From the editors of Review of Ophthalmology and Retina Specialist
THE LATEST PUBLISHED RESEARCH
WELCOME to Review of Ophthalmology's Retina Online newsletter. Each month, Medical Editor Philip Rosenfeld, MD, PhD, and our editors provide you with this timely and easily accessible report to keep you up to date on important information affecting the care of patients with vitreoretinal disease.
OCT Risk Factors for the Development of Late AMD in Fellow Eyes in HARBOR
Researchers analyzed the relationship between optical coherence tomography features and the progression to late age-related macular degeneration in the fellow eyes of individuals enrolled in the 24-month HARBOR study for neovascular AMD.
This post hoc analysis of a Phase III multicenter, prospective, randomized, double-masked, active treatment-controlled clinical trial included subjects (n=501) with macular neovascularization secondary to neovascular AMD, and early or intermediate AMD in the fellow eye.
Researchers reviewed volume OCT scans from 501 fellow eyes of 501 individuals with MNV. They assessed baseline OCT features, including intraretinal hypereflective foci (IHRF), hyporeflective foci (hRF) within drusenoid lesions (DLs), subretinal drusenoid deposits (SDD) and drusen volume (DV) ≥0.03 mm3. Masked graders graded OCT images at months six, 12, 18 and 24 for late AMD (defined as MNV and/or complete retinal pigment epithelium and photoreceptor atrophy [cRORA]). Researchers correlated subject demographic characteristics (age, gender, smoke exposure) and baseline OCT features with progression to late AMD. Main outcome measures included incidence of late AMD, hazard ratio for demographics and OCT risk factors. Here were some of the findings:
• At month 24, 33.13 percent (166/501) eyes developed late AMD, 20.96 percent (105/501) developed cRORA while 12.18 percent (61/501) developed MNV.
• Baseline demographic factors weren’t significantly associated with development of late AMD, while significant associations were identified for all OCT features.
• IHRF had an HR of 5.21 (CI, 3.29 to 8.26); hRF within DLs had an HR of 2.42 (CI, 1.74 to 3.38); SDDs had an HR of 1.95 (CI, 1.34 to 2.82); and DV ≥0.03 mm3 had an HR of 1.46 (CI, 1.03 to 2.07). The correlation remained statistically significant when considering progression to cRORA and MNV alone; however, DV wasn’t significantly associated with progression to MNV.
Researchers confirmed that four previously reported OCT risk factors were associated with progression to late AMD in the fellow eyes of subjects newly diagnosed with MNV. They added that, although outcomes after two years weren’t evaluated, the findings might help identify high-risk AMD patients.
Source: Nassisi M, Lei J, Abdelfattah NS, et al. Optical coherence tomography risk factors for development of late age related macular degeneration in the fellow eyes of patients enrolled in the HARBOR Study. Ophthalmology 2019; May 28. [Epub ahead of print].
Visual Acuity Outcomes After Anti-VEGF Treatment: AREDS2 Report Number 19
Researchers analyzed best-corrected visual acuity outcomes after anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration, as part of a prospective cohort study of participants enrolled in a clinical trial of oral supplements and receiving anti-VEGF therapy in routine clinical practice.
Participants included Age-Related Eye Disease Study 2 participants (50 to 85 years) whose eyes met AREDS2 inclusion criteria at baseline (no late AMD; BCVA ≥20/100; no previous anti-VEGF injections) but received at least one anti-VEGF injection for incident neovascular AMD during follow-up.
Participants underwent BCVA testing, ophthalmoscopic examination and stereoscopic color fundus photography at baseline, and annual study visits over five years. Self-reports of anti-VEGF injections (numbers, dates and names of drug) were collected at baseline and annual study visits, and at six monthly telephone calls.
The primary outcome measures were mean refracted BCVA and the proportions of eyes with BCVA ≥20/40 and ≤20/200. An exploratory outcome measure was the mean number of self-reported anti-VEGF injections.
A total of 1,105 eyes of 986 AREDS2 participants met the inclusion criteria; of these, 977 participants (99.1 percent) had at least one post-treatment visit. Here were some of the findings:
• At the first and subsequent annual study visits after the first injection, mean refracted BCVAs were 68 letters (20/40), 66.1, 64.7, 63.2 and 61.5 (20/60).
