Data Published in Archives of Ophthalmology Shows Visudyne(TM) Reduces The Risk of Vision Loss Associated With Wet AMD
18.10.1999, 07:56
ATLANTA, and VANCOUVER, British Columbia (PROTEXT) - For the
first time in any leading peer-review medical journal, the
October issue of Archives of Ophthalmology published extensive
positive results from Phase III clinical trials involving
Visudyne (verteporfin for injection) therapy to treat the wet
form of age-related macular degeneration (AMD), the leading cause
of blindness in people over the age of 50 in the western world.
The overall results of the study report that Visudyne therapy
reduces the risk of vision loss, compared to placebo, during the
first year of the study in patients with the wet form of AMD. The
comprehensive analysis reveals that Visudyne therapy shows
beneficial effects in the total study population. Additionally,
the data shows that a subgroup of patients whose lesions were
characterized by a specific, more aggressive, disease pattern
experienced a large, clinically relevant benefit.
Regulatory applications, based on the data, requesting
marketing clearance for Visudyne therapy have recently been
submitted to the US Food and Drug Administration (FDA), as well
as boards of health in the European Union, Switzerland,
Australia, and New Zealand. In the United States, Switzerland,
Australia and New Zealand, the application has been granted
accelerated review status.
Wet AMD typically destroys central vision, which is necessary
for reading, driving, and recognizing faces. The condition is
characterized by the formation of abnormal blood vessels
(choroidal neovascularization or CNV) that grow across the
central part of the retina, called the macula. These vessels leak
fluid and, eventually cause scar tissue, which destroys central
vision in as little as 2 months to 3 years. As the population
ages, wet AMD is predicted to increase as a major public health
concern, particularly since current treatment options are limited
in efficacy and scope.
Positive Results in the Broad, Total Study Population
Publication of the results of a 12-month analysis from two 24-
month randomized double-masked clinical trials involving 609
patients with a variety of CNV lesion characteristics, known as
the TAP (Treatment of AMD with Photodynamic therapy)
Investigation showed that vision remained stable or improved
(defined as a loss of less than 3 lines of vision on a standard
eye chart) for 61% of patients treated with Visudyne therapy
compared to 46% of patients administered placebo (p<0.001). This
result was statistically significant for both the combined and
individual studies.
Compared to placebo, the beneficial effects of Visudyne
therapy with respect to change in visual acuity were observed at
the first follow-up period three months after initial treatment
and became more pronounced through month 12. The entire change in
visual acuity distribution at 12 months differed by an average of
1.3 lines in favor of those patients on Visudyne (p<0.001).
"This is a landmark study with results that have the potential
to significantly change the way we manage patients developing wet
AMD," said Dr. Neil M. Bressler, Chair of the TAP Study Advisory
Group, and a retinal specialist and Professor of Ophthalmology at
the Wilmer Eye Institute of the Johns Hopkins University School
of Medicine in Baltimore, Maryland. "Visudyne therapy offers hope
for potentially preserving the vision and independence of many
thousands of people diagnosed around the world each year with
predominantly classic CNV."
Although the goal of Visudyne therapy is to reduce the risk of
vision loss, 16% of patients in the treatment group experienced
an improvement in vision of one or more lines on a standard eye
chart compared to 7% of patients on placebo. This result confirms
that the improvement seen in earlier studies with shorter-term
follow up was sustainable for at least 12 months.
Severe vision loss (defined as a loss of at least 6 lines of
vision on a standard eye chart) occurred in 14.7% of patients
treated with Visudyne therapy as opposed to 23.7% of patients on
placebo (p<0.001).
In order to participate in the trials, patients had to have a
best- corrected baseline visual acuity of between 20/40 and
20/200 as well as some evidence of the fluorescein angiographic
pattern regarded to be the more aggressive type, termed classic
CNV.
Positive visual acuity results were complemented by similar
outcomes for contrast sensitivity evaluations. In addition,
fluorescein angiographic assessments demonstrated that Visudyne
significantly reduced the risk of lesion growth, was associated
with the cessation of leakage from classic CNV and decreased
progression in the development of new areas of classic CNV beyond
that observed at study entry.
