CONDOR trial finds brolucizumab better preserves vision than laser in proliferative diabetic retinopathy
The CONDOR randomized clinical trial found brolucizumab better preserved visual acuity than panretinal photocoagulation in proliferative diabetic retinopathy at week 54. Brolucizumab also reduced vision-threatening complications and center-involved diabetic macular edema events, while showing more intraocular inflammation.
Brolucizumab was better able to preserve visual acuity than panretinal laser photocoagulation in patients with proliferative diabetic retinopathy, according to the CONDOR randomized clinical trial published in JAMA Ophthalmology. In the 16-country study of PRP-naïve patients with proliferative diabetic retinopathy and diabetes without diabetic macular edema, patients randomly received either 6 mg brolucizumab or panretinal photocoagulation.
Researchers analyzed December 2020 to October 2023 data from the trial, which included 689 patients, with 572 completers. Brolucizumab recipients took 3 starting doses every 6 weeks, followed by every 3 months, while the panretinal photocoagulation group underwent 1 to 4 sessions until 3 months and then could receive more treatment.
At week 54, the least-squares mean letter score change was better for brolucizumab than panretinal photocoagulation, at 0.2[0.72] versus -4.2[0.73]. Estimated least-squares mean change in best-corrected visual acuity area under the curve was greater in the brolucizumab group, at 0.5 letters versus -3.2 letters. Mean best-corrected visual acuity at the study’s beginning was 77.1 letters.
Brolucizumab recipients were also less likely to experience proliferative diabetic retinopathy at week 54, at 63.6 versus 22.4%, or a center-involved diabetic macular edema event up to week 54, at 31.1 versus 72.7%. Patients receiving brolucizumab were more likely to experience Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Score improvement of at least 2 steps, at 45.4% versus 20.4%, and of at least 3 steps, at 20.6% versus 10.8%.
Thirteen brolucizumab recipients and 51 panretinal photocoagulation recipients underwent alternative diabetic retinopathy or related diabetic macular edema treatment during the study period. Sixteen brolucizumab recipients and 36 panretinal photocoagulation recipients lost at least 15 letters.
Brolucizumab recipients were less likely to exhibit diabetic retinopathy-linked vision-threatening complications, at 33.7% versus 75.4%, ocular adverse events, at 34.3% versus 49.1%, or serious adverse events, at 2.9% versus 6.4%, but more likely to demonstrate adverse events of special interest, at 19 versus 3, and intraocular inflammation, such as retinal vasculitis, at 5.2% versus 0.6%.
The central reading center found that 101 patients exhibited non-proliferative diabetic retinopathy and 284 patients possessed central subfield thickness greater than 280 μm. Nearly 4 in 5 patients exhibited proliferative diabetic retinopathy, according to the central reading center. Study limitations include no diabetic macular edema treatment decision data.