09.05.18

Phase 3 Trial of Bausch + Lomb’s Loteprednol Etabonate Drug Candidate Meets Primary Efficacy Endpoints

Source: Bausch Health Companies

Bausch + Lomb announced that in a phase 3 trial, an investigational formulation of loteprednol etabonate ophthalmic gel 0.38% met both of the primary efficacy endpoints in that it was significantly more effective than vehicle in completely resolving ocular inflammation and pain following cataract surgery. Additionally, the results showed that submicron loteprednol etabonate ophthalmic gel 0.38% had an acceptable safety profile regardless of whether it was administered two or three times per day.

The results were published in the Journal of Cataract and Refractive Surgery (JCRS).1 

Submicron loteprednol etabonate ophthalmic gel, 0.38% has a reduced concentration and reduced dosing frequency versus existing formulations of loteprednol etabonate.

“Patients who undergo cataract surgery commonly experience inflammation that can result in pain, compromised vision, increased intraocular pressure, and other complications when untreated,” Raymond Fong, MD, founder of Raymond Fong Eye Care in New York, and lead author of the publication, said in a company news release. “Although topical corticosteroids are widely used to reduce postoperative inflammation and pain, they are associated with potential side effects. These results are very encouraging as they show the efficacy of the submicron loteprednol etabonate ophthalmic gel, 0.38% in eliminating ocular inflammation and pain after cataract surgery with a safety profile similar to other loteprednol etabonate formulations.”

The published phase 3 study, which enrolled 514 patients, showed that a significantly greater proportion of patients who received submicron loteprednol etabonate ophthalmic gel, 0.38% dosed twice daily or three times daily had complete resolution of anterior chamber cells on postoperative day 8 (26.9 percent and 28.7 percent, respectively) compared with the vehicle group (9.3 percent; P<0.0001). Similarly, a significantly greater proportion of patients who received submicron loteprednol etabonate ophthalmic gel, 0.38% twice daily or three times daily had no ocular pain (grade 0) on day 8 (73.7 percent and 73.1 percent, respectively) compared with the vehicle group (47.7 percent; P<0.001). For patients in the submicron loteprednol etabonate ophthalmic gel, 0.38% group, statistically significant differences in both anterior chamber cells and ocular pain were sustained at all subsequent visits (through postoperative day 18) relative to vehicle. Additionally, significantly fewer patients in the submicron loteprednol etabonate ophthalmic gel, 0.38% twice daily group and three times daily group (14.0 percent and 11.1 percent, respectively) required rescue medication by day 8 compared with those in the vehicle group (41.9 percent; P<0.0001). The most common ocular adverse events were eye pain, photophobia (extreme sensitivity to light), and foreign body sensation.

“Bausch + Lomb is committed to innovation and addressing unmet needs in eye care. This submicron loteprednol etabonate ophthalmic gel, 0.38% is an example of continued advancements in our portfolio,” Tracy Valorie, general manager and senior vice president, U.S. Pharmaceuticals and Surgical, Bausch + Lomb, said in a company news release. “The results highlighted in this publication support this promising investigational ophthalmic gel as a potential new treatment for postoperative inflammation and pain following ocular surgery, and we look forward to bringing it to market as quickly as possible.”

The FDA has accepted the new drug application for submicron loteprednol etabonate ophthalmic gel, 0.38% with a Prescription Drug User Fee Act (PDUFA) action date of Feb. 25, 2019.

About the Phase 3 Study



The phase 3 study was conducted at 45 ophthalmology practices in the United States and enrolled 514 patients age 18 years or older who had anterior chamber cells grade 2 or higher (6 to 15 cells) the day after uncomplicated cataract surgery. Study participants were randomized to one of four treatment groups (submicron loteprednol etabonate ophthalmic gel, 0.38% twice daily, submicron loteprednol etabonate ophthalmic gel, 0.38% three times daily, vehicle gel twice daily, or vehicle gel three times daily) for 14 days. The primary efficacy endpoints were the proportion of patients with complete resolution of anterior chamber cells (defined as a grade of 0 [or no cells]), a marker of ocular inflammation, and the proportion of patients with grade 0 pain (no pain) at postoperative day 8 in the submicron loteprednol etabonate ophthalmic gel, 0.38% twice daily, submicron loteprednol etabonate ophthalmic gel, 0.38% three times daily, and the combined vehicle groups. Safety and tolerability endpoints included ocular symptoms other than pain (e.g., itching, tearing, and discharge), study drug sensation, the incidence of ocular and non-ocular adverse events, and ocular signs (biomicroscopy), among others. Study participants who experienced worsening or no change in inflammation could be placed on anti-inflammatory rescue medication at any time during the trial.

1. Fong R, Silverstein BE, Peace JH, Williams JI, Vittitow JL. Submicron loteprednol etabonate ophthalmic gel 0.38% for the treatment of inflammation and pain after cataract surgery. J Cataract Refract Surg. 2018; in press.  

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