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Safety Profile

SUSVIMO^®'s safety profile

Safety Profile

SUSVIMO^®'s safety profile

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Most frequently reported AESIs were attributed to the surgical procedure¹

Reports occurred between days 5 and 853, with a median of 173 days. Many, but not all, of the cases of endophthalmitis reported a preceding or concurrent conjunctival retraction or erosion event.¹

In ARCHWAY and LADDER trials:¹⁷

In 1 patient, BCVA decreased to 0 after onset of endophthalmitis, prior to refill-exchange, and remained 0 throughout the study
4 patients had their SUSVIMO implant explanted
2 patients discontinued treatment

Endophthalmitis should be treated urgently per standard of care (tap and inject, vitrectomy if needed) based on the treating physician’s clinical judgment.¹⁷

In the Genentech-sponsored trials, the protocol recommended tapping and injecting with antibiotics per standard of care in addition to other treatment methods that involved treatment via the implant.¹⁷

The majority of these hemorrhages occurred within the first postoperative month following surgical implantation and the majority of vitreous hemorrhages resolved spontaneously. None of these vitreous hemorrhages required a vitrectomy.¹⁷

In ARCHWAY, events occurred in a range of 2 to 140 days where 3 patients received a surgical conjunctival erosion repair.¹⁷

In ARCHWAY, events occurred in a range of 3 to 44 days where 2 patients received a surgical conjunctival repair.¹⁷

In ARCHWAY, events occurred in a range of 15 to 194 days where 1 patient received a surgical conjunctival bleb repair.¹⁷

AESIs observed over 5 years in the PORTAL Extension Study¹³

SUSVIMO (n=114)
Overall number of AESIs		76
Mean SD follow-up time, weeks		273.3 (17.2)
	All	Sight-threatening
Total number of patients	47 (41.2)	1 (0.9)
Cataract	31 (27.2)	0
Conjunctival bleb/conjunctival filtering bleb leak	7 (6.1)	0
Vitreous hemorrage	8 (7.0)	0
Conjunctival erosion	10 (8.8)	0
Conjunctival retraction	1 (0.9)	0
Endophthalmitis	0	0
Implant dislocation	0	0
Septum dislodgement	0	0
Hyphema	3 (2.6)	1 (0.9)
Rhegmatogenous retinal detachment	1 (0.9)	0

PORTAL is an extension study designed to evaluate long-term safety and tolerability of SUSVIMO in nAMD¹³

This 5 year PORTAL analysis population included patients from the Phase 2 LADDER trial that were:

Treated with SUSVIMO PRN and rolled over to SUSVIMO 100 mg/mL Q24W
Previously treated with IVT ranibizumab Q4W and rolled over to SUSVIMO 100 mg/mL Q24W

Most adverse events were well-tolerated and resolved on their own¹

Adverse reactions in nAMD patients occurring in ≥4% of patients in the SUSVIMO arm through week 40

Adverse Reaction	SUSVIMO (n=248)	Monthly ranibizumab (n=167)
Conjunctival hemorrhage	72%	6%
Conjunctival hyperemia	26%	2%
Iritis	23%	0.6%
Eye pain	10%	5%
Vitreous floaters	9%	2%
Conjunctival bleb/filtering bleb leak	9%	0
Foreign body sensation in eyes	7%	1%
Headache	7%	2%
Hypotony of eye	6%	0
Vitreous detachment	6%	5%
Vitreous hemorrhage	5%	2%
Conjunctival edema	5%	0
Corneal disorder	4%	0
Corneal abrasion	4%	0.6%
Corneal edema	4%	0

Managing Patients on SUSVIMO

Managing Patients on SUSVIMO

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AE=adverse event; AESI=adverse event of special interest; Q4W=every-4-week dosing; Q24W=every-24-week dosing

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.

- SUSVIMO [package insert]. South San Francisco, CA: Genentech, Inc; 2022.
  
  SUSVIMO [package insert]. South San Francisco, CA: Genentech, Inc; 2022.
- Adam M, et al. Presented at Association for Research in Vision and Ophthalmology (ARVO) 2022. May 01-May 06 2022.
  
  Adam M, et al. Presented at Association for Research in Vision and Ophthalmology (ARVO) 2022. May 01-May 06 2022.
- SUSVIMO Initial Fill and Implant Procedure Instructions for Use. Genentech, Inc. 2022.
  
  SUSVIMO Initial Fill and Implant Procedure Instructions for Use. Genentech, Inc. 2022.
- Chakravarthy U et al. Eye . 2021 Nov;35(11):2983-2990.
  
  Chakravarthy U et al. Eye . 2021 Nov;35(11):2983-2990.
- Monés, J et al. Ophthalmologica. 2020: 243(1), 1-8.
  
  Monés, J et al. Ophthalmologica. 2020: 243(1), 1-8.
- Ciulla TA et al. Opthalmol Retina. 2018;2(7)645-653.
  
  Ciulla TA et al. Opthalmol Retina. 2018;2(7)645-653.
- Campochiaro PA et al. Presented at Bascom Palmer Eye Institute Angiogenesis, Exudation, and Degeneration 2022, February 11-12, 2022.
  
  Campochiaro PA et al. Presented at Bascom Palmer Eye Institute Angiogenesis, Exudation, and Degeneration 2022, February 11-12, 2022.
- Ranade SV, et al. Drug Delivery. 2022;29(1):1326-1334.
  
  Ranade SV, et al. Drug Delivery. 2022;29(1):1326-1334.
- Monés J, et al. Presented at: 21st EURETINA Congress, September 9-12, 2021.
  
  Monés J, et al. Presented at: 21st EURETINA Congress, September 9-12, 2021.
- Regillo C, et al. Am J Ophthalmol. 2023;130(7):735-747.
  
  Regillo C, et al. Am J Ophthalmol. 2023;130(7):735-747.
- Holekamp NM, et al. Opthalmol. 2022;129(3):295-307.91
  
  Holekamp NM, et al. Opthalmol. 2022;129(3):295-307.91
- ClinicalTrials.gov identifier: NCT03677934. Updated July 22, 2021. https://clinicaltrials.gov/ct2/show/NCT0367793 4
  
  ClinicalTrials.gov identifier: NCT03677934. Updated July 22, 2021. https://clinicaltrials.gov/ct2/show/NCT0367793 4
- Massop D, et al. Presented at the American Society of Retina Specialists Annual Meeting. July 28–August 1, 2023.
  
  Massop D, et al. Presented at the American Society of Retina Specialists Annual Meeting. July 28–August 1, 2023.
- Chang MA, et al. JAMA ophthalmology. 2022; 140(8), 771-778.
  
  Chang MA, et al. JAMA ophthalmology. 2022; 140(8), 771-778.
- Boulanger-Scemama E et al. J Fr Ophtalmol. 2015;38:620–627.
  
  Boulanger-Scemama E et al. J Fr Ophtalmol. 2015;38:620–627.
- Senra H et al. Am J Ophthalmol. 2017;177:213-224.
  
  Senra H et al. Am J Ophthalmol. 2017;177:213-224.
- Awh C, et al. Ophthalmol Retina. 2022;6(11),1028-1043.
  
  Awh C, et al. Ophthalmol Retina. 2022;6(11),1028-1043.