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Dou R, Jiang J. Efficacy and safety of Brolucizumab for neovascular age-related macular degeneration: a systematic review and meta-analysis. PeerJ 2024; 12:e17561. [PMID: 38915383 PMCID: PMC11195547 DOI: 10.7717/peerj.17561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/21/2024] [Indexed: 06/26/2024] Open
Abstract
Background To evaluate the efficacy and safety of Brolucizumab for neovascular age-related macular degeneration (n-AMD) through a systematic review and meta-analysis. Materials and Methods Cochrane, PubMed, Embase, and Web of Science databases were comprehensively searched for relevant studies. Stata and RevMan5.4 were applied for meta-analysis and risk of bias assessment. Data on the best-corrected visual acuity (BCVA), central subfield thickness (CSFT), presence of intraretinal fluid (IRF) and/or subretinal fluid (SRF), participants with ≥1 serious adverse events, and participants with ≥1 adverse events were analyzed. Results Six studies were finally included. Meta-analysis showed statistical differences in BCVA [SMD = -0.65, 95% CI [-0.17 to -0.23], P < 0.05], the presence of IRF and/or SRF [RR = 0.67, 95% CI [0.56-0.79], P < 0.05], and the safety of participants with ≥1 serious adverse events [RR = 0.57, 95% CI [0.39-0.84], P < 0.05] between the experimental group and the control group. However, no statistical differences were observed in CSFT [SMD = -1.16, 95% CI [-2.79 to 0.47], P > 0.05] or the safety of participants with ≥1 adverse events [RR = 1.07, 95% CI [0.97-1.17], P > 0.05]. Conclusions Compared to other anti-VEGF drugs such as Aflibercept and Ranibizumab, intravitreal injection of 6 mg Brolucizumab is more effective and safer for n-AMD, especially in the presence of IRF and/or SRF, and for participants with ≥1 serious adverse events.
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Affiliation(s)
- Ran Dou
- Department of Ophthalmology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Jian Jiang
- Department of Ophthalmology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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2
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Veritti D, Sarao V, Chhablani J, Loewenstein A, Lanzetta P. The ideal intravitreal injection setting: office, ambulatory surgery room or operating theatre? A narrative review and international survey. Graefes Arch Clin Exp Ophthalmol 2023; 261:3299-3306. [PMID: 37199802 PMCID: PMC10587024 DOI: 10.1007/s00417-023-06108-y] [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: 01/31/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors. METHODS A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools. RESULTS We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings. CONCLUSION No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy
- Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical, Tel Aviv University, Tel Aviv, Israel
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy.
- Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy.
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3
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Servillo A, Zucchiatti I, Sacconi R, Parravano M, Querques L, La Rubia P, Prascina F, Bandello F, Querques G. The state-of-the-art pharmacotherapeutic management of neovascular age-related macular degeneration. Expert Opin Pharmacother 2023; 24:197-206. [PMID: 36469544 DOI: 10.1080/14656566.2022.2154145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is a major cause of central visual loss in the developed world. Although the pathogenesis is not fully understood, vascular endothelial growth factor (VEGF) is considered the most important growth factor involved in angiogenesis and exudation in neovascular AMD eyes. Advances in anti-VEGF agents have changed the treatment approach for wet AMD, allowing better outcomes in visual acuity and retinal anatomy. AREAS COVERED The present review describes the main pharmacological and clinical characteristics of anti-VEGF drugs, focusing firstly on the molecules commonly in use and then on the new candidate therapies. We performed a comprehensive literature search using the PubMed database from 1 January 1993 to 1 June 2022, with search terms including anti-VEGF, biosimilar, neovascular macular degeneration, AMD, and safety. EXPERT OPINION The management of AMD is still onerous for both the physician and patient due to the great number of required injections. Current research is underway to resolve not only the economic burden but also the discomfort of patients, aiming to develop a drug with a different or a multiple target, increasing the potency whilst maintaining a good safety profile. Furthermore, clinical research is currently investigating different forms of drug administration.
