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Grimes KR, Aloney A, Skondra D, Chhablani J. Effects of systemic drugs on the development and progression of age-related macular degeneration. Surv Ophthalmol 2023; 68:332-346. [PMID: 36731638 DOI: 10.1016/j.survophthal.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Age-related macular degeneration (AMD) is the leading cause of severe loss of central vision among people over 50. The pathophysiology of the disease is multifactorial and can be attributed to genetics, aging, inflammation, environmental factors, and lifestyle factors including smoking, diet, obesity, and alcohol consumption. While there is no treatment for dry AMD, the current standard treatment for wet AMD is an intraocular injection of anti-vascular endothelial growth factor-an effective, yet expensive, therapy that requires ongoing treatment. As the aging population continues to grow, and AMD diagnoses continue to rise, new treatments should be explored to reduce vision complications and decrease treatment burdens. Many systemic conditions have progressive pathological changes that may affect AMD, particularly those affecting systemic vasculature like diabetes and cardiovascular status. Consequently, systemic drugs used to treat coexistent systemic diseases may influence some of the pathogenic mechanisms of AMD and lead its progression or delay. In this review we explore the current literature to summarize the findings of the reported effects of antihypertensive, immunosuppressants, cholesterol lowering agents, nonsteroidal anti-inflammatory drugs, dopamine precursors, hypoglycemic agents, and anticoagulants on AMD.
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Affiliation(s)
- Kara R Grimes
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Abhilasha Aloney
- Eye Care Institute, PBMA'S H.V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, IL, USA
| | - Jay Chhablani
- Department of Ophthalmology, The University of Pittsburgh, Pittsburgh, PA, USA.
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Chen C, Wang C, Zhou X, Xu L, Chen H, Qian K, Jia B, Su G, Fu J. Nonsteroidal anti-inflammatory drugs for retinal neurodegenerative diseases. Prostaglandins Other Lipid Mediat 2021; 156:106578. [PMID: 34245897 DOI: 10.1016/j.prostaglandins.2021.106578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common prescription drugs for inflammation, and topical NSAIDs are often used in ophthalmology to reduce pain, photophobia, inflammation, and edema. In recent years, many published reports have found that NSAIDs play an important role in the treatment of retinal neurodegenerative diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, pathological myopia, and retinitis pigmentosa (RP). The aim of the current review is to provide an overview of the role of various NSAIDs in the treatment of retinal neurodegenerative diseases and the corresponding mechanisms of action. This review highlighted that the topical application of NSAIDs for the treatment of retinal degenerative diseases has been studied to a remarkable extent and that its beneficial effects in many diseases have been proven. In the future, prospective studies with large study populations are required to extend these effects to clinical settings.
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Affiliation(s)
- Chen Chen
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Chenguang Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Xuebin Zhou
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Lingxian Xu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Han Chen
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Kun Qian
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Bo Jia
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Guanfang Su
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Jinling Fu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China.
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Abdolrahimzadeh S, Fameli V, Tizio FD, Staso FD, Fenicia V, Scuderi G. The Effect of Topical Bromfenac on Intraretinal and Subretinal Fluid in Neovascular Age-Related Macular Degeneration. J Curr Ophthalmol 2020; 32:203-206. [PMID: 32671307 PMCID: PMC7337015 DOI: 10.4103/joco.joco_105_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/26/2019] [Accepted: 11/10/2019] [Indexed: 11/05/2022] Open
Abstract
Purpose: To report the effect of topical bromfenac, a non-steroidal anti-inflammatory drug (NSAID), in a case of neovascular age-related macular degeneration (AMD). Methods: An 85-year-old woman presented with a complaint of visual acuity reduction in the right eye. Comprehensive ophthalmological examination and retinal imaging were performed. Results: Best corrected visual acuity was 2/100. Fundus examination showed reticular pseudodrusen and a small hemorrhage in the fovea. Fluorescein angiography showed an active neovascular membrane. Spectral-domain optical coherence tomography (SD-OCT) confirmed diagnosis and revealed subretinal and intraretinal fluid. The patient refused recommended intravitreal anti-vascular endothelial growth factor treatment and received topical bromfenac 0.09% twice daily. Follow-up with SD-OCT showed subretinal followed by intraretinal fluid reduction at 16 weeks after treatment. Conclusion: Short-term reduction of subretinal and intraretinal fluid was observed with topical bromfenac monotherapy in neovascular AMD.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valeria Fameli
