
Episode #32
Breaking News: Kodiak's DAYBREAK Hits β Zenkuda and Tabirafusp-ted Both Positive
Breaking news: Kodiak Sciences announced this morning that both Zenkuda (tarcocimab tedromer) and tabirafusp-ted (KSI-501, tabirafusp alfa tedromer) met their primary endpoints in the Phase 3 DAYBREAK study in wet AMD β non-inferiority in vision gains vs. aflibercept at 1 year. Kodiak plans a Q4 2026 BLA filing for Zenkuda, covering five positive Phase 3 studies across wet AMD, diabetic retinopathy, and RVO. John Kitchens, MD, and Scott Krzywonos break down what makes DAYBREAK's design unusual, why Kodiak's comeback from the KSI-301 miss matters, what 54% of patients on 6-month dosing actually means in a real-world context, and what the tabirafusp-ted data suggest about where IL-6 inhibition fits in retina. Detailed results will be presented at AAO Subspecialty Day by Charles C. Wykoff, MD, PhD, on Friday, October 9, at 4:40 PM local time, New Orleans. Hosts: John Kitchens, MD, Scott Krzywonos Topics Covered DAYBREAK: What the Data Show Study design: Phase 3; treatment-naive wet AMD patients only; three arms β Zenkuda (four monthly loading doses, then PRN based on zero-fluid-tolerance retreatment criteria based on AI volumetric data), tabirafusp-ted (four monthly loading doses, then every-other-month proactively with monthly dosing if needed), and aflibercept 2mg (three monthly loading doses, then every eight weeks); primary endpoint: mean BCVA change from weeks 40 to 48. Zenkuda primary endpoint: met (p=0.0007). Vision gains: 7.2 letters (Zenkuda) vs. 7.6 letters (aflibercept). Central subfield thickness reduction: approximately 135 Β΅m in both arms. Durability: 54% of Zenkuda patients reached 6-month dosing at year 1; 62% reached at least 5 months. Tabirafusp-ted primary endpoint: also met (p=0.0036). Anatomical key secondary endpoint also met (p Safety: Zenkuda showed 0% intraocular inflammation and a 0.5% cataract adverse event rate (vs. 0.9% for aflibercept). Tabirafusp-ted showed 0% cataract adverse events. What Makes This Design Different Zero-fluid-tolerance retreatment criteria: most trials allow some residual fluid in pursuit of extended intervals. DAYBREAK allowed none β any fluid on AI volumetric analysis triggered retreatment. This is closer to how most retina specialists actually treat in clinic, which may narrow the gap between trial outcomes and real-world results. AI-assisted retreatment: Kodiak used an AI volumetric fluid tool assessing the central 3 mm of the OCT to determine retreatment eligibility. The combination of strict criteria and a 20-day half-life for Zenkuda is what may drive the durability signal. Previously treated patients: DAYBREAK enrolled treatment-naive patients only. The companion ALTO Phase 3 study will assess both treatment-naive and previously treated patients with tabirafusp-ted in DME, actively enrolling now. Kodiak's Comeback from KSI-301 KSI-301, Kodiak's prior ABC-platform agent, missed its primary endpoint. Kodiak modified the approach with Zenkuda, allowing some free drug alongside the conjugated biopolymer to produce immediate effect on loading, then relying on the conjugated drug for durability. The ~20-day intravitreal half-life of Zenkuda exceeds what is seen with conventional anti-VEGF agents. What the Tabirafusp-ted Data Mean for IL-6 No additional vision gains with tabirafusp-ted vs. aflibercept despite monthly/bimonthly dosing. John's read: IL-6 may not add meaningful benefit in treatment-naive wet AMD. Better indications likely exist: uveitic macular edema and DME (where vascular leakage and inflammation are more tightly linked). Post-hoc analyses to identify wet AMD subgroups that might benefit are planned. What's Next Zenkuda BLA: Q4 2026 filing, covering five positive Phase 3 studies across wet AMD, diabetic retinopathy, and RVO. ALTO: Phase 3 study of tabirafusp-ted in DME; enrolling now; includes both treatment-naive and previously treated patients. Full data presentation: Charles C. Wykoff, MD, PhD, presents DAYBREAK results at AAO Subspecialty Day, Friday, October 9, 4:40 PM, New Orleans. Key Takeaways Both Zenkuda and tabirafusp-ted met their primary endpoints in DAYBREAK β Kodiak's comeback from the KSI-301 miss is complete, at least clinically. 54% of Zenkuda patients on 6-month dosing under zero-fluid-tolerance criteria is a meaningful durability signal, and the strict retreatment protocol makes these results more directly comparable to real-world practice than most trials. Tabirafusp-ted's vision data in wet AMD don't support IL-6 as a meaningful add-on in treatment-naive patients; DME and uveitic macular edema remain the more compelling targets. Kodiak plans a Q4 2026 BLA filing for Zenkuda across three indications. If approved, this would be an important new mechanism in wet AMD. Credits Production & Marketing: Laura Brown | Business Operations: Liz Hogan Listen at RetinUp.com | Apple Podcasts | Spotify | YouTube





