Several new drugs approved this year usher in an unprecedented era in ophthalmic therapy, providing patients with more treatments that improve patient outcomes and offer more options to choose from.

Susvimo (ranibizumab implant) offers wet age-related macular degeneration patients an effective one-time procedure that reduces their need for frequent anti-VEGF injections in order to maintain vision.

Vabysmo

Vabysmo is a bispecific antibody designed to block two disease pathways associated with retinal diseases that threaten vision. The antibody blocks vascular endothelial growth factor and neutralizes angiopoietin-2 – both known to contribute to fluid leakage and inflammation – so as to extend treatment sessions and decrease injection frequency; its administration should occur monthly intravitreal injection for maximum effectiveness and improved visual acuity compared with current treatments for wet age-related macular degeneration and diabetic macular edema respectively.

Vabysmo may lengthen the period between treatments compared with anti-VEGF injections such as Aflibercept and Ranibizumab that are currently recommended by NICE for treating wet age-related macular degeneration, while also targeting both angiopoietin-2 protein which may contribute to fluid leakage as part of wet AMD/DME treatment, plus it has reduced risks of serious side effects.

Roche’s faricimab-svoa (Vabysmo) received its initial FDA approvals for use in treating wet or neovascular age-related macular degeneration and diabetic retinopathy with macular edema in January 2022. As the first-in-class biologic therapy that targets and inhibits both VEGF and angiopoietin-2 signaling pathways that contribute to wet AMD/DME, Vabysmo represents an exciting new horizon for treatment of both conditions.

The FDA granted Vabysmo an accelerated approval based on results from phase 3 BALATON and COMINO trials, which demonstrated its early and sustained improvement compared with aflibercept in people living with RVO. A final decision from the FDA will likely come out by early 2023; Vabysmo may then become available in the US under an expanded label covering wet RVO as well as new/existing indications for nAMD and DME.

Susvimo

There’s nothing quite so heartwarming as walking into an unfamiliar building and witnessing all those little eyes gazing back up at you in admiration and delight! So here it comes – enjoy! Genentech was granted approval to use its port-delivery system with ranibizumab, now known as Susvimo, intravitreally via an eye implant to treat wet age-related macular degeneration that had failed to respond to two anti-vascular endothelial growth factor (anti-VEGF) injections. Susvimo provides continuous administration of ranibizumab to provide patients living with wet AMD with an alternative to monthly eye injections. The implant can be surgically placed into one eye during an outpatient procedure and then replenished every six months as part of ongoing maintenance treatment. Archway Study primary analysis demonstrated that wet AMD patients who received Susvimo eye injections every six months achieved and maintained similar vision gains to those achieved with monthly ranibizumab eye injections; only 1.6% required additional ranibizumab treatment before their scheduled refill at six months.

Ranibizumab is a VEGF inhibitor that inhibits a specific protein involved in blood vessel formation and leakiness. As such, it serves as second-line treatment for wet age-related macular degeneration, caused by abnormal growth of blood vessels within the macula which lead to loss of vision.

Aflibercept, another anti-VEGF drug approved by the FDA to treat wet AMD, can be administered via subcutaneous or intravitreal injection. As a monoclonal antibody that binds and blocks VEGF’s action – responsible for creating new blood vessels as well as growth of leaky ones – Aflibercept can be given via subcutaneous or intravitreal injection for maximum effectiveness.

However, it remains uncertain whether aflibercept can effectively compete with Susvimo for wet AMD treatments. Patients already receiving Susvimo treatments may be reluctant to switch from twice-yearly injections to monthly ones and switch treatments accordingly.

Brolucizumab

Anti-vascular endothelial growth factor (anti-VEGF) therapy is an essential therapy for wet age-related macular degeneration (wet AMD) and diabetic macular edema (DME). Anti-VEGF therapies have been proven to improve visual outcomes while helping preserve vision; however, regular injections are required which may become burdensome to both patients and caregivers, and do not always maintain visual acuity gains over time. Brolucizumab was designed specifically to minimize injection frequency while increasing treatment intervals between treatments by decreasing injection frequency by up to 30%!

Brolucizumab was approved by the FDA in 2019 for use in wet AMD treatment based on results of two phase 3 clinical trials: HAWK and HARRIER studies. Both found that brolucizumab was non-inferior to Aflibercept in terms of efficacy and safety; additionally, treatment intervals could be extended without any loss in effectiveness – something many patients suffering from wet AMD may find particularly advantageous.

VSY Biotechnology has recently developed an anti-VEGF agent to treat macular degeneration. Designed for injection into the eye, this alternative to ranibizumab targets VEGF binding sites to prevent binding with receptors – leading to decreased fluid accumulation and improved vision in those suffering wet macular degeneration.

Beovu is a prescription-only eye medication available through doctors that comes in an eyedropper-filled syringe and should only be administered by qualified healthcare providers. Use of Beovu should follow its intended usage instructions, or risk serious side effects including fast or irregular heartbeat, chest fluttering and shortness of breath that should be reported immediately to a doctor.

Ranibizumab

Ranibizumab is an injectable medication prescribed to slow vision loss from wet AMD (neovascular age-related macular degeneration). It works by blocking blood vessels behind the eye from growing or leaking; also referred to as an anti-VEGF drug. Lucentis is a monoclonal antibody drug that works against vascular endothelial growth factor, a protein in the body which promotes new blood vessels to grow and leak in the retina. Also available under its brand name Lucentis. An injection can be administered either in a doctor’s office or hospital outpatient facility without needing anesthesia, and is painless. Before injection, eyes will be washed and dilated before drapes are draped around them to maintain sterile conditions around their eye and placed in special holders for delivery of medication through small needles.

BRAVO and CRUISE were two large clinical trials conducted to compare monthly ranibizumab injections with laser therapy as a treatment option for macular edema in both non-perfused BRVO (non-perfused) and perfused CRVO patients, with all three parties remaining blinded as to assignment; changes in best corrected visual acuity (BCVA) served as the primary measure of efficacy, with rescue laser therapy only allowed if their BCVA fell below 20/40 or worse than when using laser therapy was superior;

Adam R Glassman of Jaeb Center for Health Research in Tampa, Florida and colleagues recently conducted a one-year incremental cost-effectiveness analysis comparing ranibizumab with aflibercept and bevacizumab as therapies to treat DME in early stage neovascular AMD. They used trial data as well as mathematical modeling techniques to project 10-year costs and estimates of ICERs; their results show that ranibizumab is cost-effective compared with other therapies available at treating DME early stage neovascular AMD.

Levodopa

Levodopa is an effective drug used to treat Parkinson’s disease symptoms, yet can have many undesirable side effects including hallucinations and changes in thinking or behavior, but this can be avoided with proper management. Some patients may even experience serious health issues including slurred speech, weakness or loss of balance, high fevers, profuse sweating or tremors.

Levopa may cause dyskinesia, an uncontrollable movement disorder caused by changes to systemic concentration of the medication and can be relieved by altering your schedule of dosages. Furthermore, Levopa increases your risk for dementia as well as other health conditions.

According to a Vestrum database study, eyes that were exposed to levodopa had a significantly reduced risk of neovascular AMD than those not taking this medication. Researchers compared both groups by age, sex, smoking history and AREDS stage before looking at intravitreal injection rates as well as conversation rates at years 1 and 2.

If you are taking levodopa, make sure to utilize the RxList Drug Interaction Checker before beginning any new medication. Furthermore, it would be wise to carry around a list of your medicines so as to share it with your physician or pharmacist to avoid potential drug interactions and prevent complications.