Patient Preference Data & Profiles

PATIENT PREFERENCE DATA FROM THE ARCHWAY STUDY

As an exploratory endpoint, a PDS Patient Preference Questionnaire (PPPQ) was administered at week 40 of the Archway study to all patients in the PDS arm. 234 out of 248 patients completed the survey to assess patient preference for route of administration (PDS vs intravitreal injections [IVT]). The PPPQ was administered only to patients who received IVT anti-VEGF injections prior to day 1. For patients with missing week 40 values, the last postbaseline observation was imputed.¹¹

Questionnaire Design

The survey included 3 questions that captured¹¹:

A patient’s preference for mode of administration (Port Delivery System, Intravitreal Injections, No Preference)
The strength of their preference (very strong, fairly strong, not very strong)
The reasons for their preference (fewer treatments, less discomfort, less worry or nervousness, requires less time for treatment, other reason)*

The response options in the survey did not include all clinically relevant attributes that could have inhibited patients from carrying out a comprehensive trade-off analysis.

Qualitative content validation study/cognitive debriefing was performed to test if patients understood response options given within the PPPQ.

*Patients could select multiple reasons for their preference.

Analysis Limitations and Considerations¹¹

As the study survey was not adequately designed to measure preference for method of administration, the data presented are provided for informational purposes only and should be interpreted with caution

Limitations of the data include¹¹:

The PPPQ compares patient preference for a PDS in a controlled clinical trial setting versus IVT injection administered in an uncontrolled real-world setting, so it may not yield meaningful results
The analysis did not include a crossover design and is susceptible to recall error
Some patients received aflibercept injection in their fellow eye, not a ranibizumab injection; thus, no direct comparison can be made with ranibizumab PDS

Questionnaire Results¹¹

93.2%

selected PDS as the preferred route of administration

5.6%

selected no preference

1.3%

selected IVT injections as the preferred route of administration

Percentages are based on total number of patients who completed the measures.

PATIENT PROFILES

MEET RUTH MEET CHARLES MEET JENNIFER

NAME: Ruth

RACE: Caucasian

AGE: 78

CLINICAL SUMMARY:
Ruth was initially started on ranibizumab when diagnosed with nAMD and then switched to aflibercept. One year ago, when her treatment regimen was extended beyond 8 weeks, Ruth experienced a hemorrhage and blurred vision for a couple of months. Since then, she has been anxious about losing vision and extending. She has continued on a Q8W regimen without further attempts to extend.

LIFESTYLE:
Ruth works part-time as a teacher at a local college. When she’s not teaching, Ruth devotes her time volunteering for various nonprofits in her community. Between teaching and volunteering, Ruth is constantly on the go, and finding time to make her Q8W injection appointments had become a struggle.

Current Treatment Regimen: Aflibercept injections every 8 weeks

Number of Previous Anti-VEGF Injections: 8

Pre-SUSVIMO BCVA/CPT: 75 letters (20/32 Snellen)/176 µm

Medical History: Cataract surgery. No history of ocular allergies or dry eye

NAME: Charles

RACE: African American

AGE: 65

CLINICAL SUMMARY:
Charles presented 3 years ago with early-onset nAMD and was started on ranibizumab. His treatment regimen was not able to be extended beyond 4 weeks as Charles would experience noticeable vision loss and fluid accumulation. He has been on therapy consistently for the last 3 years (36 total injections).

LIFESTYLE:
Charles is retired and recently widowed. His wife used to drive him to his appointments, but she passed away last year. He now frequently travels to visit his daughter and extended family in Florida. He would like to spend more time there but is concerned about missing his monthly intravitreal injection appointments.

Current Treatment Regimen: Ranibizumab injections every 4 weeks

Number of Previous Anti-VEGF Injections: 36

Pre-SUSVIMO BCVA/CPT: 75 letters (20/32 Snellen)/169 µm

Medical History: No history of sub-conjunctival surgical procedure

NAME: Jennifer

RACE: Asian American

AGE: 70

CLINICAL SUMMARY:
Jennifer was diagnosed with nAMD 2 years ago and started on aflibercept. Her treatment regimen was not able to be extended past 8 weeks. She has received a total of 10 intravitreal injections and missed 2 injections during this time.

LIFESTYLE:
Jennifer lives about 2 hours away from the clinic and relies on her son to both drive her to her appointments and help translate. Her son has a full-time job and is sometimes unable to drive his mom to these appointments. This ongoing travel burden is making it difficult for Jennifer to stay adherent to her current treatment regimen.