• At each annual visit, the proportions of eyes with BCVA ≥20/40 were 59.3 percent, 55.1 percent, 53.5 percent, 50.6 percent and 49.7 percent, and those with BCVA ≤20/200 were 5.5 percent, 8.6 percent, 9.4 percent, 12.4 percent and 14.4 percent.
• The mean annual numbers of self-reported anti-VEGF injections per eye were 2.9, 3.9, 3.3, 3.1 and 3.
Refracted BCVA data were obtained in a clinical trial environment but related to anti-VEGF treatment given in normal clinical practice. Researchers wrote that visual outcomes declined slowly with increased follow-up time: mean BCVA decreased by approximately 1.5 to 2 letters per year. They found that, at five years, half of eyes achieved BCVA ≥20/40, but approximately one sixth were ≤20/200. Researchers concluded that their findings might be useful in assessing the long-term effects of anti-VEGF therapy.
SOURCE: Keenan TD, Vitale S, Agrón E, et al. Visual acuity outcomes after anti-VEGF treatment for neovascular age-related macular degeneration: AREDS2 Report Number 19. Ophthalmology Retina 2019; June 11. [Epub ahead of print].
Visual Acuity Outcomes & Anti-VEGF Therapy Intensity in nAMD
Scientists assessed anti-vascular endothelial growth factor therapy intensity and its relationship with visual acuity change in “real-world” neovascular AMD patients. This retrospective analysis was performed on a large database of aggregated, longitudinal, de-identified electronic medical records from a geographically and demographically diverse sample of patients of U.S. retina specialists (Vestrum Health Retina Database).
Treatment naïve nAMD patients who underwent anti-VEGF injections between January 1, 2012, and October 31, 2016, were eligible if follow-up data was available prior to October 31, 2017. Age, gender, anti-VEGF treatment type, number of treatments and VA were extracted from the database.
The main outcome measure was mean VA change assessed at one year and stratified based on number of injections received. In this analysis 49,485 eyes were included. The mean age was 80.9 years (36 percent male, 64 percent female), with a mean baseline VA of 53.8 letters (Snellen equivalent 20/80). Here were some of the findings:
• At one year, after a mean of 7.3 injections, a mean gain was reported of one letter (0.95 letter, CI for change in VA: +0.77 to +1.13 letter, p<0.001).
• When stratified by anti-VEGF agent, mean VA changes were nearly identical at one year.
• A linear relationship existed between mean letters gained and mean number of injections between four and 10 injections over one year, after which the relationship plateaued.
• Those who received the fewest injections tended to be older and have worse baseline VA.
Scientists found that nAMD patients received fewer anti-VEGF injections and experienced worse visual outcomes compared with individuals receiving fixed, frequent therapy in randomized controlled trials. Specifically, they wrote, mean change in VA correlated with treatment intensity at one year, but with ceiling effects related to both treatment intensity and baseline VA. Scientists reported that older individuals and those with poor baseline VA might be particularly prone to undertreatment.
Source: Ciulla TA, Hussain RM, Pollack JS, et al. Visual acuity outcomes and anti-vascular endothelial growth factor therapy intensity in neovascular AMD patients: A “real world” analysis in 49,485 eyes. Ophthalmology Retina 2019; May 24. [Epub ahead of print].
Five-year Treatment Outcomes Following IVR Injections for nAMD
Researchers assessed the real-world, five-year treatment outcomes of ranibizumab therapy in Japanese patients with neovascular age-related macular degeneration as part of a retrospective, observational and open-label effectiveness study that included 295 eyes.
The participants included individuals with treatment-naïve neovascular AMD who received intravitreal ranibizumab monthly injections at least three times at the loading phase, followed by further injections pro re nata and follow-up assessments for five years. Outcomes were determined at least five years after the first ranibizumab injection. Here were some of the findings:
• Mean logMAR best-corrected visual acuity at baseline was 0.52.
• The mean BCVA significantly improved after three loading injections; however, it declined gradually.
• The BCVA at one year was significantly better than the baseline BCVA, while the three-year, four-year and five-year BCVA values were significantly lower than the baseline values.
• The average central foveal thickness improved significantly from 366 ±125 μm to 268 ±134 μm (p<0.0001).
