For many patients with wet AMD, the anti-VEGF drugs have worked wonders. These medicines, which are injected into the eye, typically every month or two, include Lucentis, Eylea, and Avastin.
They are called anti-VEGF because they work by blocking the activity of vascular endothelial growth factor (VEGF), a protein that promotes blood vessel growth.
They often protect the central vision in patients who, if they had the disease 10 years ago, might have lost their vision. However, the injections are not without problems. The burden of having an injection into the eye every month is significant. My patients always want to know when longer lasting drugs will be available.
On the Horizon
Sustained Release Lucentis
Now, there are several longer lasting versions on the horizon. Genentech, the maker of Lucentis, has a sustained release system in phase II clinical trials. The study is called LADDER, and has enrolled 220 patients. The system has received “fast track” designation by the FDA, which could result in a faster approval.
The device is implanted into the eye in a relatively simple operating room procedure. Most of the device resides inside the eye, and out of view. Part of it is flush with the eye wall (the sclera). Through this portion, an ophthalmologist can refill the device, using a technique similar to the current monthly injections. The eye doctor will likely need to refill the implant every 4-6 months.
Sustained Release Eylea
Regeneron, which makes Eylea, is also developing a sustained release system, but it is not yet in clinical trials. It involves incorporating Eylea into a gel, which, after injection into the eye, releases the drug slowly.
Abicipar
Another anti-VEGF drug with the potential to have longer-lasting effects is Abicipar, developed by Allergan in partnership with Molecular Partners. This protein is similar to an antibody and appears to remain in the eye for longer periods than the other anti-VEGF medications. Phase II trials suggested the medication may only need to be injected every three months. It is now in phase III trials, with results expected in 2018.
A Class that Failed
Unfortunately, another class of drugs that looked promising in phase II trials, and held out promise for less frequent injections, has now failed phase III trials. These drugs targeted platelet derived growth factor (PDGF), which is involved in the growth of abnormal new blood vessels in wet AMD. Two different drugs, Fovista and Rinucumab were proven ineffective.
Summary
Now that VEGF has been identified as an important target for wet AMD patients, it is likely that longer-lasting anti-VEGF drugs will be available within the next few years. In addition, new molecular targets involved in abnormal blood vessel growth are being identified through research supported by NIH, BrightFocus Foundation, and others. It is likely that blocking these, in addition to VEGF, will prove more effective and less burdensome than the current anti-VEGF treatments.
Resources:
- Promising New Treatments for AMD (Audio and Transcript)
- Injections for Wet Macular Degeneration: What to Expect (Article)
- How Effective are Age-Related Macular Degeneration Treatments? (Article)
- Fovista (Article)
- Macular Degeneration: Essential Facts (Publication)
- Macular Degeneration Toolkit (Helpful Information to Understand and Manage Macular Degeneration)
- BrightFocus Chats (Audio Discussions on Macular Degeneration)
