In the treatment of patients with proliferative diabetic retinopathy (PDR), brolucizumab outperforms panretinal laser photocoagulation (PRP) in terms of preserving visual acuity, according to the international phase III CONDOR trial.
CONDOR met its primary endpoint, with brolucizumab being both noninferior and superior to PRP for best-corrected visual acuity (BCVA) at week 54. BCVA remained stable with a 0.2-letter gain among brolucizumab-treated patients, whereas it decreased by 4.2 letters among those who underwent PRP (difference, 4.4, 95 percent confidence interval [CI], 2.4–6.4; p<0.001). [JAMA Ophthalmol 2026;doi:10.1001/jamaophthalmol.2026.1008]
More patients in the brolucizumab arm than in the PRP arm were classified as having no PDR at week 54 (63.6 percent vs 22.4 percent; p<0.001) and achieved improvements in Diabetic Retinopathy Severity Score level of 2 steps (45.4 percent vs 20.4 percent; p<0.001) or 3 steps (20.6 percent vs 10.8 percent; p<0.001).
In terms of safety, ocular adverse events occurred in 34.3 percent of patients in the brolucizumab arm and 49.1 percent in the PRP arm. The rate of intraocular inflammation, including retinal vasculitis, was 5.2 percent and 0.6 percent in the respective treatment arms, consistent with the established safety profile of brolucizumab. No new safety findings emerged during the study.
“Brolucizumab is a single-chain antibody fragment that has a high affinity for VEGF,” the investigators noted.
“The value of anti-VEGF therapy as an adjunctive treatment to PRP has been demonstrated in the past, with superior functional and structural outcomes vs PRP alone. The efficacy results from CONDOR, however, suggest that brolucizumab may be a viable treatment alternative to PRP monotherapy for patients with PDR,” they added. [Medicine (Baltimore) 2023;102:e34856]
Prevention of vision-threatening complications is central to diabetic retinopathy treatment, and anti-VEGF therapy has been shown to be efficacious in this regard, according to the investigators. Indeed, in CONDOR, far fewer patients in the brolucizumab arm vs the PRP arm experienced vision-threatening complications (33.7 percent vs 75.4 percent). [Curr Opin Ophthalmol 2021;32:590-598]
Furthermore, centre-involved diabetic macular edema (DME) occurred less frequently in the brolucizumab arm vs the PRP arm (31.1 percent vs 72.7 percent; p<0.001). This finding did not come as a surprise to the investigators, who noted that brolucizumab had already been reported to be “highly effective at resolving retinal fluid in patients with DME.” [Am J Ophthalmol 2022;238:157-172]
Taken together, the data from CONDOR indicate that “brolucizumab provides effective disease control in PDR by reversing disease progression and maintaining functional vision through the prevention of vision-threatening complications,” they said.
Conducted at 152 sites across 16 countries, CONDOR included 689 patients (mean age 53.9 years, 40.1 percent female, mean BCVA 77.1 letters) with diabetes and PDR. These patients were randomly assigned to receive brolucizumab 6 mg (n=347) or undergo PRP (n=342).
Patients in the brolucizumab arm received three loading doses every 6 weeks, followed by every 12 weeks, with the option from week 48 onward to extend the treatment interval by 6 weeks at a time up to 24 weeks based on disease activity. Those in the PRP arm, on the other hand, underwent treatment in 1 to 4 sessions up to week 12, followed by additional PRP treatment as needed.
The authors highlighted the potential for brolucizumab to alleviate the treatment burden for patients with PDR.
“In previous studies comparing anti-VEGF therapy to PRP in PDR, the loading dose intervals were shorter, requiring patients to receive monthly loading injections, as opposed to every 6 weeks for brolucizumab in the current study. Furthermore, in the maintenance phase of the CONDOR study, patients were placed on a 12-week interval just after the loading phase, unlike previous studies that stipulated more regular monitoring or treatments,” they explained. [JAMA Ophthalmol 2018;136:1138-1148; Lancet 2017;389:2193-2203]
A total of 572 patients completed the week-54 visit.