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Awwad S, Ibeanu N, Liu T, Velentza-Almpani A, Chouhan N, Vlatakis S, Khaw PT, Brocchini S, Bouremel Y. Real-Time Monitoring Platform for Ocular Drug Delivery. Pharmaceutics 2023; 15:pharmaceutics15051444. [PMID: 37242686 DOI: 10.3390/pharmaceutics15051444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
Real-time measurement is important in modern dissolution testing to aid in parallel drug characterisation and quality control (QC). The development of a real-time monitoring platform (microfluidic system, a novel eye movement platform with temperature sensors and accelerometers and a concentration probe setup) in conjunction with an in vitro model of the human eye (PK-Eye™) is reported. The importance of surface membrane permeability when modelling the PK-Eye™ was determined with a "pursing model" (a simplified setup of the hyaloid membrane). Parallel microfluidic control of PK-Eye™ models from a single source of pressure was performed with a ratio of 1:6 (pressure source:models) demonstrating scalability and reproducibility of pressure-flow data. Pore size and exposed surface area helped obtain a physiological range of intraocular pressure (IOP) within the models, demonstrating the need to reproduce in vitro dimensions as closely as possible to the real eye. Variation of aqueous humour flow rate throughout the day was demonstrated with a developed circadian rhythm program. Capabilities of different eye movements were programmed and achieved with an in-house eye movement platform. A concentration probe recorded the real-time concentration monitoring of injected albumin-conjugated Alexa Fluor 488 (Alexa albumin), which displayed constant release profiles. These results demonstrate the possibility of real-time monitoring of a pharmaceutical model for preclinical testing of ocular formulations.
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Affiliation(s)
- Sahar Awwad
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Nkiruka Ibeanu
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Tianyang Liu
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Angeliki Velentza-Almpani
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Nerisha Chouhan
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Stavros Vlatakis
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Peng Tee Khaw
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Steve Brocchini
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
| | - Yann Bouremel
- Optceutics Ltd., 28a Menelik Road, London NW2 3RP, UK
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK
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Muñoz-Villegas P, Sanchez-Rios A, Quinonez-Alvarado MG, Olvera-Montaño O, Quintana-Hau JD, Baiza-Duran L. Pharmacokinetics and Safety of an Intravitreal Humanized Anti-VEGF-A Monoclonal Antibody (PRO-169), a Biosimilar Candidate to Bevacizumab. J Exp Pharmacol 2021; 13:545-554. [PMID: 34113182 PMCID: PMC8185251 DOI: 10.2147/jep.s308388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/28/2021] [Indexed: 01/15/2023] Open
Abstract
Background PRO-169 is a biosimilar candidate to bevacizumab (BEV), a monoclonal antibody (mAb) that inhibits vascular endothelial growth factor-A (VEGF-A) developed for intravitreal use. The current study demonstrates the intraocular pharmacokinetics (PK) of PRO-169 and its safety using New Zealand white (NZW) rabbits. Methods Intraocular concentration was evaluated in thirty-six rabbits at 1h, 1, 2, 5, 14 and 30 days after a single bilateral injection of PRO-169 or BEV (1.25 mg/0.05 mL). In a secondary experiment, safety was evaluated after three consecutive unilateral injections at 30-day intervals in twenty-four rabbits (PRO-169: 1.25 mg/0.05 mL or ranibizumab [RZB]: 0.5 mg/0.05 mL), by liver-associated enzymes (LAE), ophthalmological examination and adverse event (AE) incidence. Primary endpoints were vitreous maximum concentration (Cmax), time to attain maximum concentration (tmax), area under curve (AUC0-t), half-life (t1/2) and LAE. Secondary endpoints included aqueous humor (AH) and plasma pharmacokinetics, clinical examination and AEs. Results The Cmax in the vitreous was 593.75 ± 45.63 (PRO-169) vs 644.79 ± 62.65 µg/mL (BEV) (p= 0.136). Tmax was 0.53 ± 0.82 vs 0.85 ± 0.73 days (p= 0.330). The AUC0-t was 3837.72 ± 465.91 vs 4247.31 ± 93.99 days*µg/mL (p= 0.052) and the half-life was 4.99 ± 0.89 vs 5.18 ± 0.88 days (p= 0.711). LAEs were normal in 92% of NZW rabbits; no differences between groups were observed (p>0.05). The AH and plasma PKs were also similar. Finally, clinical examinations found no alterations. AEs were observed in 25% of PRO-169 rabbits, without differences vs RZB (p=0.399). Conclusion PRO-169 can be efficiently diffused and distributed in ocular compartments, showing vitreous pharmacokinetics analogous to BEV. The safety experiment did not find evidence of clinical alterations from a repeated injection of PRO-169. These results provide scientific justification supporting that PRO-169 should be evaluated in future clinical trials to confirm its safety and efficacy.
