AAO data highlight a growing push to reduce repeated anti-VEGF injections, with tarcocimab showing durable benefit while gene therapy delivers encouraging early results and topical steroid OCS-01 falls short on vision.
Late-stage data presented at the American Academy of Ophthalmology meeting pointed to a widening pipeline of treatments for diabetic eye disease, with one injectable therapy showing durable benefit in diabetic retinopathy and several other approaches trying to reduce the burden of repeated anti-VEGF injections for diabetic macular oedema. The presentations, covered by Retinal Roundup and other ophthalmology outlets, ranged from a phase 3 antibody treatment to early gene therapy and a topical steroid candidate.
The strongest signal came from the phase 3 GLOW2 study of tarcocimab tedromer, a long-acting anti-VEGF treatment from Kodiak Sciences. Margaret Chang of Retinal Consultants Medical Group said patients with moderately severe non-proliferative diabetic retinopathy through mild proliferative disease were randomised to tarcocimab or sham treatment, and the drug met both its main and secondary goals. After 48 weeks, 62.5% of treated patients had improved by at least two steps on the Diabetic Retinopathy Severity Scale, compared with 3.3% in the sham group. The study also found an 85% reduction in the risk of a prespecified sight-threatening complication. Chang said the benefit appeared durable for at least six months, with no reported intraocular inflammation, vasculitis or vascular occlusion.
A different strategy, gene therapy delivered under the retina, also generated encouraging early data. Arshad Khanani of Sierra Eye Associates described preliminary findings from the phase 2 ELAAVATE trial of surabgene lomparvovec, or sura-vec, for centre-involving diabetic macular oedema. In the small study, patients who received the higher dose recorded a mean gain of 15 letters in visual acuity and a reduction of 183 microns in central retinal thickness, while the lower-dose group saw more modest improvements. Both treatment groups also appeared to reduce the need for repeated anti-VEGF injections by roughly 70% to 80%. Khanani said the programme remains proof-of-concept work, but the results support the idea that selected patients who struggle with treatment burden may benefit from a surgical, longer-acting approach.
Not all of the newer approaches delivered clear visual gains. Donald D’Amico of Weill Cornell Medical College presented one-year results from the BRUNELLO trial of remigromig, a tri-specific antibody that aims to restore the blood-retinal barrier through the Wnt pathway rather than by blocking vascular endothelial growth factor. In the pivotal phase 2b/3 study, both remigromig doses proved non-inferior to ranibizumab on the main endpoint of best-corrected visual acuity, while central subfield thickness improvements were broadly similar across groups. Safety was generally balanced, although proliferative diabetic retinopathy events were more frequent in the remigromig arms, something D’Amico suggested may reflect the drug’s different mechanism rather than treatment failure.
By contrast, the topical steroid OCS-01 did not meet its primary visual endpoint in the DIAMOND programme, despite some anatomical benefit. Baruch Kuppermann of the University of California, Irvine, reported 52-week results showing that best-corrected visual acuity gains were not superior to vehicle in either of the two phase 3 studies, even though central retinal thickness fell more than it did with placebo through much of the trial. The drop also brought predictable steroid-related concerns: elevated intraocular pressure and cataracts were more common among treated patients. Kuppermann told discussants that missed doses and variable adherence may have contributed to the mismatch between anatomy and vision, underscoring how difficult it can be to turn a theoretically attractive topical therapy into a consistently effective real-world treatment.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
