13 December 2018 - - French biopharma company GenSight Biologics (PAR: SIGHT) (Euronext: SIGHT, ISIN: FR0013183985, PEA-PME eligible) reported that Week 72 analyses of the data from its Phase III REVERSE clinical trial revealed a sustained improvement in composite scores and selected sub-scores of a questionnaire used to measure patient perceptions of vision-related quality of life and ability to carry out daily activities impacted by loss of visual acuity, the company said.

The REVERSE trial evaluates the safety and efficacy of a single intravitreal injection of GS010 (rAAV2/2-ND4) in 37 subjects whose visual loss due to 11778-ND4 Leber Hereditary Optic Neuropathy commenced between six and 12 months prior to study treatment.

All 37 patients in REVERSE were asked to complete the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), a reliable and valid vision-specific quality-of-life instrument that measures patients' perception of their ability to perform daily activities requiring high-acuity vision and their general sense of well-being.

The test defines sub-scales for functions such as near-distance vision and vision-related dependency as well as measures of well-being such as ocular pain and vision-related mental health. These sub-scale scores are aggregated into a composite score, excluding the general health rating question.

Well-accepted as a source of patient-reported measures of vision-related function, the questionnaire has been used in many clinical trials.

A study in neovascular AMD which, like LHON, leads to loss of central vision showed that a clinically meaningful 15-letter change in BCVA was associated with a 4- to 6-point change in the NEI VFQ-25 composite score and in sub-scores in three pre-specified areas (near activities, distance activities, and vision-specific dependency).

At Week 72, REVERSE patients reported mean improvement from baseline for NEI VFQ-25 scores in domains important to patients with loss of central vision: near activities, distance activities, vision-specific dependency and composite score.

An improvement had already been observed at Week 48, confirming sustained enhancement of ability to perform activities of daily living.

In addition, large improvements were also noted in other domains relevant to LHON patients: role difficulties, general vision, and overall mental health.

Again, the improvements observed at Week 48 were sustained at Week 72. The relevant comparison in REVERSE is against patients' own baseline, because the NEI VFQ-25 is assessed by patient; by design, all REVERSE patients received an injection in one eye.

Improvement from baseline at Week 72 for other sub-scales: social functioning: +2.4 (23.3%); ocular pain: +1.4 ; color vision: +5.6 (20.8%); peripheral vision: +1.4 (15.5%). Missing values for general health subscale. Driving questions not pertinent to LHON patients.

Dr. Mark Moster, Neuro-Ophthalmology, Wills Eye Hospital; Professor of Neurology and Ophthalmology at Thomas Jefferson University, Philadelphia, PA; and Principal Investigator in the REVERSE, RESCUE, and REFLECT trials, concurred.

As per protocol, REVERSE subjects will be evaluated again at 96 weeks, and data will be reported in the second quarter of 2019.

Topline 48-week data for RESCUE, the second Phase III clinical trial of GS010 in the treatment of LHON, is expected in early 1Q19.

Reference cited: Suñer et al., Invest Ophthalmol Vis Sci. 2009;50:3629–3635. DOI: 10.1167/iovs.08-3225
On the VFQ-25: The National Eye Institute sponsored the development of the VFQ-25, which aims to measure the influence of visual disability and visual symptoms on generic health domains and task-oriented domains related to daily visual functioning.

The survey consists of a base set of vision-targeted questions that represent 11 vision-related constructs (domains), plus an additional single-item general health rating question.

Respondents use numerical scales to rate their difficulty in performing vision-dependent activities and to assess their well-being.

For example, "near activities," referring to "difficulty with near vision activities," encompasses activities such as "doing work or hobbies that require [the respondent] to see well up close, such as cooking, sewing, fixing..." and "finding something on a crowded shelf."

The numerical scores are converted to a 0-to-100 scale, with higher scores representing better functioning. The sub-scale scores within a domain are averaged to create the domain sub-scale score.

The composite score is a simple average of the domain sub-scale scores, excluding the general health rating question.

GenSight Biologics is a clinical-stage biopharma company focused on discovering and developing innovative gene therapies for retinal neurodegenerative diseases and central nervous system disorders.