Peter J Kertes, MD: Insights into the TALON Trial on Brolucizumab Versus Aflibercept

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Brolucizumab was deemed superior to aflibercept in treatment naive patients with neovascular age-related macular degeneration.

Brolucizumab proved to be superior to aflibercept in the phase 3, matched treat-and-extend TALON study in treatment-naive patients with neovascular age-related macular degeneration (nAMD).

An interview with Peter Kertes, MD, Department of Ophthalmology and Vision Sciences, University of Toronto, at the 2022 American Academy of Ophthalmology Meeting provided more insight into the comparison.

The primary outcome of the trial was to determine the longest duration that patients could have disease stability with no disease activity. As a superiority study, Kertes noted it was unique in the recent AMD trial space.

"[Brolucizumab] proved to be superior," he said. "Almost 40% of patients were able to extend to 12 weeks at that 32-week primary outcome timepoint compared to about 20% of those randomized to aflibercept."

Greater durability was additionally achieved with noninferior visual outcomes and brolucizumab was also a superior drying agent, with greater reductions in central subfield thickness.

Kertes noted that trial investigators were alerted to the risk of intraocular inflammation (IOI) with brolucizumab and remained vigilant as a result.

"We saw that about 5% of patients had IOI as a consequence of being randomized to brolucizumab, which is kind of the expected incidence," He said. "We saw similar incidence in HAWK and HARRIER, so that was replicated in the TALON study."

As a result, Kertes noted that clinicians have the balance the benefits and the risk and have open discussions with their patients.

"We have to be mindful of the safety and we have to watch for it and certainly stop the treatment and aggressively treat the IOI for the in those few patients for whom it does happen," he added.

The trial is ongoing with the end of study at 64 weeks, with results expected early next year, according to Kertes.

The study, "TALON, a Phase IIIb study of brolucizumab vs aflibercept in a matched (Treat & Extend) regimen in nAMD," was presented at AAO 2022.