Current Treatment Regimen: Aflibercept injections every 8 weeks

Number of Previous Anti-VEGF Injections: 10

Pre-SUSVIMO BCVA/CPT: 70 letters (20/40 Snellen)/177 µm

Medical History: Medical history of dry AMD without geographic atrophy

Review the Safety Profile

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BCVA=best corrected visual acuity; CPT=center point thickness; IVT=intravitreal; nAMD=neovascular (wet) age-related macular degeneration; PDS=port delivery system; VEGF=vascular endothelial growth factor.

Indication

SUSVIMO (ranibizumab injection) is indicated for the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) who have previously responded to at least 2 intravitreal injections of a vascular endothelial growth factor (VEGF) inhibitor medication.

WARNING: ENDOPHTHALMITIS

The SUSVIMO implant has been associated with a 3-fold higher rate of endophthalmitis than monthly intravitreal injections of ranibizumab. Many of these events were associated with conjunctival retractions or erosions. Appropriate conjunctiva management and early detection with surgical repair of conjunctival retractions or erosions may reduce the risk of endophthalmitis. In clinical trials, 2.0% of patients receiving a ranibizumab implant experienced at least 1 episode of endophthalmitis.

Contraindications

SUSVIMO is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or hypersensitivity to ranibizumab products or any of the excipients in SUSVIMO.

Warnings and Precautions

The SUSVIMO implant and/or implant-related procedures have been associated with endophthalmitis, rhegmatogenous retinal detachment, implant dislocation, septum dislodgement, vitreous hemorrhage, conjunctival erosion, conjunctival retraction, and conjunctival blebs. Patients should be instructed to report any signs or symptoms that could be associated with these events without delay. In some cases, these events can present asymptomatically. The implant and the tissue overlying the implant flange should be monitored routinely following the implant insertion and refill-exchange procedures to permit early medical or surgical intervention as necessary. Special precautions need to be taken when handling SUSVIMO components.

Endophthalmitis

In the active comparator period of controlled clinical trials, the ranibizumab implant has been associated with a 3-fold higher rate of endophthalmitis than monthly intravitreal injections of ranibizumab (1.7% in the SUSVIMO arm vs 0.5% in the intravitreal arm). When including extension phases of clinical trials, 2.0% (11/555) of patients receiving the ranibizumab implant experienced an episode of endophthalmitis. Reports occurred between day 5 and day 853, with a median of day 173. Many, but not all, of the cases of endophthalmitis reported a preceding or concurrent conjunctival retraction or erosion event.

Endophthalmitis should be treated promptly in an effort to reduce the risk of vision loss and maximize recovery. The SUSVIMO dose (refill-exchange) should be delayed until resolution of endophthalmitis.

Patients should not have an active or suspected ocular or periocular infection or severe systemic infection at the time of any SUSVIMO implant or refill procedure. Appropriate intraoperative handling followed by secure closure of the conjunctiva and Tenon’s capsule, and early detection and surgical repair of conjunctival erosions or retractions may reduce the risk of endophthalmitis.

Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachments have occurred in clinical trials of SUSVIMO and may result in vision loss. Rhegmatogenous retinal detachments should be promptly treated with an intervention (e.g., pneumatic retinopexy, vitrectomy, or laser photocoagulation). The SUSVIMO dose (refill-exchange) should be delayed in the presence of a retinal detachment or retinal break.

Careful evaluation of the retinal periphery is recommended to be performed, and any suspected areas of abnormal vitreo-retinal adhesion or retinal breaks should be treated before inserting the implant in the eye.

Implant Dislocation

In clinical trials, the device dislocated/subluxated into the vitreous cavity or extended outside the vitreous cavity into or beyond the subconjunctival space. Device dislocation requires urgent surgical intervention. Strict adherence to the scleral incision length and appropriate targeting of the pars plana during laser ablation may reduce the risk of implant dislocation.

Septum Dislodgement

In clinical trials, a type of implant damage where the septum has dislodged into the implant body has been reported. Perform a dilated slit lamp exam and/or dilated indirect ophthalmoscopy to inspect the implant in the vitreous cavity through the pupil prior to and after the refill-exchange procedure to identify if septum dislodgement has occurred. Discontinue treatment with SUSVIMO following septum dislodgement and consider implant removal should the benefit of the removal procedure outweigh the risk.

Appropriate handling and insertion of the refill needle into the septum (avoid twisting and/or rotation) is required to minimize the risk of septum dislodgement.