• Macular atrophy was significantly more likely to occur in cases with classic choroidal neovascularization than in cases with other AMD (p=0.01).
Researchers concluded that IVR was well-tolerated in eyes with AMD although they noted that a PRN regimen for AMD might have limited real-world effectiveness for long-term maintenance of improved visual acuity. They added that macular atrophy might occur more frequently in classic CNV. To maintain good vision, researchers suggested that IVR treatment should be started early and performed continuously.
SOURCE: Wada I, Oshima Y, Shiose S, et al. Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients. Graefes Arch Clin Exp Ophthalmol 2019; May 22. [Epub ahead of print].
Intravitreal Ranibizumab vs. Aflibercept Following Treat-and-extend Protocol for nAMD
Investigators assessed the morphological and functional outcome and stability of the treat-and-extend protocol using aflibercept compared with ranibizumab for the treatment of eyes with neovascular age-related macular degeneration.
The retrospective study included 100 eyes of 94 individuals with primary onset neovascular age-related macular degeneration, followed up for 12 months. Investigators studied two groups of eyes: group one: 50 eyes treated with 0.5 mg/0.05 mL ranibizumab; and group two, 50 eyes treated with 2 mg/0.05 mL aflibercept. During the first year, all eyes received three aflibercept or ranibizumab injections monthly as the upload phase. Then eyes were treated with a treat-and-extend algorithm.
The main outcome measures included best-corrected visual acuity, central macular thickness and the number of injections. In addition, investigators compared recurrence rates between the two groups. Here were some of the findings:
• BCVA (log MAR) was 0.54 ±0.31 in group one vs. 0.49 ±0.30 in group two (p=0.38) before treatment and 0.49 ±0.33 in group one vs. 0.47 ±0.32 in group two (p=0.85) after treatment.
• The visual improvement (decimal) was 0.05 ±0.13 in group one vs. 0.04 ±0.12 in group two (p=0.91).
• The CMT was 375.6 ±98.3 μm in group one vs. 369.6 ±103.7 μm in group two (p=0.73) before treatment and 306.3 ±71.8 μm in group one vs. 294.8 ± 96 μm in group two (p=0.54) after treatment.
• The decrease in CMT was 69.3 ±93 μm in group one vs. 74.8 ±96 μm in group two (p=0.77).
• The number of injections/eye after upload phase was 5.88 ±1.4 in group one vs. 6.16 ±1.3 in group two (p=0.25).
• Finally, major recurrence rates were statistically significantly different between group one (2 percent) vs. group two (6 percent)(p=0.04).
Investigators concluded that significant differences regarding BCVA, CMT and number of injections weren’t found between aflibercept and ranibizumab during the first year following the treat-and-extend protocol. However, they wrote that the significantly higher major recurrence rates in the aflibercept group after extending the treatment interval to 10 weeks might indicate that aflibercept shouldn’t be used in longer than eight-week intervals during the first year of treatment.
SOURCE: Abdin AD, Suffo S, Asi F, et al. Intravitreal ranibizumab versus aflibercept following treat and extend protocol for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2019; May 29. [Epub ahead of print
Changes in OCTA and Disease Activity in Type 3 Neovascularization After Anti-VEGF
Scientists evaluated disease activity in individuals with type 3 neovascularization undergoing anti-vascular endothelial growth factor treatment through image analysis using optical coherence tomography angiography.
Thirty-nine treatment-naive eyes with type 3 neovascularization were included in the retrospective analysis. All individuals were treated with three loading injections of an anti-VEGF agent, followed by further injections as needed. Changes in the type 3 lesion were analyzed through OCTA imaging during 12 months of follow-up. Here were some of the findings:
• The high-flow signal of type 3 neovascularization on OCTA images disappeared in 46.2 percent of eyes (19 of 39) and was persistent in 53.8 percent of eyes (20 of 39) after loading injections.
• A persistent high-flow signal on OCTA after treatment was found at the subretinal pigment epithelium in 65 percent of eyes (13 of 20), deep vascular plexus in 30 percent of eyes (six of 20), and outer neurosensory retina in 15 percent of eyes (three of 20).
• Eyes without lesions on OCTA images received significantly fewer injections (3.7 vs. 5.5; p=0.016) and showed a longer retreatment-free period (mean 7.57 vs. 4.07 months; p=0.002) during the 12-month follow-up than eyes with a persistent high-flow signal on OCTA.