- Ophthalmology Unit, Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Federico Di Tizio
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Di Staso
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Vito Fenicia
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Ogurel T, Ogurel R, Ozkal F, Ölmez Y, Örnek N, Onaran Z. Evaluation effectiveness of 0.1% nepafenac on injection-related pain in patients undergoing intravitreal Ozurdex injection. Ther Adv Ophthalmol 2019; 11:2515841419861856. [PMID: 31317125 PMCID: PMC6620721 DOI: 10.1177/2515841419861856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/01/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose: To evaluate the analgesic effect of topical 0.1% nepafenac solution during intravitreal Ozurdex injection. Methods: This prospective, randomized, double-blind placebo-controlled study included 59 patients who were diagnosed with retinal vein occlusion or pseudophakic cystoid macular edema and were selected to receive intravitreal Ozurdex injection. The patients were divided into two groups. Group 1, consisting of 31 eyes of 31 patients, received topical 0.1% nepafenac with topical anesthesia (0.5% proparacaine HCl, Alcaine; Alcon, TX, USA), and group 2, consisting of 28 eyes of 28 patients, received placebo with topical anesthesia. Results: There were 14 (45.2%) men and 17 (54.8%) women in group 1 and 16 (57.1%) men and 12 (42.9%) women in group 2. The mean age of the subjects was 64.42 ± 5.51 years in group 1 and 62.32 ± 7.54 years in group 2. The median visual analog scale pain score was 2 (1–3) in group 1 and 4 (1–6) in group 2. The visual analog scale pain score was significantly lower in group 1 than in group 2 (p < 0.001). Conclusion: Topical 0.1% nepafenac has an additive analgesic effect when combined with topical anesthesia for intravitreal Ozurdex injection.
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Affiliation(s)
- Tevfik Ogurel
- Department of Ophthalmology, Faculty of Medicine, Kırıkkale University, Yahsihan, Turkey
| | | | - Fatma Ozkal
- Department of Ophthalmology, Faculty of Medicine, Kırıkkale University, Yahsihan, Turkey
| | - Yaşar Ölmez
- Adıyaman Besni State Hospital, Besni, Turkey
| | - Nurgül Örnek
- Department of Ophthalmology, Faculty of Medicine, Kırıkkale University, Yahsihan, Turkey
| | - Zafer Onaran
- Department of Ophthalmology, Faculty of Medicine, Kırıkkale University, Yahsihan, Turkey
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Oğurel T, Oğurel R, Onaran Z, Örnek K. 0.1% Nepafenac reduces pain and increases patient comfort during cataract surgery. Cont Lens Anterior Eye 2018; 41:448-451. [DOI: 10.1016/j.clae.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/02/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022]
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Margulis AV, Houben E, Hallas J, Overbeek JA, Pottegård A, Torp-Pedersen T, Perez-Gutthann S, Arana A. Ophthalmic nepafenac use in the Netherlands and Denmark. Acta Ophthalmol 2017; 95:509-517. [PMID: 28493461 PMCID: PMC5518196 DOI: 10.1111/aos.13468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/24/2017] [Indexed: 02/01/2023]
Abstract
Purpose To describe nepafenac use in the Netherlands and Denmark with reference to its approved indications. For context, we also describe the use of ketorolac and diclofenac. Methods We identified users in the PHARMO Database Network (the Netherlands, 2008–2013) and the Danish national health registers (Denmark, 1994–2014). We described prevalence of cataract surgery and duration of use in patients with cataract surgery with and without diabetes. Results In the Netherlands, 9530 nepafenac users (mean age, 71 years; 60% women) contributed 12 691 therapy episodes, of which 21% had a recently recorded cataract surgery. Of 2266 episodes in adult non‐diabetic patients with cataract surgery, 60% had one bottle dispensed (treatment duration ≤21 days). Of 441 episodes in adult diabetic patients with cataract surgery, 90% had up to two bottles dispensed (≤60 days). Denmark had 60 403 nepafenac users (mean age, 72 years; 58% women) and 73 648 episodes (41% had recorded cataract surgery). Of 26 649 nepafenac episodes in adult non‐diabetic patients with cataract surgery, 92% had one bottle dispensed. Of 3801 episodes in adult diabetic patients with cataract surgery, 99.8% had up to two bottles dispensed. Use patterns of nepafenac, ketorolac and diclofenac were roughly similar in the Netherlands, but not in Denmark. Conclusion Less than half of therapy episodes were related to cataract surgery; around 90% of episodes with surgery were within the approved duration. Underrecording of ophthalmic conditions and procedures was a challenge in this study.
