 dose and topical-eyedrops-only prophylaxis into Phase 3. One of the unique, and in my view, profound aspects of this LUNA update was the near unanimous patient preference for Ixo-vec, as assessed via a pre-specified patient survey. The vast majority preferred Ixo-vec over their prior intravitreal injections. No patients on topical eyedrops alone stated that the steroid eyedrops were difficult to manage. And 100% of patients who received Ixo-vec 6E10 and eyedrops alone preferred Ixo-vec over prior anti-VEGF treatments.”1
Charles Wykoff, MD, PhD, is the Director of Research, Retina Consultants of Texas, Professor of Clinical Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital and a principal investigator for LUNA. He is also an editorial advisory board member for Modern Retina. In the press release,1 Wykoff noted the takeaways from the dosing used in this study and the potential for using this candidate in the future. He said, “The LUNA 52-week clinical data further establish that the 6E10 dose of Ixo-vec has the potential to meaningfully reduce treatment burden for patients with wet AMD, even among patients with highly active disease who are receiving frequent dosing. Encouragingly, the 6E10 dose with extended prophylaxis also resulted in less inflammation. Taking these LUNA results together with 4-year data from the 2E11 dose in OPTIC, the totality of data indicates a predictable immune response with inflammation that, if it occurs, is manageable with local steroids, doesn’t impact vision, and ultimately resolves. These data from LUNA and OPTIC studies suggest a favorable benefit-risk profile for patients, which I believe many patients would consider if Ixo-vec were available in routine clinical practice. I look forward to working with the Adverum team as Ixo-vec advances toward pivotal studies next year.”
LUNA and OPTIC trials
LUNA is an ongoing double-masked, randomized Phase 2 trial in which 60 patients with wet AMD were randomized equally across 2 dose cohorts, 6E10 or 2E11 vg/eye. The trial is evaluating multiple prophylactic regimens, including topical steroid eyedrops (difluprednate) with or without Ozurdex and with or without oral steroids. LUNA is designed to inform the selection of both the Ixo-vec dose and prophylactic regimen for Phase 3 registrational trials.1
OPTIC is an ongoing, open-label, dose-ranging first-in-human trial. In this trial, 30 patients with wet AMD requiring frequent IVT injections were enrolled equally across 2 doses, 2E11 or 6E11. Patients received either 6 weeks of prophylactic topical steroid eye drops or 13 days of prophylactic oral steroids. The OPTIC trial was a 2-year study, with an optional 3-year extension.1
The LUNA and OPTIC data cutoff dates were August 29, 2024, and August 21, 2024, respectively. At the data cutoff date for LUNA, 57 patients had completed the 52-week study visit, with 3 discontinuations due to adverse events unrelated to study drug. 23 OPTIC patients elected to participate in the OPTIC extension. At the data cutoff date for OPTIC, 21 patients had completed the 4-year study visit, with 2 discontinuations unrelated to study drug.1
Both LUNA and OPTIC were designed to assess a broad wet AMD population, including hard-to-treat patients with severe disease who required frequent anti-VEGF injections before enrolling in the trial. At baseline, mean annualized prior anti-VEGF injections in the year prior to enrolling in LUNA and OPTIC were 10.1 (2.6 SD) and 9.9 (1.9 SD), respectively.1
LUNA 52-week analysis topline sata Summary
- Both doses of Ixo-vec maintained visual and anatomic endpoints through 52 weeks.
- Best Corrected Visual Acuity (BCVA) - least squares mean BCVA change from baseline at week 52 (95% CI)*:
- 6E10: -2.1 (-4.8, 0.7)
- 2E11: -1.8 (-4.6, 0.9)
- *Excludes 1 participant at each dose with letter loss due to cataract
- Central Subfield Thickness (CST) - least squares mean CST (μm) change from baseline at week 52 (95% CI):
- 6E10: -10.2 (-29.0, 8.5)
- 2E11: -21.9 (-40.4, -3.3)
- Best Corrected Visual Acuity (BCVA) - least squares mean BCVA change from baseline at week 52 (95% CI)*:
- Both doses of Ixo-vec achieved an industry leading treatment burden reduction and proportion patients who were injection free through 52 weeks.
- Treatment Burden Reduction - % reduction in mean annualized anti-VEGF injections:
- 6E10: 88% treatment burden reduction
- 2E11: 92% treatment burden reduction
- Proportion of Patients Injection Free:
- 6E10: 54% injection free, with 75% of patients with ≤1 injection
- 2E11: 69% injection free, with 79% of patients with ≤1 injection
- Treatment Burden Reduction - % reduction in mean annualized anti-VEGF injections:
- Both doses of Ixo-vec were well tolerated, with local steroids effectively managing inflammation when present.
- No 6E10 patients had inflammation at week 52 or at any subsequent visit**.
- No Ixo-vec-related serious adverse events. All Ixo-vec-related AEs were either mild or moderate: no episcleritis, vasculitis, retinitis, choroiditis, vascular occlusion, or hypotony.
