Age-related macular degeneration (AMD), which causes vision loss over time, typically presents as dry AMD where tiny protein deposits known as drusen accumulate gradually to cause central vision loss over time. But a small minority suffer more serious wet AMD where abnormal blood vessels grow and leak fluids leading to severe vision loss.

1. Pegcetacoplan

Pegcetacoplan, a targeted C3 therapy, helps slow geographic atrophy (GA) progression in age-related macular degeneration (AMD), the leading cause of irreversible blindness among seniors. This treatment works by inhibiting complement cascade activity which normally triggers inflammation and tissue damage within the body. Two phase 3 trials OAKS and DERBY demonstrated monthly or every other month injections of pegcetacoplan reduced GA lesion growth by about 30% when administered to nonexudative dry AMD patients compared to placebo; additionally this therapy was associated with increases in lower limb visual acuity but these changes were not statistically significant.

However, pegcetacoplan proved more effective at decreasing GA lesion growth than visual function effects and was well tolerated by physicians; nonetheless, its lack of functional benefits led some survey respondents to indicate they do not intend to add pegcetacoplan to their practice.

Interviews with KOLs reveal that many physicians are still seeking therapies that improve vision and prevent blindness in GA patients. Though current therapies such as pegcetacoplan and avacincaptad pegol are effective, physicians prefer treatments which offer more immediate benefit by slowing or stopping disease progression.

Alkeus Pharmaceuticals and Belite Bio are currently researching drugs to halt the progression of GA. Alkeus’ orally administered ALK-001 and LBS-008 as well as Novartis AREDS2-IVA, Genentech ARGOS-201, and Astellas ASK-231 provide temporary relief; however, KOLs indicated the need for permanent solutions that halt disease progression over time.

Current treatments for GA include Avacincaptad Pegol and Pegcetacoplan, but only 39% and 22% of patients, respectively, reported as receiving these prescriptions prior to FDA approval respectively. To meet demand from clinicians for an intravitreal pegcetacoplan solution to treat GA, an amendment has been accepted with a Prescription Drug User Fee Act goal date set for February 26th 2023 – fast track and orphan drug designations being received simultaneously by its manufacturer.

2. Vabysmo

Vabysmo is an eye drop to treat macular degeneration by relieving any fluid accumulation caused by macular degeneration. This therapy also helps protect vision by blocking the action of vascular endothelial growth factor (VEGF) and angiopoietin-2 proteins that stimulate blood vessel expansion leading to macular edema.

Vabysmo became the first bispecific monoclonal antibody approved to treat wet age-related macular degeneration (wet nAMD) and diabetic macular edema (DME), when it received approval by the U.S. Food and Drug Administration in January 2022. As the only VEGF inhibitor that also blocks Ang-2, it addresses both pathways involved in developing wet nAMD/DME while stabilising retinal blood vessels to preserve vision.

Vabysmo performed as expected in both of its Phase III studies – BALATON and COMINO – by producing early and sustained improvement of visual acuity that met its primary endpoint of non-inferiority to Aflibercept (avg vision gain at 24 weeks) as well as maintaining its safety profile consistent with previous trials.

Vabysmo, a treatment for macular degeneration that blocks vascular endothelial grow factor (VEGF) and angiopoietin-2 action to improve quality of life for those living with wet macular degeneration, was granted marketing authorisation by the European Commission this week. This treatment seeks to decrease eye injection frequency while simultaneously decreasing impactful disease-related activities and vision outcomes by stabilising blood vessels within macula regions while decreasing macular edema; its administration should occur once every four months by trained clinicians; prior authorization should be obtained before taking this medication.

3. Susvimo

Susvimo from Genentech/Roche is the first drug-eluting implant approved to directly deliver anti-VEGF therapy directly into retina, offering direct anti-VEGF treatment to treat neovascular wet macular degeneration in patients who have responded well to two monthly anti-VEGF injections. This one-time procedure, previously referred to as port delivery system (PDS), allows anti-VEGF medication directly into patients’ retinas before needing refilling every six months.

Clinical trials conducted to test this treatment showed it to be as effective as monthly intravitreal injections in improving vision and slowing progression of wet AMD (in which leaky blood vessels form and spread into the macula), though its rate of side effects was higher – particularly endophthalmitis rates; its manufacturer subsequently revised their device in order to minimize septum dislodgement rates. As a result, new implants have temporarily been suspended pending refill-exchange procedures taking place simultaneously.

Susvimo may soon be on its way, but is currently unavailable to all patients. At an initial patient consultation, a retina specialist will evaluate whether Susvimo would meet an individual patient’s individual needs and lifestyle preferences; Susvimo may be particularly appealing for people who cannot travel long distances for monthly injections or who wish to reduce doctor visits per year.

Susvimo, an FDA-approved ranibizumab injection, offers several key advantages over its predecessor Lucentis. An ocular implant inserted during one surgery and filled every month for six months thereafter with 100mg/mL ranibizumab was found as effective at improving vision and slowing wet AMD progression as monthly injections; clinical trials demonstrated this method was approximately half as long between treatments than monthly injections.

Archway study participants living with wet age-related macular degeneration who were receiving anti-VEGF injections saw results similar to monthly intravitreal injections of ranibizumab for preventing vision loss over time and was associated with lower incidence of endophthalmitis than standard injectable VEGF inhibitors. Roche continues to assess its safety while conducting other trials – such as Velodrome which involves refilling Susvimo every nine months instead of every six – including Velodrome which uses Susvimo refilling frequency instead.

4. EURETINA

Retinal and choroidal vascular diseases cause significant vision loss among adults worldwide, creating a substantial burden for both patients and healthcare systems. Antivascular endothelial growth factor (anti-VEGF) intravitreal injections have long been the go-to treatment option for both neovascular age-related macular degeneration (nvAMD, or “wet” AMD), as well as diabetic macular edema (DME), but poor adherence due to high medication dosage and frequency can result in suboptimal visual outcomes in real world as compared with clinical trial results. New treatments targeting expanded therapeutic targets with longer delivery mechanisms are being researched to improve treatment burden.

Join us September 10-12th 2021 for this interactive virtual congress hosted by world-renowned retina specialists as we present International Symposia, Instructional Courses and Free Papers – all accessible from your own home or office! We welcome everyone who’s interested.

Tibor Lohmann, MD and colleagues conducted a retrospective study involving 63 eyes with persistent full-thick macular holes after primary pars plana vitrectomy with internal limiting membrane peeling followed by secondary surgery using heavy silicone oil tamponade to close it.2 Their researchers discovered that preoperative best-corrected visual acuity (BCVA) and minimum linear diameter on spectral-domain optical coherence tomography (SD-OCT) imaging were good predictors of anatomic success.

Unfortunately, that has changed considerably over time and now everyone who visits should know this: the aim is not purely aesthetic but functional as well. The AZURE study is a multicenter, randomized, open-label phase IIIb noninferiority trial designed to examine the efficacy and safety of intravitreal Aflibercept treatment at variable intervals for up to 76 weeks in those diagnosed with Neovascular Age Related Macular Degeneration (nvAMD) with treatment-nave DME. Oxurion funded and conducted the research at 27 sites in 16 countries. Optomap was used for image capture and grading of central subfield thickness (CST), vascular leakage, and macular capillary leakage. Plasma THR-687 levels were determined using liquid chromatography-tandem mass spectrometry method. Oxurion NV has developed THR-687 as an anti-VEGF agent; they are currently conducting a randomized clinical trial to assess its effectiveness at treating DME in patients receiving IVT-AFL therapy.