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Affiliation(s)
| | - Eline Houben
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
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Semeraro F, Russo A, Gambicorti E, Duse S, Morescalchi F, Vezzoli S, Costagliola C. Efficacy and vitreous levels of topical NSAIDs. Expert Opin Drug Deliv 2015; 12:1767-82. [PMID: 26173446 DOI: 10.1517/17425247.2015.1068756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications and are routinely used for their analgesic, antipyretic, and anti-inflammatory properties. Because of their potent cyclooxygenase-inhibitory activity, they can inhibit pro-inflammatory prostaglandin synthesis, leading to complex inflammatory cascades. NSAIDs have been broadly used systemically for many decades and have recently become commercially available in the form of topical ophthalmic formulations. NSAIDs are weak acids with pKa values mostly between 3.5 and 4.5 and are poorly water-soluble. New, aqueous ophthalmic solutions of NSAIDs that afford better tissue penetration have recently been developed. In ophthalmological practice, topical NSAIDs are mostly used to stabilize pupillary dilation during intraocular surgery, manage postoperative pain and inflammation, and treat pseudophakic cystoid macular edema. AREAS COVERED This review focuses on the vitreous penetration of topical NSAIDs and their potential clinical applications in the treatment of retinal diseases. EXPERT OPINION A growing body of evidence suggests that NSAIDs may be beneficial in the treatment of age-related macular degeneration, diabetic retinopathy, and ocular tumors. Recent studies from our group and other authors have shown that the vitreous levels of NSAID exceed the median inhibitory concentration, which can significantly decrease vitreous PGE2 levels.
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Affiliation(s)
- Francesco Semeraro
- a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ;
| | - Andrea Russo
- a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ;
| | - Elena Gambicorti
- a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ;
| | - Sarah Duse
- a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ;
| | - Francesco Morescalchi
- a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ;
| | - Sara Vezzoli
- b 2 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Forensic Medicine , Brescia, Italy
| | - Ciro Costagliola
- c 3 University of Molise, Department of Medicine and Health Sciences , Campobasso, Italy.,d 4 I.R.C.C.S Neuromed, Località Camerelle , Pozzilli (Isernia), Italy
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Jones BM, Neville MW. Nepafenac: An Ophthalmic Nonsteroidal Antiinflammatory Drug for Pain After Cataract Surgery. Ann Pharmacother 2013; 47:892-6. [DOI: 10.1345/aph.1r757] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To examine the efficacy of nepafenac in the treatment of pain and inflammation in patients after cataract surgery using evidence from controlled clinical studies. DATA SOURCES: Citations in Google Scholar, PubMed, and Web of Science from January 1, 2005, to March 25, 2013, were identified using nepafenac and cataract as search terms. STUDY SELECTION AND DATA EXTRACTION: The literature search was limited to human studies published in English. Three trials that compared nepafenac with other nonsteroidal antiinflammatory drugs (NSAIDs) were included. DATA SYNTHESIS: The pharmacokinetics and pharmacodynamics of nepafenac 0.1% suspension (and its active metabolite, amfenac) were compared with bromfenac 0.09% solution and ketorolac 0.4% solution with respect to aqueous humor concentrations and ability to reduce cyclooxygenase 1 and 2 (COX-1 and COX-2) enzymes. The maximum concentration (Cmax) values of ketorolac and amfenac were statistically similar, while the Cmax of bromfenac was significantly lower than that of amfenac. Ketorolac most effectively inhibited COX-1 enzymes; COX-2 enzymes were most effectively reduced by amfenac. When nepafenac 0.1% suspension was compared with placebo and ketorolac 0.5% solution, nepafenac achieved a higher percentage cure rate than placebo at day 14 (p = 0.0241). Significant differences in cure rates between nepafenac and ketorolac were not observed. Nepafenac 0.1%, bromfenac 0.09%, and ketorolac 0.45% were compared to determine which most effectively reduced prostaglandin E2 (PGE2) following surgery. PGE2 concentrations were significantly lowest in the ketorolac group, followed by the bromfenac and nepafenac groups, respectively. Topical nepafenac 0.1% suspension was approved in 2005. A 0.3% suspension was approved in October 2012. The 0.3% product may have some advantages over its predecessor: it is dosed once rather than thrice daily, which may increase patient adherence and improve outcomes. The price and dosing frequency of the 0.3% product are comparable to those of bromfenac 0.09% solution. CONCLUSIONS: The 2 nepafenac products appear to be equally efficacious, with a slightly increased adverse event rate in patients using the 0.3% versus 0.1% formulation. Head-to-head clinical trials that compare the 0.3% product with the 0.1% product or other commercially available NSAIDs are unavailable.
