Novartis: Phase 3 Beovu Data Show Potential for Fluid Resolution in More DME Patients With Fewer Injections Versus Aflibercept

Source: Novartis

Novartis announced positive 1-year results of the phase III KESTREL and KITE studies, evaluating the efficacy and safety of Beovu (brolucizumab-dbll) 6 mg in diabetic macular edema (DME).

Both studies met their primary endpoints of noninferiority in change in best corrected visual acuity (BCVA) from baseline for Beovu 6 mg versus aflibercept 2 mg at year one.1 In KESTREL, patients on Beovu 6 mg gained a mean of 9.2 letters versus 10.5 letters for patients on aflibercept 2 mg.1 In KITE, patients on Beovu 6 mg gained a mean of 10.6 letters versus 9.4 letters for patients on aflibercept 2 mg.1 These results will be presented at the Association for Research in Vision and Ophthalmology (ARVO) 2021 Annual Meeting.  

In prespecified secondary endpoints, fewer eyes treated with Beovu had intraretinal and/or subretinal fluid (IRF/SRF) at week 32 (first assessment of disease activity) and week 52 versus eyes treated with aflibercept.1 More eyes treated with Beovu 6 mg than eyes treated with aflibercept achieved central subfield thickness (CSFT) levels below 280 μm at weeks 32 and 52.1 Fluid is a key marker of disease activity in DME and CSFT is a key indicator of fluid in the retina.1

“Treatment for diabetic macular edema is a high unmet medical need in the US and globally. Our goal as physicians is to work on preventing blindness for the significant proportion of diabetics affected by this condition,” David M Brown,MD, FACS, Director of Clinical Research at the Retina Consultants of Texas and principal investigator of the KESTREL clinical trial, said in a company news release. “DME patients often struggle with adherence due to the need to manage multiple comorbidities related to diabetes. The KESTREL and KITE clinical trials—the first pivotal trials to examine a longer dosing interval in the loading phase—confirm Beovu’s potential to be an important therapy for these patients.”

To study its potential in reducing treatment burden, Beovu was given at 6-week dosing intervals during the loading phase versus aflibercept, which was given at the standard 4-week dosing intervals, in line with its label.1,2 Following the loading phase, over half of patients in the Beovu 6 mg arm (55.1% in KESTREL and 50.3% in KITE) remained on a 3-month dosing interval through year 1, based on a treatment approach determined by disease activity assessment.1 If disease activity was detected, Beovu 6 mg patients were switched to 2-month intervals through the end of the trial.1 All aflibercept patients were on a 2-month interval after the loading phase.1

“We are pleased to share these data, which underscore Beovu’s potential to address an unmet need in the DME landscape,” said Jill Hopkins, Global Development Unit Head, Ophthalmology, Novartis Pharmaceuticals. “With these data demonstrating vision gains, fluid resolution and the potential for less frequent injections for eligible patients, we are one step closer to providing DME patients with a potential new treatment option.”

The phase 3 KESTREL and KITE studies enrolled a total of 926 patients in 36 countries. Beovu 6 mg is the commercialized dose in wet age-related macular degeneration (AMD).3 The brolucizumab 3 mg arm, which was only included in KESTREL, did not meet the primary endpoint.1

Beovu was overall well-tolerated in KESTREL and KITE.1 The most common ocular and nonocular adverse events (≥5%) in KESTREL and KITE were conjunctival hemorrhage, nasopharyngitis and hypertension.4 IOI rates in KESTREL were 4.7% for brolucizumab 3 mg (including 1.6% retinal vasculitis), 3.7% for Beovu 6 mg (including 0.5% retinal vasculitis), and 0.5% for aflibercept 2 mg.1 IOI rates in KITE were equivalent (1.7%) between the Beovu 6 mg and aflibercept 2 mg arms with no retinal vasculitis reported.1 Retinal vascular occlusion was reported in KESTREL for brolucizumab 3 mg (1.1%) and 6 mg (0.5%), and in KITE for brolucizumab and aflibercept (0.6% each).1 The majority of these events were manageable and resolved with or without treatment.1

Novartis is committed to bringing Beovu 6 mg to market for DME patients, subject to regulatory approvals, and will be submitting these one-year data from the KESTREL and KITE trials to global health authorities in H1 2021. Novartis anticipates 2-year results from KESTREL and KITE later in 2021.


  1. Brown D, Wolf S, Garweg JG, et al. Brolucizumab for the treatment of visual impairment due to diabetic macular edema: 52-week results from the KESTREL & KITE studies. Presented at: The Association for Research in Vision and Ophthalmology (ARVO) 2021 Annual Meeting. May 2021.
  2. Eylea [prescribing information] Tarrytown, NY: Regeneron Pharmaceuticals, Inc; 2018.
  3. Beovu [US prescribing information] East Hanover, NJ. Novartis: 2020.
  4. Data on file. KESTREL and KITE Clinical Study Report. Novartis, 2021.
  5. Romero-Aroca P. Managing diabetic macular edema: The leading cause of diabetes blindness. World J Diabetes. 2011;2(6):98-104.
  6. National Eye Institute. Macular Edema. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-edema. Accessed April 2021.
  7. National Eye Institute. Diabetic Retinopathy. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy. Accessed April 2021.
  8. Beovu [summary of product characteristics] Basel, Switzerland. Novartis: 2020.
  9. Pharma Japan. National Health Insurance Pricing. Available at: https://pj.jiho.jp/sites/default/files/pj/document/2020/05/New%20Drugs%20to%20Be%20Added%20to%20NHI%20Price%20List%20on%20May%2020_1.pdf. Accessed April 2021.
  10. Canadian Agency for Drugs and Technologies in Health. CADTH Canadian Drug Expert Committee Recommendation. Available at: https://cadth.ca/sites/default/files/cdr/complete/SR0632%20Beovu%20-%20CDEC%20Final%20Recommendation%20%E2%80%93%20May%2025%2C%202020_for%20posting.pdf. Accessed April 2021.
  11. Beovu [prescription medicine decision summary] Australia. Novartis: 2020.

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