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Yuen YS, Gilhotra JS, Dalton M, Aujla JS, Mehta H, Wickremasinghe S, Uppal G, Arnold J, Chen F, Chang A, Fraser-Bell S, Lim L, Shah J, Bowditch E, Broadhead GK. Diabetic Macular Oedema Guidelines: An Australian Perspective. J Ophthalmol 2023; 2023:6329819. [PMID: 36824442 PMCID: PMC9943607 DOI: 10.1155/2023/6329819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 02/16/2023] Open
Abstract
The number of people living with diabetes is expected to rise to 578 million by 2030 and to 700 million by 2045, exacting a severe socioeconomic burden on healthcare systems around the globe. This is also reflected in the increasing numbers of people with ocular complications of diabetes (namely, diabetic macular oedema (DMO) and diabetic retinopathy (DR)). In one study examining the global prevalence of DR, 35% of people with diabetes had some form of DR, 7% had PDR, 7% had DMO, and 10% were affected by these vision-threatening stages. In many regions of the world (Australia included), DR is one of the top three leading causes of vision loss amongst working age adults (20-74 years). In the management of DMO, the landmark ETDRS study demonstrated that moderate visual loss, defined as doubling of the visual angle, can be reduced by 50% or more by focal/grid laser photocoagulation. However, over the last 20 years, antivascular endothelial growth factor (VEGF) and corticosteroid therapies have emerged as alternative options for the management of DMO and provided patients with choices that have higher chances of improving vision than laser alone. In Australia, since the 2008 NHMRC guidelines, there have been significant developments in both the treatment options and treatment schedules for DMO. This working group was therefore assembled to review and address the current management options available in Australia.
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Affiliation(s)
| | | | | | - Jaskirat S. Aujla
- South Australian Institute of Ophthalmology, Adelaide, SA, Australia
| | - Hemal Mehta
- Save Sight Registries, University of Sydney, Sydney, NSW, Australia
- Strathfield Retina Clinic, Sydney, Australia
| | - Sanj Wickremasinghe
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Gurmit Uppal
- Moreton Eye Group, Brisbane, Queensland, Australia
| | | | - Fred Chen
- Centre for Ophthalmology and Visual Sciences (Incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Victoria, Australia
| | - Andrew Chang
- Sydney Institute of Vision Science, University of Sydney, Sydney, NSW, Australia
- Sydney Retina Clinic and Day Surgery, University of Sydney, Sydney, NSW, Australia
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Lyndell Lim
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Janika Shah
- Sydney Eye Hospital, Sydney, Australia
- Singapore National Eye Centre, Singapore
| | - Ellie Bowditch
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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Battaglia LS, Dorati R, Maestrelli F, Conti B, Gabriele M, Di Cesare Mannelli L, Selmin F, Cosco D. Repurposing of parenterally administered active substances used to treat pain both systemically and locally. Drug Discov Today 2022; 27:103321. [PMID: 35850432 DOI: 10.1016/j.drudis.2022.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
Pain is a constant in our lives. The efficacy of drug therapy administered by the parenteral route is often limited either by the physicochemical characteristics of the drug itself or its adsorption-distribution-metabolism-excretion (ADME) mechanisms. One promising alternative is the design of innovative drug delivery systems that can improve the pharmacokinetics |(PK) and/or reduce the toxicity of traditionally used drugs. In this review, we discuss several products that have been approved by the main regulatory agencies (i.e., nano- and microsystems, implants, and oil-based solutions), highlighting the newest technologies that govern both locally and systemically the delivery of drugs. Finally, we also discuss the risk assessment of the scale-up process required, given the impact that this approach could have on drug manufacturing. Teaser: The management of pain by way of the parenteral route can be improved using complex drug delivery systems (e.g., micro- and nanosystems) which require high-level assessment and shorten the regulatory pathway.
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Affiliation(s)
- Luigi S Battaglia
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Rossella Dorati
- Department of Drug Science, University of Pavia, Pavia, Italy
| | | | - Bice Conti
- Department of Drug Science, University of Pavia, Pavia, Italy
| | - Mirko Gabriele
- Patheon Italia SPA, Thermo Fisher Scientific, Ferentino, Italy; President Elect, PDA Italy Chapter
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Francesca Selmin
- Department of Pharmaceutical Science, University of Milan, Milan, Italy.