- The most common Ixo-vec-related AEs were dose-dependent anterior inflammation responsive to local corticosteroids and anterior pigmentary changes with no impact on vision.
- No new onset inflammation after week 30.
- **Inflammation defined as grade ≥ 1 AC/VC cells
- 6E10 dose with topical eyedrops as prophylactic regimen selected for pivotal program, providing a predictable long-term favorable safety profile.
- No patients at 6E10 with topical eyedrops had inflammation at week 52 or at any subsequent visit.
- Only one subject had inflammation, which resolved by year 1.
- LUNA results underscored by sub-group analyses that support potential best-in-class product profile and position Ixo-vec for potential clinical, regulatory and commercial success.
- Demonstrated consistent benefit in both patients with ≤300 μm baseline CST (“dry”) and patients with > 300 μm baseline CST (“wet”).
- Demonstrated maintenance of visual and anatomic outcomes in injection-free patients.
- Demonstrated even more robust clinical activity in patients with less treatment burden (experienced patients with <6 injections in year prior to LUNA).
- Results from our LUNA patient preference survey demonstrate strong preference for Ixo-vec over prior anti-VEGF therapies and acceptability of steroid regimen.
- 93% (n=56) of LUNA patients at 52 weeks prefer Ixo-vec, including accompanying steroid regimen, over prior treatments. Patient preference for Ixo-vec over prior treatments increased over time, from 88% (n=57) at 26 weeks.
- 95% (n=56) of LUNA patients would elect to receive Ixo-vec in the other eye if both eyes had wet AMD.
- 96% (n=56) of LUNA patients would recommend Ixo-vec to their family or friends with wet AMD.
- 100% (n=10) of patients on the 6E10 pivotal dose and topical eyedrop steroid regimen prefer Ixo-vec over prior treatments for wet AMD.
- 100% (n=10) of patients on the 6E10 pivotal dose and topical eyedrop steroid regimen would elect to receive Ixo-vec in other eye if both eyes had wet AMD.
- 100% (n=10) of patients on the 6E10 pivotal dose and topical eyedrop steroid regimen would recommend Ixo-vec to their family or friends with wet AMD.
- No patients receiving topical eyedrop alone prophylaxis (n=20) stated it was difficult to manage.
OPTIC (2E11) 4-year Analysis Topline Data Summary
- Patients in OPTIC received 9.9 mean annualized injections prior to receiving Ixo-vec. Despite significant treatment need at baseline, these patients continue to experience long-term benefit from Ixo-vec through at least 4 years of follow up, including maintenance of vision, durability of anatomical improvements and sustained reduction in anti-VEGF treatment burden. Aflibercept levels have been demonstrated up to 5-years post-treatment.
- Patients had an 86% reduction in annualized anti-VEGF injections through year 4, with a robust reduction in treatment burden demonstrated in each year following Ixo-vec administration.
- Through Year 1: 84% reduction in anti-VEGF injections
- Through Year 2: 81% reduction in anti-VEGF injections
- Through Year 3: 84% reduction in anti-VEGF injections
- Through Year 4: 86% reduction in anti-VEGF injections
- 4-year OPTIC data underscore Ixo-vec’s reliable long-term benefit.
- Nearly 50% of patients were injection free through 4 years following Ixo-vec treatment.
- 78% of OPTIC participants who were injection free through year 1 remained injection free through year 4.
- 88% of OPTIC participants who were injection free through year 2 remained injection free through year 4.
- Durable aqueous aflibercept protein levels up to 5 years after a single Ixo-vec IVT injection.
- Ixo-vec at 2E11 was generally well tolerated and demonstrated a favorable safety profile.
- Inflammation was dose dependent, did not impact vision and, when present, was responsive to local corticosteroids.
- Long-term data establish a 10-fold safety margin from highest dose tested in nAMD.
- Patients had an 86% reduction in annualized anti-VEGF injections through year 4, with a robust reduction in treatment burden demonstrated in each year following Ixo-vec administration.
Design Elements of the Ixo-vec Phase 3 Pivotal Program
- The company plans to conduct 2, double-masked, randomized Phase 3 clinical trials.
- The initial 284-patient, US-based ARTEMIS Phase 3 study is expected to enroll a broad patient population, including both treatment-naïve and treatment-experienced wet AMD patients.
- The primary endpoint, measured at an average of weeks 52 and 56, is non-inferiority (NI) in mean BCVA change from baseline between Ixo-vec (6E10 vg/eye) and aflibercept (2mg Q8W). The non-inferiority margin for this study is -4.5 letters.
- All patients will receive three monthly loading doses of aflibercept prior to Ixo-vec.
- The study will utilize a sham in the control arm to support masking. Patients in both arms will be eligible for supplemental injections of aflibercept and will receive topical steroid eye drops.
- This trial design is based on our end-of-Phase 2 feedback from the US Food and Drug Administration (FDA).
- ARTEMIS remains on track and is expected to initiate in 1H 2025.