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Affiliation(s)
| | | | | | - Oscar Olvera-Montaño
- Medical Affairs Department, Laboratorios Sophia, S.A. de C.V., Zapopan, Jalisco, México
| | | | - Leopoldo Baiza-Duran
- Medical Affairs Department, Laboratorios Sophia, S.A. de C.V., Zapopan, Jalisco, México
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Stahl A. [Review of clinical trials in retinopathy of prematurity : Current state and future perspectives]. Ophthalmologe 2019; 115:456-463. [PMID: 29789899 DOI: 10.1007/s00347-018-0720-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The treatment of retinopathy of prematurity (ROP) has gained a new dynamic since the introduction of anti-vascular endothelial growth factor (VEGF) therapy. This review summarizes clinical trial data in order to aid informed decision-making. METHODS In this article, pivotal clinical trials are summarized and discussed with regard to their implications for ROP therapy. RESULTS The longest follow-up phase exists for children treated in the CRYO-ROP study, which used retinal cryocoagulation to treat ROP. Based on results of the ETROP study and others, retinal laser therapy has replaced cryotherapy as standard of care. For anti-VEGF treatment, three controlled clinical trials exist to date: BEAT-ROP, CARE-ROP, and the PEDIG study. Combined, these studies demonstrate efficacy of anti-VEGF in treating acute ROP. However, they also emphasize the risk of (late) recurrences and the largely unsolved questions regarding choice of drug and dose as well as long-term safety. CONCLUSION Treatment of ROP remains a highly individual decision in which many variables need to be considered. The data discussed in this article can help in decision-making and emphasize the unique characteristics of the available therapeutic approaches, in particular regarding postoperative follow-up.
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Affiliation(s)
- Andreas Stahl
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
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Serum Vascular Endothelial Growth Factor Levels before and after Intravitreous Ranibizumab Injection for Retinopathy of Prematurity. J Ophthalmol 2019; 2019:2985161. [PMID: 31236289 PMCID: PMC6545787 DOI: 10.1155/2019/2985161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/28/2019] [Accepted: 05/08/2019] [Indexed: 12/11/2022] Open
Abstract
Background Retinopathy of prematurity (ROP) is one of the common complications of prematurity. Intravitreal injection of ranibizumab (IVR), an antivascular endothelial growth factor (VEGF) drug, showed significant benefit for ROP. However, there are concerns about systemic complications of anti-VEGF therapy in preterm infants. Objectives To evaluate serum VEGF level in the systemic circulation after IVR and the complications associated with IVR for the premature infants with ROP. Methods This prospective investigation assessed the serum concentrations of VEGF in ROP patients before and after IVR therapy. All the infants had binocular retinopathy and received IVR 0.25 mg per eye as the primary treatment. Serum samples were collected 1 day prior to injection and 1 day, 3 days, and 7 days after IVR treatment. Serum VEGF level was measured by the enzyme-linked immunosorbent assay (ELISA). Results Fifteen infants (6 girls and 9 boys) were enrolled. The serum concentrations of VEGF 1 day before and 1 day, 3 days, and 7 days after a total of 0.5 mg intravitreal injections of ranibizumab were 226.9 (198.4, 272.4), 12.8 (7.0, 22.4), 16 (12.0, 20.8), and 33.7 (24.0, 48.0) pg/ml, respectively. Serum VEGF levels decreased significantly at 1 day, 3 days, and 7 days after IVR treatment compared with pretreatment concentration (P < 0.05). Compared to days 1 and 3 after IVR, serum VEGF level at 7 days after IVR treatment increased significantly (P < 0.05). Conclusion Serum VEGF levels in patients with ROP were suppressed for at least 7 days after IVR treatment. Although the clinical significance of this phenomenon is uncertain, its safety profile requires further investigation.
