The role of future treatments in the management of neovascular age-related macular degeneration in Europe

Anti-vascular endothelial growth factor (VEGF) agents have transformed the management of patients with neovascular age-related macular degeneration (nAMD) over the past two decades. However, as more long-term real-world data become available, it is clear that treatment outcomes are inferior to those reported in large, controlled clinical trials. This is largely driven by undertreatment, that is, not maintaining a consistent injection frequency to achieve sustained VEGF suppression, whether due to patient non-compliance, an important injection burden, or non/incomplete anatomical response. Newer therapeutic advances under evaluation hold promise in achieving more, for less. We review the latest drugs currently in or having successfully finished phase III clinical trials, and determine their potential place in the management of patients with nAMD in Europe.

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Treatments for dry age-related macular degeneration: therapeutic avenues, clinical trials and future directions

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318452 ◽

2021 ◽

pp. bjophthalmol-2020-318452

Author(s):

Thales Antonio Cabral de Guimaraes ◽

Malena Daich Varela ◽

Michalis Georgiou ◽

Michel Michaelides

Keyword(s):

Clinical Trials ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Vascular Endothelial ◽

Age Related ◽

Wide Variability ◽

Dry Amd ◽

Early Phase Clinical Trials ◽

Endothelial Growth Factor ◽

Developed World

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed world. The identification of the central role of vascular endothelial growth factor (VEGF) in the pathogenesis of neovascular AMD and the introduction of anti-VEGF agents as gold-standard treatment, have drastically changed its prognosis—something yet to be seen in dry AMD. Several therapeutic avenues with a wide variability of targets are currently being investigated in dry AMD. The approaches being investigated to reduce the rate of disease progression include, (1) drugs with antioxidative properties, (2) inhibitors of the complement cascade, (3) neuroprotective agents, (4) visual cycle inhibitors, (5) gene therapy and (6) cell-based therapies. A number of early phase clinical trials have provided promising results, with many more ongoing and anticipated in the near future. In this review, we aim to provide an update of the interventional trials to date and future prospects for the treatment of dry AMD.

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Treat and Extend Dosing Regimen with Anti-vascular Endothelial Growth Factor Agents for Neovascular Age-related Macular Degeneration

American Journal of Ophthalmic Clinical Trials ◽

10.25259/ajoct-2-2018 ◽

2018 ◽

Vol 1 ◽

pp. 1 ◽

Cited By ~ 5

Author(s):

Karen M. Wai ◽

Rishi P. Singh

Keyword(s):

Vascular Endothelial Growth Factor ◽

Clinical Trials ◽

Growth Factor ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Vascular Endothelial ◽

Dosing Regimen ◽

Anti Vegf ◽

Age Related ◽

Endothelial Growth Factor

Anti-vascular endothelial growth factor (anti-VEGF) agents are the mainstay of therapy for treatment of neovascular age-related macular degeneration (nvAMD), one of the leading causes of blindness in the developed world. There have been a variety of different treatment regimens that have been examined for the administration of anti-VEGF therapies, including continuous fixed dosing, pro re nata administration, and treat and extend (TAE) protocols. There is no clear consensus on which dosing regimen optimizes visual and anatomical outcomes while accounting for factors such as cost and patient burden. Based on recent surveys in 2014 and 2017 by the American Society of Retina Specialists (ASRS), the majority of ophthalmology providers are utilizing TAE protocol for anti-VEGF dosing for the management of nvAMD. Although there are a number of clinical trials that have examined TAE dosing, the ALTAIR study is the first, large, prospective randomized controlled trial to compare two different TAE protocols utilizing the anti-VEGF agent aflibercept for nvAMD. The ALTAIR study, in conjunction with other previous clinical trials, suggests that TAE protocol with aflibercept is an effective anti-VEGF dosing regimen for patients with nvAMD as it produces good visual gains and minimizes cost and burden for the patient.

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