Specifically, at 12 months, Visudyne-treated eyes had a lower
mean number of contrast sensitivity letters lost (1.3 vs. 4.5,
p<0.001) and were less likely to show progression of classic CNV
beyond the original lesion (46% vs. 71%, p<0.001), have
fluorescein leakage from classic CNV (77% vs. 88%, p=0.002), and
have a lesion size larger than 6 disc areas (41% vs. 73%,
p<0.001).
Substantially Enhanced Results in Specific Subgroup
No subgroups were identified in which placebo-treated patients
fared significantly better than patients receiving Visudyne
therapy. However, the visual acuity benefit observed in the
overall population was substantially enhanced in 243 patients
whose lesions at baseline constituted predominantly classic CNV
(> or = 50% classic). Vision remained stable or improved in 67%
of these patients treated with Visudyne therapy versus 39% on
placebo (p<0.001). At 12 months, 12% of these patients on
Visudyne therapy had lost greater than six lines of vision
whereas 33.3% of placebo patients in this subgroup had
experienced severe vision loss (p<0.001).
"This finding identifies a very clinically relevant and
substantial indication for justifying prompt consideration of
treatment for AMD patients with subfoveal lesions who present
with predominantly classic CNV," said Dr. Bressler.
Visudyne therapy well-tolerated
The therapy was well tolerated with few adverse events, and
less than 3% of patients withdrawing from the study due to
adverse events. The majority of adverse events occurred in
similar numbers among the treatment and placebo groups. Those
events that occurred more often with Visudyne therapy were:
reactions at the injection site that occurred in 10% more treated
patients; transient mild to moderate transient visual
disturbances that occurred in 2% more treated patients; and self-
resolving photosensitivity reactions that usually were mild and
occurred within 24 hours post-treatment in less than 3% of
treated patients.
"In addition to the significant reduction in risk of vision
loss noted with Visudyne therapy in these trials, we are
extremely pleased with the product's excellent safety profile.
This is an important finding, particularly since the drug will be
used primarily in a population whose average age probably will be
around 75," said Dr. Bressler.
"We certainly are indebted to the hundreds of patients that
participated in this trial," he added, "Their commitment is
evident by the fact that over ninety-four percent of the
participants given Visudyne or placebo therapy completed their
12-month follow-up exam."
Protocol
Two-thirds of the 609 participants in the trials received
Visudyne via intravenous injection over ten minutes while the
remaining one-third were administered a placebo in a masked
fashion. Fifteen minutes after the start of the infusion, a non-
thermal light was shone into the patient's eye for approximately
one and one-half minutes to activate the drug. Once activated,
Visudyne selectively affects the abnormal blood vessels,
resulting in a greater chance to stop growth of these blood
vessels and corresponding vision loss compared to placebo
treatment.
Re-treatments were administered every three months if leakage
was identified on fluorescein angiography. At the 12-month time
period, only 64% of the Visudyne-treated patients required re-
treatment.
Study Conclusions
"Based on these results, we recommend the use of Visudyne
therapy in the management of AMD patients with subfoveal CNV
lesions that are predominantly classic CNV, once the drug is
approved by regulatory agencies for commercial use," said the
study authors.
"The fact that these trials were rigorous and well-controlled
makes these results even more compelling," added Dr. Bressler.
About Visudyne Therapy and AMD
Visudyne therapy is being co-developed for various ocular
conditions by CIBA Vision Corporation, the eye care unit of
Novartis AG, and QLT PhotoTherapeutics Inc. (Nasdaq: QLTI;
Toronto). Upon commercialization, CIBA Vision will market the
product worldwide while QLT will be responsible for manufacturing
Visudyne. Pending regulatory approval, the companies hope to make
Visudyne therapy commercially available by early 2000.
Visudyne therapy involves the use of a specifically designed
laser that produces the low level, non-thermal 689 nm light
required to activate the drug. These lasers have been developed
by two of the world's leading laser companies, Coherent Inc.
(Nasdaq: COHR), based in California, and The Carl Zeiss Group,
based in Germany.