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Gharbiya M, Bruscolini A, Sacchetti M, Rosso P, Carito V, Segatto M, Fico E, Tirassa P, Lambiase A. In vivo antivascular endothelial growth factor treatment induces corneal endothelium apoptosis in rabbits through changes in p75NTR–proNGF pathway. J Cell Physiol 2018; 233:8874-8883. [DOI: 10.1002/jcp.26806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/30/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Magda Gharbiya
- Department of Sense Organs University of Rome Sapienza Rome Italy
| | - Alice Bruscolini
- Department of Sense Organs University of Rome Sapienza Rome Italy
| | - Marta Sacchetti
- Department of Sense Organs University of Rome Sapienza Rome Italy
| | - Pamela Rosso
- National Research Council ‐ Department of Biomedical Sciences Institute of Cell Biology and Neurobiology (IBCN‐CNR) Rome Italy
| | - Valentina Carito
- National Research Council ‐ Department of Biomedical Sciences Institute of Cell Biology and Neurobiology (IBCN‐CNR) Rome Italy
| | - Marco Segatto
- Department of Sense Organs University of Rome Sapienza Rome Italy
| | - Elena Fico
- National Research Council ‐ Department of Biomedical Sciences Institute of Cell Biology and Neurobiology (IBCN‐CNR) Rome Italy
- Department of Biotechnological and Applied Clinical Sciences University of L’Aquila L’Aquila Italy
| | - Paola Tirassa
- National Research Council ‐ Department of Biomedical Sciences Institute of Cell Biology and Neurobiology (IBCN‐CNR) Rome Italy
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Stahl A, Krohne TU, Eter N, Oberacher-Velten I, Guthoff R, Meltendorf S, Ehrt O, Aisenbrey S, Roider J, Gerding H, Jandeck C, Smith LEH, Walz JM. Comparing Alternative Ranibizumab Dosages for Safety and Efficacy in Retinopathy of Prematurity: A Randomized Clinical Trial. JAMA Pediatr 2018; 172:278-286. [PMID: 29309486 PMCID: PMC5840003 DOI: 10.1001/jamapediatrics.2017.4838] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Anti-vascular endothelial growth factor (VEGF) therapies are a novel treatment option in retinopathy of prematurity (ROP). Data on dosing, efficacy, and safety are insufficient. OBJECTIVE To investigate lower doses of anti-VEGF therapy with ranibizumab, a substance with a significantly shorter systemic half-life than the standard treatment, bevacizumab. DESIGN, SETTING, AND PARTICIPANTS This randomized, multicenter, double-blind, investigator-initiated trial at 9 academic medical centers in Germany compared ranibizumab doses of 0.12 mg vs 0.20 mg in infants with bilateral aggressive posterior ROP; ROP stage 1 with plus disease, 2 with plus disease, or 3 with or without plus disease in zone I; or ROP stage 3 with plus disease in posterior zone II. Patients were recruited between September 2014 and August 2016. Twenty infants were screened and 19 were randomized. INTERVENTIONS All infants received 1 baseline ranibizumab injection per eye. Reinjections were allowed in case of ROP recurrence after at least 28 days. MAIN OUTCOMES AND MEASURES The primary end point was the number of infants who did not require rescue therapy at 24 weeks. Key secondary end points included time-to-event analyses, progression of physiologic vascularization, and plasma VEGF levels. Stages of ROP were photodocumented and reviewed by an expert committee. RESULTS Nineteen infants with ROP were enrolled (9 [47.4%] female; median [range] postmenstrual age at first treatment, 36.4 [34.7-39.7] weeks), 3 of whom died during the study (1 in the 0.12-mg group and 2 in the 0.20-mg group). Of the surviving infants, 8 (88.9%) (17 eyes [94.4%]) in the 0.12-mg group and 6 (85.7%) (13 eyes [92.9%]) in the 0.20-mg group did not require rescue therapy. Both ranibizumab doses were equally successful in controlling acute ROP (Cochran-Mantel-Haenszel analysis; odds ratio, 1.88; 95% CI, 0.26-13.49; P = .53). Physiologic intraretinal vascularization was superior in the 0.12-mg group. The VEGF plasma levels were not systematically altered in either group. CONCLUSIONS AND RELEVANCE This pilot study demonstrates that ranibizumab is effective in controlling acute ROP and that 24% of the standard adult dose (0.12 mg) appears equally effective as 40% (0.20 mg). Superior vascularization of the peripheral retina with 0.12 mg of ranibizumab indicates that the lower dose may be favorable. Unchanged plasma VEGF levels point toward a limited systemic drug exposure after ranibizumab. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02134457 and clinicaltrialsregister.eu Identifier: 2013-002539-13.
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Affiliation(s)
- Andreas Stahl
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim U. Krohne
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | | | - Rainer Guthoff
- Department of Ophthalmology, Faculty of Medicine, University of Dusseldorf, Dusseldorf, Germany
| | - Synke Meltendorf
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
| | - Oliver Ehrt
- Department of Ophthalmology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Sabine Aisenbrey
- University Eye Hospital, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Kiel, Germany
| | | | | | - Lois E. H. Smith
- Department of Ophthalmology, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts
| | - Johanna M. Walz
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
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Awwad S, Al-Shohani A, Khaw PT, Brocchini S. Comparative Study of In Situ Loaded Antibody and PEG-Fab NIPAAM Gels. Macromol Biosci 2017; 18. [PMID: 29205853 DOI: 10.1002/mabi.201700255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/18/2017] [Indexed: 01/01/2023]
Abstract
Hydrogels can potentially prolong the release of a therapeutic protein, especially to treat blinding conditions. One challenge is to ensure that the protein and hydrogel are intimately mixed by better protein entanglement within the hydrogel. N-isopropylacrylamide (NIPAAM) gels are optimized with poly(ethylene glycol) diacrylate (PEDGA) crosslinker in the presence of either bevacizumab or PEG conjugated ranibizumab (PEG10 -Fabrani ). The release profiles of the hydrogels are evaluated using an outflow model of the eye, which is previously validated for human clearance of proteins. Release kinetics of in situ loaded bevacizumab-NIPAAM gels displays a prolonged bimodal release profile in phosphate buffered saline compared to bevacizumab loaded into a preformed NIPAAM gel. Bevacizumab release in simulated vitreous from in situ loaded gels is similar to bevacizumab control indicating that diffusion through the vitreous rather than from the gel is rate limiting. Ranibizumab is site-specifically PEGylated by disulfide rebridging conjugation. Prolonged and continuous release is observed with the in situ loaded PEG10 -Fabrani -NIPAAM gels compared to PEG10 -Fabrani injection (control). Compared to an unmodified protein, there is better mixing due to PEG entanglement and compatibility of PEG10 -Fabrani within the NIPAAM-PEDGA hydrogel. These encouraging results suggest that the extended release of PEGylated proteins in the vitreous can be achieved using injectable hydrogels.
