KESTREL and KITE: 52-Week Results From Two Phase III Pivotal Trials of Brolucizumab for Diabetic Macular Edema

David M. Brown, Andrés Emanuelli, Francesco Bandello, Jose Juan Escobar Barranco, João Figueira, Eric Souied, Sebastian Wolf, Vishali Gupta, Nor Fariza Ngah, Gerald Liew, Raman Tuli, Ramin Tadayoni, Dilsher Dhoot, Lixin Wang, Emmanuel Bouillaud, Ying Wang, Lidija Kovacic, Nicolas Guerard, Justus G. Garweg

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Purpose: To compare the efficacy and safety of brolucizumab with aflibercept in patients with diabetic macular edema (DME). Design: Double-masked, 100-week, multicenter, active-controlled, randomized trials. Methods: Subjects were randomized 1:1:1 to brolucizumab 3 mg/6 mg or aflibercept 2 mg in KESTREL (n = 566) or 1:1 to brolucizumab 6 mg or aflibercept 2 mg in KITE (n = 360). Brolucizumab groups received 5 loading doses every 6 weeks (q6w) followed by 12-week (q12w) dosing, with optional adjustment to every 8 weeks (q8w) if disease activity was identified at predefined assessment visits; aflibercept groups received 5 doses every 4 weeks (q4w) followed by fixed q8w dosing. The primary endpoint was best-corrected visual acuity (BCVA) change from baseline at Week 52; secondary endpoints included the proportion of subjects maintained on q12w dosing, change in Diabetic Retinopathy Severity Scale score, and anatomical and safety outcomes. Results: At Week 52, brolucizumab 6 mg was noninferior (NI margin 4 letters) to aflibercept in mean change in BCVA from baseline (KESTREL: +9.2 letters vs +10.5 letters; KITE: +10.6 letters vs +9.4 letters; P < .001), more subjects achieved central subfield thickness (CSFT) <280 µm, and fewer had persisting subretinal and/or intraretinal fluid vs aflibercept, with more than half of brolucizumab 6 mg subjects maintained on q12w dosing after loading. In KITE, brolucizumab 6 mg showed superior improvements in change of CSFT from baseline over Week 40 to Week 52 vs aflibercept (P = .001). The incidence of ocular serious adverse events was 3.7% (brolucizumab 3 mg), 1.1% (brolucizumab 6 mg), and 2.1% (aflibercept) in KESTREL; and 2.2% (brolucizumab 6 mg) and 1.7% (aflibercept) in KITE. Conclusion: Brolucizumab 6 mg showed robust visual gains and anatomical improvements with an overall favorable benefit/risk profile in patients with DME.

Original languageEnglish (US)
Pages (from-to)157-172
Number of pages16
JournalAmerican Journal of Ophthalmology
StatePublished - Jun 2022

ASJC Scopus subject areas

  • Ophthalmology


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