• However, no significant between-group differences were observed in terms of improved visual acuity.
Scientists wrote that individuals with type 3 neovascularization who had no lesions on an OCTA scan after anti-VEGF treatment showed a lower recurrence rate and maintained visual acuity with fewer injections than those with persistent high-flow lesions on an OCTA scan. They wrote that OCTA might provide an additional biomarker for clinical guidance in the treatment and monitoring of disease activity in type 3 neovascularization.
SOURCE: Han JW, Cho HJ, Kang DH, et al. Changes in optical coherence tomography angiography and disease activity in type 3 neovascularization after anti-vascular endothelial growth factor treatment. Retina 2019; May 14. [Epub ahead of print].
Macular Vessel Density Before & After Anti-VEGF Therapy in DR
Investigators evaluated changes in macular vessel density following intravitreal anti-VEGF injection in individuals with diabetic macular edema and proliferative diabetic retinopathy in a retrospective case series.
Optical coherence tomography angiography images from 55 eyes of 35 individuals with either DME (46 eyes) or PDR (nine eyes) were included. Investigators calculated macular capillary vessel density at the level of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) and total retinal capillary plexus (TCP), before and after anti-VEGF treatment. They analyzed longitudinal changes in vessel density following serial anti-VEGF treatment in a subset of eyes. Here were some of the findings:
• Vessel density in the SCP, DCP and TCP wasn’t found to be significantly different after one, two or three intravitreal injections (p>0.05 for all time points).
• Subgroup analyses revealed no significant changes in DME or PDR subgroups (all p>0.05).
• Multivariate analyses revealed no effect on VD measurements of injected anti-VEGF agent type or presence of previous treatment (all p>0.05).
• No correlation was found between the anatomic response of DME to treatment or VD measurements.
Investigators determined that macular vessel density remained statistically unchanged following up to three intravitreal injections of any of the anti-VEGF agents. They wrote that this finding indicated that there might not be an early effect of anti-VEGF treatment on macular vessel density and that anti-VEGF treatment’s effect on macular perfusion might not be directly related to a change in microvascular flow.
SOURCE: Sorour OA, Sabrosa AS, Yasin Alibhai A, et al. Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy. Int Ophthalmol 2019; May 22. [Epub ahead of print].
Improved Blood Flow on OCTA After Panretinal Photocoagulation for PDR
Researchers evaluated macular microvascular changes in eyes with proliferative diabetic retinopathy following panretinal photocoagulation. Using optical coherence tomography angiography, researchers prospectively studied 10 eyes of 10 subjects with high risk PDR immediately before, one month, and three to six months following PRP, using a 3 x 3 mm OCTA scan at each visit.
The following parameters were calculated for the superficial, middle (MCP) and deep capillary plexuses (DCP): parafoveal vessel density; adjusted flow index (AFI); and percent area of non-perfusion (PAN). Researchers also evaluated parafoveal SCP vessel length density. They performed univariate and multivariable statistics, adjusting for age and signal strength. To model the hemodynamic effect of PRP, they also presented a mathematical model based on electrical circuits. Here were some of the findings:
• No significant difference was detected for the vascular density parameters following PRP, except for decreased density at the MCP at the latest time point in the adjusted multivariable model.
• PAN, a metric of non-perfusion adjusted for noise, as well as AFI, a surrogate metric of blood flow, showed significant increase at all capillary levels in the adjusted model.
• The mathematical model explained how PRP would increase macular blood flow.
Researchers wrote that, using OCTA, they found an overall increase in the flow metrics of all capillary layers in the macula following PRP, unrelated to macular edema or thickening, and in line with the mathematical model.
SOURCE: Fawzi AA, Fayed AE, Linsenmeier RA, et al. Improved macular capillary flow on optical coherence tomography angiography after panretinal photocoagulation for proliferative diabetic retinopathy. Am J Ophthalmol 2019; May 9. [Epub ahead of print].
Predictive Genes for the Prognosis of CSC
Investigators evaluated potential genetic prognostic factors associated with spontaneous resolution of serous retinal detachment and development of choroidal neovascularization in central serous chorioretinopathy, as part of a retrospective analysis of a case series.