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Affiliation(s)
- Sahar Awwad
- UCL School of Pharmacy, London, WC1N 1AX, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Athmar Al-Shohani
- UCL School of Pharmacy, London, WC1N 1AX, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Steve Brocchini
- UCL School of Pharmacy, London, WC1N 1AX, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK
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Neovascular age-related macular degeneration in Austria. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gok M, Kapti HB. Effect of intravitreal aflibercept (Eylea ®) on retrobulbar hemodynamics in patients with neovascular age-related macular degeneration. Int Ophthalmol 2017; 38:713-719. [PMID: 28421399 DOI: 10.1007/s10792-017-0522-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the short-term effect of single intravitreal aflibercept injection on retrobulbar blood flow in patients with neovascular age-related macular degeneration (nAMD). METHODS Twenty eyes of 20 patients with nAMD scheduled for single intravitreal aflibercept (Eylea®) injection and 20 fellow eyes (uninjected) were enrolled in this prospective interventional study. The hemodynamic parameters of the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) comprising peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured by using color Doppler ultrasonography (CDU) in both injected and uninjected fellow eyes at baseline and 1 week after the injection. RESULTS The measured first-week values of PSV and EDV in the CRA, OA and PCA showed a statistically significant reduction when comparing baseline values in both injected and uninjected fellow eyes (p = 0.0001). Also, it was found a significant increase in the post-injection RI values of all the CRA, OA, PCA in injected eye and OA in the uninjected eye (p = 0.0001). There was any significant difference between pre- and post-injection RI values of the CRA and PCA in the fellow eyes (p = 0.137, p = 0.736, respectively). CONCLUSION Single intravitreal administration of aflibercept alters retrobulbar blood flow velocities (BFVs) in both injected and uninjected fellow eyes in the short-term period.
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Affiliation(s)
- Mustafa Gok
- Department of Ophthalmology, Ministry of Health - Ordu University Research and Training Hospital, 52200, Ordu, Turkey.
| | - Hasan Burhanettin Kapti
- Department of Ophthalmology, Ministry of Health - Ordu University Research and Training Hospital, 52200, Ordu, Turkey
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Awwad S, Lockwood A, Brocchini S, Khaw PT. The PK-Eye: A Novel In Vitro Ocular Flow Model for Use in Preclinical Drug Development. J Pharm Sci 2015; 104:3330-42. [PMID: 26108574 DOI: 10.1002/jps.24480] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 01/09/2023]
Abstract
A 2-compartment in vitro eye flow model has been developed to estimate ocular drug clearance by the anterior aqueous outflow pathway. The model is designed to accelerate the development of longer-acting ophthalmic therapeutics. Dye studies show aqueous flow is necessary for a molecule injected into the vitreous cavity to clear from the model. The clearance times of proteins can be estimated by collecting the aqueous outflow, which was first conducted with bevacizumab using phosphate-buffered saline in the vitreous cavity. A simulated vitreous solution was then used and ranibizumab (0.5 mg) displayed a clearance time of 8.1 ± 3.1 days, which is comparable to that observed in humans. The model can estimate drug release from implants or the dissolution of suspensions as a first step in their clearance mechanism, which will be the rate-limiting step for the overall resident time of a candidate dosage form in the vitreous. A suspension of triamcinolone acetonide (Kenalog®) (4.0 mg) displayed clearance times spanning 26-28 days. These results indicate that the model can be used to determine in vitro-in vivo correlations in preclinical studies to develop long-lasting therapeutics to treat blinding diseases at the back of the eye.