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Affiliation(s)
- Benjamin M Jones
- Benjamin M Jones, PharmD student, College of Pharmacy, University of Georgia, Athens
| | - Michael W Neville
- Michael W Neville PharmD BCPS FASHP, Clinical Associate Professor, College of Pharmacy, University of Georgia
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Wang Y, Wang VM, Chan CC. The role of anti-inflammatory agents in age-related macular degeneration (AMD) treatment. Eye (Lond) 2010; 25:127-39. [PMID: 21183941 DOI: 10.1038/eye.2010.196] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although age-related macular degeneration (AMD) is not a classic inflammatory disease like uveitis, inflammation has been found to have an important role in disease pathogenesis and progression. Innate immunity and autoimmune components, such as complement factors, chemokines, cytokines, macrophages, and ocular microglia, are believed to be heavily involved in AMD development. Targeting these specific inflammatory molecules has recently been explored in an attempt to better understand and treat AMD. Although antivascular endothelial growth factor therapy is the first line of defence against neovascular AMD, anti-inflammatory agents such as corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressive agents (eg, methotrexate and rapamycin), and biologics (eg, infliximab, daclizumab, and complement inhibitors) may provide an adjunct or alternative mechanism to suppress the inflammatory processes driving AMD progression. Further investigation is required to evaluate the long-term safety and efficacy of these drugs for both neovascular and non-neovascular AMD.
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Affiliation(s)
- Y Wang
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892-1857, USA
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Chen E, Benz MS, Fish RH, Brown DM, Wong TP, Kim RY, Major JC. Use of nepafenac (Nevanac) in combination with intravitreal anti-VEGF agents in the treatment of recalcitrant exudative macular degeneration requiring monthly injections. Clin Ophthalmol 2010; 4:1249-52. [PMID: 21151329 PMCID: PMC2993124 DOI: 10.2147/opth.s14092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study is to determine the efficacy of combining topical nepafenac with monthly intravitreal injections of ranibizumab or bevacizumab in the treatment of recalcitrant exudative macular degeneration. Methods This was a retrospective, consecutive case series of patients with exudative macular degeneration requiring maintenance therapy of antivascular endothelial growth factor ( anti-VEGF) injections at least every 6 weeks, who were started on topical nepafenac. Despite frequent anti-VEGF dosing, all patients included in the study had persistence of any combination of the following: intraretinal cysts, subretinal fluid, and/or pigment epithelial detachment. Patients underwent pinhole visual acuity, clinical exam, and optical coherence tomography (OCT) at baseline and every follow-up visit. Response to therapy was graded by reviewing quantitative and qualitative OCT data, and statistical analysis was done with paired Student’s t-test. Results Twenty-five patients (average age 77; 14 male and 11 female) were reviewed; the mean number of previous injections was 17.4 (range 3–31). Baseline mean visual acuity was 20/55, and final mean visual acuity after 3 months of treatment was 20/51 (P = 0.13). Monthly mean central foveal thickness measurements were 248, 250, 257, and 247 μm (P = 0.53) at baseline, 1, 2, and 3 months, respectively. By the end of the 3-month time point, qualitative OCT findings on 13 patients treated with nepafenac were classified as stable, 10 as better, and 2 as worse. Conclusions There was no significant change in visual acuity or quantitative OCT measurements, but there appeared to be a mild trend toward improved anatomy and qualitative OCT findings when topical nepafenac was added to monthly anti-VEGF injections in patients with persistent intraretinal cysts, subretinal fluid, and/or pigment epithelial detachment. Further prospective studies with longer follow-up may be warranted.
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Affiliation(s)
- Eric Chen
- Retina Consultants of Houston, The Methodist Hospital, Houston, TX, USA.
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