A total of 196 eyes from 196 individuals with active CSC were included. Investigators retrospectively reviewed medical records, and determined the presence or absence of SRD using optical coherence tomographic imaging. They analyzed the duration until the spontaneous SRD resolution by using the Kaplan-Meier method. And they evaluated associations between the duration to spontaneous resolution and CFH I62V, ARMS2 A69S or VIPR2 rs3793217 genotypes, and assessed associations with CNV that developed secondary to CSC.
In 105 of the 196 study participants, investigators revealed spontaneous SRD resolution in eyes during follow-up evaluation. Sixty-eight eyes received treatment, and 23 eyes dropped out before spontaneous SRD resolution. Here were some of the findings:
• Among the three genetic polymorphisms assessed, only CFH I62V was predictive of spontaneous SRD resolution among its genotypes (p=0.017).
• The average duration for the spontaneous SRD resolution was: for individuals with the AA genotype, 126.6 ±115.5 days; for those with the AG genotype, 157.7 ±243.1 days; and for those with the GG genotype, 242.7 ±198 days, indicating that the G allele was associated with significantly longer persistent SRD (p=0.035).
• Among all eyes participating, 14 developed CNV by follow-up evaluations.
• The CFH I62V G allele (p=0.0023) and ARMS2 A69S T allele (p=0.019) were significantly associated with CNV development, while VIPR2 rs3793217 wasn’t.
Investigators concluded that CFH I62V and ARMS2 A69S genotypes could predict the prognosis of CSC. They wrote that awareness of genetic status might help physicians determine the need for early treatment and possibly prevent subsequent CNV development. However, investigators suggested that further prospective studies would be needed to confirm the observed genotype-phenotype relationship.
SOURCE: Hosoda Y, Yamashiro K, Miyake M, et al. Predictive genes for the prognosis of central serous chorioretinopathy. Ophthalmology Retina 2019; May 31. [Epub ahead of print].
Findings in a Large Cohort of Chinese Patients with Suspected RP
Researchers characterized the genetic landscape of individuals with suspected retinitis pigmentosa in the Chinese population, as part of a cohort study. A total of 1,243 individuals of Chinese origin with clinically suspected RP and their available family members (n=2,701) were recruited.
All individuals and available family members were screened using multigene panel testing (including 586 eye disease-associated genes), followed by clinical variant interpretation.
Main outcome measures included diagnostic yield, the 17 most commonly implicated genes, age at onset, de novo mutations and clinical usefulness of genetic testing.
Overall, 72.08 percent of individuals received a molecular diagnosis, and the 17 top genes covered 75.63 percent of diagnostic cases. Here were some of the findings:
• Diagnostic yield was higher among individuals in the early-onset subgroup (≤5 years old, 79.58 percent) than in the childhood or adolescence-onset subgroup (6 to 16 years old, 73.74 percent) and late-onset subgroup (≥17 years old, 65.99 percent).
• Moreover, different genes were associated with different onset ages, and subgroups with different onset ages showed a diverse mutation spectrum.
• Only 11 de novo mutations (3.18 percent) were identified.
• Furthermore, 16.84 percent of individuals who received a molecular diagnosis had refinement of the initial clinical diagnoses, and the remaining 83.16 percent received definite genetic subtypes of RP.
Researchers wrote that genetic testing improved the chance to establish a precise diagnosis, identified features not previously determined and enabled a more accurate refinement of the risk to family members. They added that their results not only expanded the existing genotypic spectrum, but also served as an efficient reference for the design of panel-based genetic diagnostic testing and genetic counseling for individuals with suspected RP in China.
Source: Gao FJ, Li JK, Chen H, et al. Genetic and clinical findings in a large cohort of Chinese patients with suspected retinitis pigmentosa. Ophthalmology 2019; May 1. [Epub ahead of print].
ALLEGRO PHASE II STUDY EVALUATING RISUTEGANIB MEETS PRIMARY ENDPOINT
Allegro Ophthalmics announced that its prospective, double-masked, placebo-controlled Phase II study of risuteganib (Luminate) for the treatment of intermediate non-exudative age-related macular degeneration met its primary endpoint, with 48 percent of patients in the risuteganib arm (two injections) gaining ≥8 letters of vision at week 28 compared with baseline (one sham treatment). Read more.