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Affiliation(s)
- Sahar Awwad
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom.,UCL School of Pharmacy, London, WC1N 1AX, United Kingdom
| | - Alastair Lockwood
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom.,UCL School of Pharmacy, London, WC1N 1AX, United Kingdom
| | - Steve Brocchini
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom.,UCL School of Pharmacy, London, WC1N 1AX, United Kingdom
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, United Kingdom
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Zehetner C, Kralinger MT, Modi YS, Waltl I, Ulmer H, Kirchmair R, Bechrakis NE, Kieselbach GF. Systemic levels of vascular endothelial growth factor before and after intravitreal injection of aflibercept or ranibizumab in patients with age-related macular degeneration: a randomised, prospective trial. Acta Ophthalmol 2015; 93:e154-9. [PMID: 25488124 DOI: 10.1111/aos.12604] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/15/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the changes of vascular endothelial growth factor (VEGF) plasma levels after intravitreal injections of aflibercept or ranibizumab in patients with exudative age-related macular degeneration (AMD). METHODS Thirty-eight patients with exudative AMD were included in this randomised, prospective study. Nineteen patients were randomised to treatment with intravitreal aflibercept (2.0 mg) and 19 to intravitreal ranibizumab (0.5 mg). The concentration of VEGF was measured by ELISA just before the injection, after 7 days and 1 month. Twenty-two age- and sex-matched healthy patients without chorioretinal diseases served as control. RESULTS The median baseline plasma VEGF concentration was 61.0 pg/ml in the control group, 43.0 pg/ml in the aflibercept group and 59.0 pg/ml in the ranibizumab group (p=0.127). Seven days after intravitreal injection of aflibercept plasma levels were significantly reduced to values below the minimum detectable dose (MDD) in 17 of 19 patients (89.5%) resulting in a median VEGF concentration of <9 pg/ml (p<0.001). The reduction persisted throughout 1 month with values below the MDD in 5 of 19 patients (26.3%) and a median measurement of 17.0 pg/ml (p<0.001). In patients treated with ranibizumab no significant effects could be observed with a baseline VEGF of 59.0 pg/ml, 54.0 pg/ml at 7 days (p=0.776) and 58.5 pg/ml at 4 weeks of follow-up (p=0.670). CONCLUSION After intravitreal aflibercept injection, the systemic VEGF levels were significantly reduced throughout the observational period of 4 weeks. No significant systemic effects of intravitreal ranibizumab on plasma VEGF were observed.
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Affiliation(s)
- Claus Zehetner
- Department of Ophthalmology; Medical University Innsbruck; Innsbruck Austria
| | | | - Yasha S. Modi
- Bascom Palmer Eye Institute; University of Miami; Miami Florida USA
| | - Inga Waltl
- Department of Ophthalmology; Medical University Innsbruck; Innsbruck Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics; Medical University Innsbruck; Innsbruck Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine; Medical University Innsbruck; Innsbruck Austria
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Aboul Naga SH, Dithmer M, Chitadze G, Kabelitz D, Lucius R, Roider J, Klettner A. Intracellular pathways following uptake of bevacizumab in RPE cells. Exp Eye Res 2015; 131:29-41. [DOI: 10.1016/j.exer.2014.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/11/2014] [Accepted: 12/17/2014] [Indexed: 12/23/2022]
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Stahl A, Hellstrom A, Smith LEH. Insulin-like growth factor-1 and anti-vascular endothelial growth factor in retinopathy of prematurity: has the time come? Neonatology 2014; 106:254-60. [PMID: 25300950 PMCID: PMC4197141 DOI: 10.1159/000365132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Treatment of retinopathy of prematurity (ROP) is currently evolving. Novel therapeutic options are emerging that have the potential to complement existing therapies and improve treatment outcomes. However, any new therapeutic option must be thoroughly evaluated before existing (and successful) treatment paradigms can be amended. This is particularly so when switching from locally effective therapies like photoablative laser therapy to systemic pharmacological treatments, which may have hitherto unknown widespread side effects. This review compiles the current knowledge of where and when the two most advanced pharmacological treatment options for ROP, insulin-like growth factor-1 supplementation and anti-vascular endothelial growth factor treatment, may have their place in future therapy regimens for ROP. The requirement for clinical studies is emphasized: these are needed to address safety considerations before any of these interventions can achieve the status of standard clinical care in the very vulnerable population of ROP infants.
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Affiliation(s)
- Andreas Stahl
- Eye Center, University of Freiburg, Freiburg, Germany
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