| | - Donato Cosco
- Department of Health Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
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Kodjikian L, Bandello F, de Smet M, Dot C, Zarranz-Ventura J, Loewenstein A, Sudhalkar A, Bilgic A, Cunha-Vaz J, Dirven W, Behar-Cohen F, Mathis T. Fluocinolone acetonide implant in diabetic macular edema: International experts' panel consensus guidelines and treatment algorithm. Eur J Ophthalmol 2022; 32:1890-1899. [PMID: 35139688 DOI: 10.1177/11206721221080288] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Center-involving diabetic macular edema (DME) is a leading cause of vision impairment in working-age adults. While its management is particularly challenging in a poorly compliant population, continuous innovation and the advent of new molecules have improved its outcome. The control of glycemia and of systemic aggravating factors remain essential to slow down progression of disease complications including DME. The indications for macular laser photocoagulation has progressively been phased out as a standard of care and replaced by local intraocular anti-VEGFs biologics and glucocorticoids (GCs). Intravitreal GCs in controlled-release drug delivery systems have allowed to reduce injection frequency and treatment burden. The non biodegradable Fluocinolone Acetonide (FAc) implant allows a long-lasting stabilization of both functional and anatomic improvements. However, adequate patient selection and monitoring through regular follow-up are essential for optimal results. Based on their experience and the latest literature, the aim of the present review is to provide international expert panel consensus on the place of the FAc implant in the treatment algorithm of DME, as well as its safety profile and how to manage it.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University Milan, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marc de Smet
- Department of Ophthalmology, 4496University of Leiden, Leiden, the Netherlands.,MicroInvasive Ocular Surgery Center, Lausanne, Switzerland
| | - Corrine Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.,French Military Health Service Academy, Val de Grâce, Paris, France
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), 16493Hospital Clínic de Barcelona, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alper Bilgic
- Sudhalkar Eye Hospital and Retina Centre, Baroda, India
| | - José Cunha-Vaz
- Faculty of Medicine, AIBILI - Association for Innovation and Biomedical Research on Light and Image, University of Coimbra, Coimbra, Portugal
| | - Werner Dirven
- Department of Ophthalmology, AZ Turnhout Hospital, Turnhout, Belgium
| | - Francine Behar-Cohen
- Department of Ophthalmology, 26935Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, From physiopathology of retinal diseases to clinical advances, Paris, France
| | - Thibaud Mathis
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
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Baino F, Kargozar S. Regulation of the Ocular Cell/Tissue Response by Implantable Biomaterials and Drug Delivery Systems. Bioengineering (Basel) 2020; 7:E65. [PMID: 32629806 PMCID: PMC7552708 DOI: 10.3390/bioengineering7030065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023] Open
Abstract
Therapeutic advancements in the treatment of various ocular diseases is often linked to the development of efficient drug delivery systems (DDSs), which would allow a sustained release while maintaining therapeutic drug levels in the target tissues. In this way, ocular tissue/cell response can be properly modulated and designed in order to produce a therapeutic effect. An ideal ocular DDS should encapsulate and release the appropriate drug concentration to the target tissue (therapeutic but non-toxic level) while preserving drug functionality. Furthermore, a constant release is usually preferred, keeping the initial burst to a minimum. Different materials are used, modified, and combined in order to achieve a sustained drug release in both the anterior and posterior segments of the eye. After giving a picture of the different strategies adopted for ocular drug release, this review article provides an overview of the biomaterials that are used as drug carriers in the eye, including micro- and nanospheres, liposomes, hydrogels, and multi-material implants; the advantages and limitations of these DDSs are discussed in reference to the major ocular applications.
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Affiliation(s)
- Francesco Baino
- Department of Applied Science and Technology, Institute of Materials Physics and Engineering, Politecnico di Torino, 10129 Turin, Italy
| | - Saeid Kargozar
- Tissue Engineering Research Group (TERG), Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran;
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Behar-Cohen F. Recent advances in slow and sustained drug release for retina drug delivery. Expert Opin Drug Deliv 2019; 16:679-686. [PMID: 31092046 DOI: 10.1080/17425247.2019.1618829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Striking recent advance has occurred in the field of medical retina, greatly because intraocular drugs have been developed, enhancing their clinical efficacy while avoiding systemic side-effects. However, the burden of repeated intraocular administration makes limits the optimal efficacy of treatments, prompting the development of new drugs with prolonged half-life or of sustained drug delivery systems. AREAS COVERED In this review, we describe the various drugs and drug delivery systems that have reached the clinical stage and those that are in clinical development and we discuss the limitations to clinical translation. EXPERT OPINION Substantial fundamental work is still required to build guidelines on optimal animal models for ocular pharmacokinetics and safety studies depending on the target disease site and the on the type of therapeutic compounds. The effects of a drug administered as a bolus at high concentration in the vitreous might differ from those resulting from the sustained release of a lower concentration, and no delivery platform can be simply adapted to any drug. For the treatment of retinal diseases, development of therapeutic compounds should integrate from its early conception, the combination of an active drug with a specific drug delivery system, administered by a specific route.
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Affiliation(s)
- Francine Behar-Cohen
- a Inserm UMR_S 1138, Team 17, Physiopathology of ocular diseases: Therapeutic Innovations at Centre de recherche des Cordeliers, Ophthalmopole at Hôpital Cochin , Paris , France.,b Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers , Université Paris Descartes , Paris , France.,c UMR_S 1138, Centre de Recherche des Cordeliers , Sorbonne University, University of Pierre et Marie Curie , Paris , France.,d Assistance Publique-Hôpitaux de Paris , Hôtel-Dieu de , Paris , France
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