EURETINA 2024: Efficacy results and patient preference findings from the Pagoda trial

Margaret A. Chang, MD, MS

Greetings from Barcelona! This year, the European Society of Retina Specialists (EURETINA) holds its annual congress in Spain, and the Eye Care Network is on site to report on the research findings being presented this year.

Ahead of the meeting, Ophthalmology Times Europe touched base with Margaret A. Chang, MD, MS, of Retinal Consultants Medical Group in California, USA. She discussed her EURETINA presentation, “Patient Preference for the Port Delivery System With Ranibizumab vs Intravitreal Injections: Results From the Phase 3 Pagoda Trial in Patients With Diabetic Macular Oedema.” Dr Chang provided the key takeaways for retina specialists to take back to their practices after the meeting and discussed what clinicians are missing when it comes to patient burden and medication adherence.

Editor’s note: This transcript has been lightly edited for clarity.

Hattie Hayes: Dr Chang, thank you so much for speaking with me. Can you provide some key findings from these Phase 3 Pagoda (NCT04108156) year 2 trial results?

Margaret A. Chang, MD, MS: The Phase 3 Pagoda trial evaluated the efficacy and safety of the Port Delivery System (PDS) with ranibizumab, or Susvimo, in diabetic macular oedema (DMO) – a condition which is highly prevalent among people with diabetes, and essentially demonstrates the potential for Susvimo to be a sustainable, long-term alternative to eye injections to treat DMO. The two-year data we are presenting here at EURETINA supported the one-year primary analyses, and showed that the visual and anatomical improvements obtained with Susvimo, refilled every 6 months, during the first study year, were maintained through the second year, with no new safety signals. This means we saw a consistent improvement in both best-corrected visual acuity, with patients gaining up to 9.8 letters from baseline, or two lines, on an eye chart. We also saw a sustained decrease in central subfield thickness, which is a measure of retinal drying and is important as swelling from excess fluid in the back of the eye has been associated with distorted and blurred vision.

In patients who previously received IVT treatment and were then implanted with PDS at year 2, we also saw similar improvements: a 9.4 letter gain from baseline and similar CST reductions as in the PDS arm. These patients had received on average about 16 IVT injections at year 1. What this shows is that even in previously treated patients, the same benefits of continuous delivery with PDS refilled every 6 months are achievable.

In another presentation at EURETINA, we also looked into the patient preference data in Pagoda at year 1. They captured this with the PPPQ, a validated questionnaire that was developed with patients' input. We saw that 83% of patients reported they preferred the continued delivery of Susvimo over intravitreal injections, most strongly or very strongly, and almost 75% said the reason they preferred Susvimo was due to the reduction in treatment burden. The preference for PDS held true regardless of baseline characteristics, history of prior IVT injection, and whether the patient experienced any adverse events or not. The patient voice is becoming increasingly important for informing clinical decisions, so I found this measurement particularly striking as further evidence to support the use of Susvimo as a meaningful intervention.

HH: I understand that patients’ treatment burden is a focal point of these findings. What are retina specialists, as a broad group, getting wrong or misunderstanding about patient burden and treatment adherence?

MC: We know there is a high treatment burden for people living with retinal conditions. In addition, we must not forget their caregivers who may need to take them to appointments and help with everyday tasks. This is something that I, and many retina specialists, are acutely aware of. It's important to remember the daily struggles patients encounter, which can impact their adherence to treatment. The medical aspects are often the priority, but the practical realities of frequent appointments may be overlooked. People with retinal conditions have to deal with transportation issues, missing work, and balancing other health concerns, which can make it more difficult for them to stick to their treatment plans. The emotional impact of vision-threatening conditions is also significant - patients may hesitate or postpone treatment due to fear, anxiety, or frustration.

Communication is key, and we, as retina specialists, should always aim to broach these topics with our patients, listen carefully, and demonstrate empathy, offering support and advice where we can to encourage adherence. There are many factors at play overall, which is why the Pagoda data on Susvimo are so interesting. With the potential for fewer clinic visits, patients may find it easier to achieve the optimal treatment adherence regimen required, which can ultimately lead to improved vision in the long-term.

HH: What are the main takeaways from this research you hope fellow EURETINA attendees put into practice?

MC: As physicians, we take many factors into account when we are presenting treatment options to our patients. We are used to looking at the efficacy, safety, and duration of different therapies, but I think we need to more consciously think about patient preferences. The treatment plan for each patient needs to incorporate not only objective evidence for treatment but also these more holistic factors for the best outcomes.

HH: I’ve got a bonus question: What’s your best piece of conference advice?

MC: There is so much exciting data to absorb at conferences, but I have found that I have learned a lot about practice and patient management through conversations with colleagues outside the meeting rooms. I also find that walks outside are a great way to take a break and recharge. We are lucky enough to have conferences in many fantastic locations, and we need to take advantage of that when we can!