GenSight Biologics announced positive long-term outcomes from the REFLECT and RESTORE Phase III clinical trials, demonstrating sustained efficacy and safety of LUMEVOQ® (lenadogene nolparvovec) gene therapy in patients with Leber Hereditary Optic Neuropathy (LHON). The five-year data indicate that a single administration of LUMEVOQ provides lasting visual acuity improvements and a favorable safety profile, particularly with bilateral injections.
The REFLECT trial, a randomized, double-masked, placebo-controlled study, involved 98 subjects with vision loss due to LHON caused by a mutated ND4 mitochondrial gene. Participants received an intravitreal injection of lenadogene nolparvovec in their first affected eye, with the second eye randomized to either a second injection of LUMEVOQ or a placebo. The study's primary endpoint was the Best-Corrected Visual Acuity (BCVA) reported in LogMAR at 1.5 years post-treatment in the second-affected eye.
Sustained Visual Improvement
Data from the REFLECT trial showed that visual acuity improvement was maintained over five years in all subjects treated with lenadogene nolparvovec. Notably, the improvement observed in placebo eyes highlighted a consistent contralateral treatment effect, also seen in previous REVERSE and RESCUE trials. According to the press release, relative to the observed nadirs, average VA for all eyes treated with lenadogene nolparvovec increased beyond the +15-letter threshold (-0.3 LogMAR change) that conventionally defines clinically meaningful improvement.
Bilateral Treatment Benefits
Responder analyses indicated improved outcomes for patients, with a higher rate of clinically relevant recovery from their nadir in bilaterally treated patients (75%) compared to those receiving unilateral treatment (60%). Moreover, 79% of bilaterally treated patients could read letters on a screen, versus 72% in the unilateral group. RESTORE study showed that Lumevoq-treated eyes achieved a mean improvement against nadir of +22 letters equivalent and sham-treated eyes demonstrated a mean improvement of +20 letters equivalent.
Safety Profile
The favorable safety profile of LUMEVOQ was confirmed, with comparable safety observed in bilaterally and unilaterally treated subjects. There were no study discontinuations related to systemic or ocular adverse events, and no serious ocular adverse events were reported. The main ocular adverse event was intraocular inflammation, mostly mild and responsive to conventional treatment.
Expert Commentary
"The latest REFLECT data confirms that the improvement seen with lenadogene nolparvovec is sustained 5 years after treatment has been given, including the additional benefit observed in participants receiving a bilateral intravitreal injection of the gene therapy," said Prof. Patrick Yu-Wai-Man, Professor of Ophthalmology and Honorary Consultant Neuro-ophthalmologist at the University of Cambridge, Moorfields Eye Hospital, and the UCL Institute of Ophthalmology, United Kingdom, and International Principal Investigator of REFLECT. "Importantly, REFLECT participants receiving a bilateral injection had a comparable safety profile to those treated unilaterally."
RESTORE Study
Further supporting the long-term efficacy and safety, the RESTORE study, a long-term follow-up of patients from the RESCUE and REVERSE trials, demonstrated that the benefits of LUMEVOQ were sustained for up to five years post-treatment. Participants in RESTORE had already experienced clinically meaningful improvement relative to their nadir at the two-year mark, with Lumevoq-treated eyes showing a +20 ETDRS letters equivalent and sham-treated eyes showing +17 ETDRS letters equivalent. At five years, these improvements were maintained, with Lumevoq-treated eyes achieving a mean improvement against nadir of +22 letters equivalent and sham-treated eyes demonstrating a mean improvement of +20 letters equivalent.
About Leber Hereditary Optic Neuropathy (LHON)
LHON is a rare, maternally inherited mitochondrial genetic disease characterized by the degeneration of retinal ganglion cells, leading to rapid and irreversible vision loss, primarily affecting adolescents and young adults. It is typically a bilateral condition with poor functional visual recovery.
About LUMEVOQ
LUMEVOQ (lenadogene nolparvovec) targets LHON by utilizing a mitochondrial targeting sequence (MTS) proprietary technology platform. This gene therapy delivers a functional ND4 gene into the mitochondria of retinal ganglion cells, aiming to restore mitochondrial function and improve visual outcomes. It is administered via a single intravitreal injection.
