FDA Approves Roche's Susvimo, First Refillable Eye Implant for Wet AMD Treatment
Key Insights
The FDA approved Susvimo, the first refillable eye implant for neovascular age-related macular degeneration (search), offering patients as few as two treatments per year compared to monthly injections.
The approval was based on the Archway phase III study showing Susvimo achieved equivalent vision gains to monthly ranibizumab injections while maintaining treatment efficacy for six months.
Susvimo represents a significant advancement in AMD treatment, potentially reducing treatment burden for the approximately 20 million people worldwide affected by neovascular AMD.
The U.S. Food and Drug Administration has approved Susvimo (ranibizumab injection) 100 mg/mL, marking a breakthrough in neovascular age-related macular degeneration (search) treatment as the first FDA-approved refillable eye implant that can reduce treatment frequency to as few as two procedures per year. The approval represents the first new treatment approach for wet AMD (search) in 15 years, offering an alternative to standard monthly eye injections.
Susvimo delivers ranibizumab continuously through a surgically implanted device that is refilled every six months during outpatient procedures. The treatment is indicated for patients with neovascular AMD who have previously responded to at least two anti-VEGF injections.
"Susvimo represents a major advancement in the treatment of retinal disease and is an important new option for patients with wet AMD (search)," said Carl Regillo, M.D., Chief of Retina Service at Wills Eye Hospital in Philadelphia and an Archway study investigator. "With Susvimo, my patients now have an option that can help them maintain their vision as well as anti-VEGF injections, but on a more manageable twice-yearly treatment schedule."
Clinical Trial Results Demonstrate Efficacy
The FDA approval was based on positive results from the phase III Archway study, which enrolled 415 patients with neovascular AMD. The randomized, multicentre, open-label trial compared Susvimo refilled every six months to monthly intravitreal ranibizumab injections.
According to pre-specified study criteria, Susvimo demonstrated non-inferiority and equivalence to monthly ranibizumab injections. Patients treated with Susvimo gained an average of 0.2 eye chart letters in visual acuity from baseline compared with 0.5 eye chart letters for the monthly ranibizumab arm at the primary endpoint of weeks 36 and 40.
Notably, only 1.6% of Susvimo patients (4 out of 246) required supplemental ranibizumab treatment before their first refill, while 98.4% of patients (242 out of 246) successfully completed the six-month treatment interval without additional intervention.
Safety Profile and Risk Considerations
While Susvimo was generally well-tolerated with a favorable benefit-risk profile, the implant has been associated with a three-fold higher rate of endophthalmitis (search) compared to monthly intravitreal injections of ranibizumab. In clinical trials, 2.0% of patients receiving the ranibizumab implant experienced at least one episode of endophthalmitis.
Many endophthalmitis (search) events were associated with conjunctival retractions or erosions. The FDA noted that appropriate conjunctiva management and early detection with surgical repair of conjunctival retractions or erosions may reduce the risk of endophthalmitis.
The most common adverse events included conjunctival hemorrhage, conjunctival hyperemia, iritis, and eye pain. The safety profile will continue to be monitored closely as the treatment becomes available.
Addressing Significant Medical Need
Neovascular AMD affects approximately 20 million people worldwide and represents a leading cause of blindness in individuals over age 60. The condition destroys sharp, central vision needed for daily activities like reading, driving, and watching television.
"We believe that Susvimo can help people with nAMD preserve their vision while potentially alleviating the treatment burden associated with current standards of care," said Levi Garraway, M.D., Ph.D., Roche's Chief Medical Officer and Head of Global Product Development.
The current standard of care requires anti-VEGF eye injections as often as once a month, creating a significant treatment burden for patients and healthcare systems. Susvimo's extended dosing interval could substantially reduce this burden while maintaining therapeutic efficacy.
Expanding Clinical Development Program
Roche has established a robust phase III clinical development program for Susvimo beyond neovascular AMD. The Portal study is evaluating long-term safety and efficacy in AMD patients, while Pagoda is investigating the treatment for diabetic macular edema (search). The Pavilion study focuses on diabetic retinopathy (search) without diabetic macular edema, and Velodrome is exploring a nine-month refill schedule for AMD patients.
Susvimo is also under review by the European Medicines Agency for neovascular AMD treatment. The company expects the treatment to become available in the United States in the coming months.
The approval adds to Roche's ophthalmology portfolio, which includes the established Lucentis (ranibizumab injection) and the investigational bispecific antibody faricimab, currently under FDA and EMA review for multiple retinal conditions.