Ophthalmology and Therapy (Nov 2023)

Efficacy and Safety of Biosimilar QL1207 vs. the Reference Aflibercept for Patients with Neovascular Age-Related Macular Degeneration: A Randomized Phase 3 Trial

  • Bing Li,
  • Ke Fan,
  • Tonghe Zhang,
  • Zhifeng Wu,
  • Siming Zeng,
  • Mingwei Zhao,
  • Qian Ren,
  • Dongping Zheng,
  • Lifei Wang,
  • Xiaoling Liu,
  • Mei Han,
  • Yanping Song,
  • Jian Ye,
  • Cheng Pei,
  • Jinglin Yi,
  • Xian Wang,
  • Hui Peng,
  • Hong Zhang,
  • Zhanyu Zhou,
  • Xiaoling Liang,
  • Fangliang Yu,
  • Miaoqin Wu,
  • Chaopeng Li,
  • Chunling Lei,
  • Jilong Hao,
  • Luosheng Tang,
  • Huiping Yuan,
  • Shanjun Cai,
  • Qiuming Li,
  • Jingxiang Zhong,
  • Suyan Li,
  • Lin Liu,
  • Min Ke,
  • Jing Wang,
  • Hui Wang,
  • Mengli Zhu,
  • Zenghua Wang,
  • Yang Yan,
  • Feng Wang,
  • Youxin Chen

DOI
https://doi.org/10.1007/s40123-023-00836-4
Journal volume & issue
Vol. 13, no. 1
pp. 353 – 366

Abstract

Read online

Abstract Introduction This trial aimed to compare the efficacy and safety between biosimilar QL1207 and the reference aflibercept for the treatment of neovascular age-related macular degeneration (nAMD). Methods This randomized, double-blind, phase 3 trial was conducted at 35 centers in China. Patients aged ≥ 50 years old with untreated subfoveal choroidal neovascularization secondary to nAMD and best-corrected visual acuity (BCVA) letter score of 73–34 were eligible. Patients were randomly assigned to receive intravitreous injections of QL1207 or aflibercept 2 mg (0.05 ml) in the study eye every 4 weeks for the first 3 months, followed by 2 mg every 8 weeks until week 48, stratified by baseline BCVA ≥ or < 45 letters. The primary endpoint was BCVA change from baseline at week 12. The equivalence margin was ± 5 letters. The safety, immunogenicity, pharmacokinetics (PK), and plasma vascular endothelial growth factor (VEGF) concentration were also evaluated. Results A total of 366 patients were enrolled (QL1207 group, n = 185; aflibercept group, n = 181) from Aug 2019 to Jan 2022 with comparable baseline characteristics. The least-squares mean difference in BCVA changes was − 1.1 letters (95% confidence interval − 3.0 to 0.7; P = 0.2275) between the two groups, within the equivalence margin. The incidences of treatment-emergent adverse events (TEAE; QL1207: 71.4% [132/185] vs. aflibercept: 71.8% [130/181]) and serious TEAE (QL1207: 14.1% [26] vs. aflibercept: 12.7% [23]) appeared comparable between treatment groups, and no new safety signal was found. Anti-drug antibody, PK profiles, and VEGF concentration were similar between the two groups. Conclusions QL1207 has equivalent efficacy to aflibercept for nAMD with similar safety profiles. It could be used as an alternative anti-VEGF agent for clinical practice. Trial Registration ClinicalTrials.gov: NCT05345236 (retrospectively registered on April 25, 2022); National Medical Products Administration of China: CTR20190937 (May 20, 2019).

Keywords