Vitreous Hemorrhage

Vitreous hemorrhages may result in temporary vision loss. Vitrectomy may be needed in the case of a nonclearing vitreous hemorrhage.

In clinical trials of SUSVIMO, including extension phases, vitreous hemorrhages were reported in 5.2% (23/443) of patients receiving SUSVIMO. The majority of these hemorrhages occurred within the first postoperative month following surgical implantation, and the majority of vitreous hemorrhages resolved spontaneously. Patients on antithrombotic medication (e.g., oral anticoagulants, aspirin, nonsteroidal anti-inflammatory drugs) may be at increased risk of vitreous hemorrhage. Antithrombotic medications are recommended to be temporarily interrupted prior to the implant insertion procedure. The SUSVIMO dose (refill-exchange) should be delayed in the event of sight-threatening vitreous hemorrhage. The use of pars plana laser ablation and scleral cauterization should be performed to reduce the risk of vitreous hemorrhage.

Conjunctival Erosion or Retraction

A conjunctival erosion is a full-thickness degradation or breakdown of the conjunctiva in the area of the implant flange. A conjunctival retraction is a recession or opening of the limbal and/or radial peritomy. Conjunctival erosions or retractions have been associated with an increased risk of endophthalmitis, especially if the implant becomes exposed. Surgical intervention (e.g., conjunctival/Tenon’s capsule repair) is recommended to be performed in cases of conjunctival erosion or retraction with or without exposure of the implant flange.

In clinical trials of SUSVIMO, including extension phases, 3.6% (16/443) of patients receiving SUSVIMO reported conjunctival erosion and 1.6% (7/443) of patients receiving SUSVIMO reported conjunctival retraction in the study eye.

Appropriate intraoperative handling of the conjunctiva and Tenon’s capsule to preserve tissue integrity and secure closure of peritomy while ensuring placement of sutures away from implant edge may reduce the risk of conjunctival erosion or retraction. The implant and the tissue overlying the implant flange should be monitored routinely following the implant insertion.

Conjunctival Bleb

A conjunctival bleb is an encapsulated elevation of the conjunctiva above the implant flange, which may be secondary to subconjunctival thickening or fluid. Conjunctival blebs may require surgical management to avoid further complications, especially if the implant septum is no longer identifiable due to the conjunctival bleb.

In clinical trials of SUSVIMO, including extension phases, 5.9% (26/443) of patients receiving SUSVIMO reported conjunctival bleb/conjunctival filtering bleb leak in the study eye. Strict adherence to the scleral incision length, appropriate intraoperative handling of the conjunctiva and Tenon’s capsule to preserve tissue integrity and secure closure of peritomy, and proper seating of the refill needle during refill-exchange procedures may reduce the risk of conjunctival bleb.

Postoperative Decrease in Visual Acuity

Visual acuity was decreased by an average of 4 letters in the first postoperative month and an average of 2 letters in the second postoperative month following initial implantation of SUSVIMO.

Air Bubbles Causing Improper Filling of the Implant

Minimize air bubbles within the implant reservoir, as they may cause slower drug release. During the initial fill procedure, if an air bubble is present, it must be no larger than ⅓ of the widest diameter of the implant. If excess air is observed after initial fill, do not use the implant. During the refill-exchange procedure, if excess air is present in the syringe and needle, do not use the syringe and needle. If excess air bubbles are observed after the refill-exchange procedure, consider repeating the refill-exchange procedure.

Deflection of the Implant

Use caution when performing ophthalmic procedures that may cause deflection of the implant and subsequent injury. For example, B-scan ophthalmic ultrasound, scleral depression, or gonioscopy.

Adverse Reactions

In the nAMD Archway study following the SUSVIMO initial fill and implant insertion, refill, and implant removal (if necessary) procedures up to week 40, the most common (≥10%) adverse reactions up to week 40 were conjunctival hemorrhage (72%), conjunctival hyperemia (26%), iritis (23%), and eye pain (10%).

Females and Males of Reproductive Potential

Females of reproductive potential should use effective contraception during treatment with SUSVIMO and for at least 12 months after the last dose of SUSVIMO. No studies on the effects of ranibizumab on fertility have been conducted and it is not known whether ranibizumab can affect reproduction capacity. Based on the anti-VEGF mechanism of action for ranibizumab, treatment with SUSVIMO may pose a risk to reproductive capacity.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

Please see additional Important Safety Information in the full SUSVIMO Prescribing Information, including BOXED WARNING.

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