The FDA has approved Roche's Susvimo (ranibizumab injection) for the treatment of diabetic macular edema (DME), offering a new option that reduces the frequency of eye injections. This approval marks a significant advancement for individuals with DME, a leading cause of vision loss among adults with diabetes, affecting approximately 29 million people worldwide.
Susvimo is the first and only FDA-approved treatment for DME that maintains vision with fewer injections than standard treatments. The implant delivers a customized formulation of ranibizumab via a refillable ocular implant, providing continuous treatment. The therapy is now available to retina specialists and patients in the US.
Clinical Trial Data
The FDA's approval was based on positive one-year results from the Phase 3 Pagoda study. The study compared the efficacy, safety, and pharmacokinetics of Susvimo refilled every six months to monthly ranibizumab 0.5 mg intravitreal injections in 634 patients with DME. The results showed that Susvimo provided sustained vision improvements, with a safety profile consistent with its known characteristics.
Patients receiving Susvimo every six months experienced non-inferior improvements in vision compared to those receiving monthly ranibizumab injections. Both groups showed improvements of approximately 9.6 and 9.4 eye chart letters, respectively. According to Roche, about 95% of patients treated with Susvimo did not need additional treatment with supplemental injections during the primary analyses study of 64 weeks.
Mechanism of Action
Susvimo delivers a customized formulation of ranibizumab through a port delivery system, offering continuous treatment. Ranibizumab is a vascular endothelial growth factor (VEGF) inhibitor designed to bind to and inhibit VEGF-A, a protein that plays a critical role in the formation of new blood vessels and the leakiness of vessels.
Expert Commentary
"Susvimo presents a unique, convenient treatment alternative to routine eye injections for people with a potentially blinding diabetic eye condition," said Levi Garraway, MD, PhD, Roche's Chief Medical Officer and Head of Global Product Development. "As the global prevalence of diabetic macular edema continues to grow, today’s FDA approval for Susvimo reflects our dedication to innovation and enhancing the patient experience."
Vitreoretinal surgeon Jordan Graff, MD, from Barnet Dulaney Perkins Eye Center, Arizona, added, "I am excited to offer Susvimo to my patients living with diabetic macular edema who want an option with longer intervals between treatments due to their busy personal and professional lives. Having completed dozens of Susvimo surgeries in my patients with wet, or neovascular, age-related macular degeneration (nAMD), I’ve seen first-hand how Susvimo, with its continuous delivery of medication, can help preserve vision with fewer treatments. I look forward to broadening Susvimo’s impact to even more patients in my clinic."
Current Treatment Landscape
DME is often caused by the swelling of the macula due to diabetes-related retinal disease, leading to weakened blood vessels in the eyes. Traditionally, DME has been treated with anti-VEGF intravitreal injections, including aflibercept, farcimab-svoa, bevacizumab, and ranibizumab (Lucentis). Susvimo offers a different approach with less frequent administration.
Dosing and Administration
Susvimo is administered via a refillable ocular implant that is surgically inserted into the eye during a one-time, outpatient procedure. The implant delivers ranibizumab continuously over time, with refills required approximately every six months.
Safety Profile
Adverse events associated with the ranibizumab implant include eye infection, conjunctival erosion, conjunctival retraction, implant dislocation, vitreous hemorrhage, conjunctival bleb, retinal detachment, implant damage, and temporary decrease in vision after the procedure. The Susvimo implant has been associated with an up to 3-fold higher rate of endophthalmitis than monthly intravitreal injections of ranibizumab.