Additional Phase III trials are being conducted to determine
the effectiveness of Visudyne therapy in patients with an earlier
stage of AMD who were originally excluded from the TAP
Investigation, as well as patients with a similar but distinct
condition of abnormal blood vessels associated with progressive
near-sightedness known as pathologic myopia.
The wet form of the condition represents an estimated 15% of
all AMD cases, but accounts for approximately 90% of the severe
vision loss associated with the disease. Worldwide, nearly
500,000 new cases of wet AMD develop each year, 200,000 of which
occur in North America.
Visudyne therapy is protected by a series of U.S. and foreign
issued patents which cover the composition of matter,
formulations and manufacturing, and the method of use in treating
AMD and other conditions.
Background on CIBA Vision and QLT
With worldwide headquarters in Atlanta, Georgia, USA, CIBA
Vision is a global leader in research, development and
manufacturing of optical and ophthalmic products and services,
including contact lenses, lens care products, ophthalmic surgical
products and ophthalmic pharmaceuticals. CIBA Vision products are
available in more than 70 countries. For more information, visit
the CIBA Vision website at www.cibavision.com .
CIBA Vision is the eye care unit of Novartis AG, a world
leader in Life Sciences with core businesses in Healthcare,
Agribusiness and Consumer Health (Nutrition and Self-Medication).
In 1998, Novartis Group sales were CHF 31.7 billion, of which CHF
17.5 billion were in Healthcare, CHF 8.4 billion in Agribusiness
and CHF 5.8 billion in Consumer Health. The group annually
invests more than CHF 3.7 billion in R&D. Headquartered in Basel,
Switzerland, Novartis employs about 82,000 people and operates in
over 140 countries around the world.
QLT PhotoTherapeutics Inc. is a world leader in the
development and commercialization of proprietary pharmaceutical
products for use in photodynamic therapy, an emerging field of
medicine utilizing light-activated drugs in the treatment of
disease. QLT's innovative science has advanced photodynamic
therapy beyond applications in cancer towards potential
breakthrough treatments in ophthalmology and autoimmune disease.
In addition to Visudyne therapy, QLT's portfolio of products
include PHOTOFRIN(R) (porfimer sodium), the world's only approved
photodynamic therapy drug, used in the treatment of various
cancers throughout North America, Japan and Europe. For more
information, visit QLT's web site at www.qltinc.com .
Visudyne(TM) is a trademark of Novartis AG
PHOTOFRIN(R) is a registered trademark of QLT
PhotoTherapeutics Inc.
For more information, visit the CIBA Vision web site at
www.cibavision.com or the Visudyne therapy website at
www.visudyne.com .
For more information, visit the QLT web site at www.qltinc.com
QLT PhotoTherapeutics Inc. is listed on The Nasdaq Stock
Market under the trading symbol "QLTI" and on The Toronto Stock
Exchange under the trading symbol "QLT".
The foregoing information contains forward-looking statements
which involve known and unknown risks, uncertainties and other
factors which may cause the actual results to be materially
different from any future results, performance, or achievements
expressed or implied by such statements. Such factors include:
risks associated with the commercialization of Visudyne(TM)
therapy; dependence on corporate relationships; manufacturing
uncertainties; uncertainty of pricing and reimbursement;
uncertainties relating to clinical trials and product
development; the Company's history of operating losses and
uncertainty of future profitability; competition; rapid growth;
uncertainty regarding patents and proprietary rights; product
liability claims and insurance; no assurance of regulatory
approval; government regulation; uncertainty of access to
capital; anti-takeover provisions; and volatility of common share
price; among others, all as described in the Company's Annual
Information Form on Form 10-K. ots Original Text Service: CIBA
Vision Corporation Internet: http://www.newsaktuell.de Contact:
Karen Handel or Ann Berry, Corporate Communications of CIBA
Vision, 678-415-4208, or fax, 678-415-3592, or Elayne Wandler or
Tamara Hicks, Corporate Communications and Investor Relations of
QLT PhotoTherapeutics Inc., 1-800-663-5486, or 604-872-7881, or
fax, 604-873-0816 Web site: http://www.visudyne.com Web site:
http://www.qltinc.com Web site: http://www.cibavision.com
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