SOURCE: Allegro Ophthalmics, June 2019
REGENXBIO COMPLETES DOSING FOR PHASE I/IIA RGX-314 TRIAL
Regenxbio completed dosing across all five cohorts in the Phase I/IIa clinical trial of RGX-314 for the treatment of wet age-related macular degeneration. The trial is designed to evaluate the safety and tolerability of RGX-314 as a one-time therapy for individuals with wet AMD who were previously treated with anti-vascular endothelial growth factor injections. Regenxbio is planning to initiate a Phase IIb trial in wet AMD by the end of 2019 based on the Phase I/IIa trial data and file an Investigational New Drug application for the use of the drug in diabetic retinopathy in the second half of 2019. Read more.
Source: Regenxbio, May 2019
Adverum Doses First Patient in Second Cohort of OPTIC Trial
Adverum Biotechnologies announced that the first patient was dosed in the second cohort of the ongoing OPTIC Phase I clinical trial for ADVM-022 for the treatment of wet age-related macular degeneration. Patients are receiving a single intravitreal injection of gene therapy candidate ADVM-022 at a dose of 2 x 1011 vg/eye. Read more.
Adverum Biotechnologies, June 2019
PING AN COMPLETES TRIALS FOR RETINAL DISEASE SCREENING SYSTEM
Ping An Insurance Company of China announced that its technology arm completed a prospective, multicenter clinical trial for what it deems the world's first intelligent optical coherence tomography retinal disease screening system that integrates an OCT with artificial intelligence lesion detection software. The system will be jointly developed with Optovue. Read more.
SOURCE: Ping An Technology, May 2019
OptiKira Awarded Phase II SBIR Grant
OptiKira, a biotechnology company developing drugs that inhibit the unfolded protein response, was awarded a Phase II Small Business Innovation Research grant to support continued development of a therapy that has the potential to preserve vision in patients with retinitis pigmentosa. The $1.6M grant will be used to advance one or more of OptiKira’s most promising compounds into investigational new drug-enabling studies. Read more.
SOURCE: BioMotiv, May 2019
Outlook Signs Manufacturing Supply Agreement with Fujifilm Diosynth
Outlook Therapeutics, a biopharmaceutical company focused on developing ONS-5010, a proprietary ophthalmic bevacizumab product candidate for the treatment of wet age-related macular degeneration and other retinal diseases, announced that it has signed a services agreement with Fujifilm Diosynth Biotechnologies for the production of ONS-5010. Under the terms of this agreement, FDB will provide global manufacturing of ONS-5010 to Outlook in support of the commercialization strategy for the drug. Additional terms of the agreement weren’t disclosed. Read more.
SOURCE: Fujifilm Diosynth Biotechnologies, June 2019
Northwestern Grad Students Get Top Prize for ROP Screening Technology
Startup company Presight, founded in 2018 with the goal of creating a safer method to screen infants for retinopathy of prematurity using an infant’s tears, took first prize and $30,000 at VentureCat, an annual student startup competition at Northwestern University. The company says that the tear method offers a harmless alternative to current ROP eye-prying exams, and allows nurses to use a VEGF protein found in natural tears to perform the screenings bedside. Company founders Rosemary Fuller and Simon Yin, graduate students at Northwestern’s Kellogg School of Management, said the $30,000 will go toward a bench study for their proprietary tear-gathering method in advance of FDA clinical trials. Read more.
Source: The Daily Northwestern, May 2019
REVENIO (ICARE) TO ACQUIRE CENTERVUE
The Revenio Group signed an agreement to purchase CenterVue, a global supplier of ophthalmic devices. Revenio says CenterVue’s retinal imaging innovations will enable its product portfolio to expand beyond glaucoma into retinal diseases such as diabetic retinopathy and age-related macular degeneration. Read more.
SOURCE: The Revenio Group, April 2019
AbbVie to Acquire Allergan
AbbVie and Allergan announced that the companies have entered into a definitive transaction agreement under which AbbVie will acquire Allergan in a cash and stock transaction for a transaction equity value of approximately $63 billion, based on the closing price of AbbVie's common stock of $78.45 on June 24, 2019. AbbVie describes the deal as a "transformational transaction for both companies" that "achieves unique and complementary strategic objectives." Read more.
SOURCE: PR Newswire, June 2019
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