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Affiliation(s)
- Andrea Servillo
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Zucchiatti
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Sacconi
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Lea Querques
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paula La Rubia
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Prascina
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Querques
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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4
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Korobelnik JF, Delcourt C, Creuzot-Garcher C, Melaine A, Chassetuillier J, Lejeune A, Bénard S, Dupont-Benjamin L. Real-life management of neovascular age-related macular degeneration (nAMD) in France: a nationwide observational study using retrospective claims data. J Med Econ 2021; 24:1087-1097. [PMID: 34420480 DOI: 10.1080/13696998.2021.1971416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is standard care for neovascular age-related macular degeneration (nAMD), but the recommended monthly injection regimen is burdensome. Evidence suggests low injection/monitoring frequencies in clinical practice and suboptimal vision outcomes. This observational cohort study uses administrative claims data from the French national healthcare system to assess anti-VEGF treatment patterns and nAMD-specific healthcare resource demands and costs. PATIENTS AND METHODS nAMD patients ≥50 years initiating intravitreal ranibizumab, aflibercept or bevacizumab treatment (2014‒2015), and propensity score-matched non-nAMD patients (controls), were identified from the Echantillon Généraliste de Bénéficiaires database. Outcomes of interest included anti-VEGF treatment patterns, and healthcare resource utilization and associated costs of patients vis-à-vis controls over 24 months. RESULTS Study patients (n = 355) received (mean) 5.2 and 2.4 anti-VEGF injections over 0‒12 and 12‒24 months, respectively. Most patients (79.0%) remained on their initial anti-VEGF agent; among treatment switchers, the most common transition was from ranibizumab to aflibercept. During follow-up, nAMD patients were more likely than controls to require ophthalmology visits (99.7% vs. 44.8%), ocular procedures (optical coherence tomography/angiography/fundoscopy) (96.9% vs. 27.2%), cataract surgery (13.0% vs. 6.7%), and medical transports (38.0% vs. 31.9%). Mean numbers of ophthalmology visits (25.1 vs. 1.2) and medical transports (6.0 vs. 3.5) were higher (p<.01) among nAMD patients. Total reimbursed costs were two-fold higher for nAMD patients than controls (mean €16,799 vs. €8,255) due to higher treatment costs (€6,847 vs. €1,156), medical fees (€1,858 vs. €295), hospital fees (€6,396 vs. €5,235), and transport costs (€358 vs. €259). Excess total healthcare cost was (mean) €5,279 and €7,918 over the first 12 and 24 months of treatment, respectively. CONCLUSIONS Current intravitreal anti-VEGF treatment and monitoring requirements place a considerable economic burden on the French healthcare system. New intravitreal therapies with extended dosing intervals and predictable efficacy might reduce demand for ophthalmology services.
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Affiliation(s)
- Jean-François Korobelnik
- Department of Ophthalmology, University Hospital Center of Bordeaux, Bordeaux, France
- University of Bordeaux, INSERM, 'Bordeaux Population Health Research Center' (BPH), UMR1219, Bordeaux, France
| | - Cécile Delcourt
- University of Bordeaux, INSERM, 'Bordeaux Population Health Research Center' (BPH), UMR1219, Bordeaux, France
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5
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Kiss S, Campbell J, Almony A, Shih V, Serbin M, LaPrise A, Wykoff CC. Management and Outcomes for Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 127:1179-1188. [DOI: 10.1016/j.ophtha.2020.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
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6
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Sreekumar PG, Kannan R. Mechanisms of protection of retinal pigment epithelial cells from oxidant injury by humanin and other mitochondrial-derived peptides: Implications for age-related macular degeneration. Redox Biol 2020; 37:101663. [PMID: 32768357 PMCID: PMC7767738 DOI: 10.1016/j.redox.2020.101663] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
The mitochondrial-derived peptides (MDPs) are a new class of small open reading frame encoded polypeptides with pleiotropic properties. The prominent members are Humanin (HN) and small HN-like peptide (SHLP) 2, which encode 16S rRNA, while mitochondrial open reading frame of the twelve S c (MOTS-c) encodes 12S rRNA of the mitochondrial genome. While the multifunctional properties of HN and its analog 14-HNG have been well documented, their protective role in the retinal pigment epithelium (RPE)/retina has been investigated only recently. In this review, we have summarized the multiple effects of HN and its analogs, SHLP2 and MOTS-c in oxidatively stressed human RPE and the regulatory pathways of signaling, mitochondrial function, senescence, and inter-organelle crosstalk. Emphasis is given to the mitochondrial functions such as biogenesis, bioenergetics, and autophagy in RPE undergoing oxidative stress. Further, the potential use of HN and its analogs in the prevention of age-related macular degeneration (AMD) are also presented. In addition, the role of novel, long-acting HN elastin-like polypeptides in nanotherapy of AMD and other ocular diseases stemming from oxidative damage is discussed. It is expected MDPs will become a promising group of mitochondrial peptides with valuable therapeutic applications in the treatment of retinal diseases.
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Affiliation(s)
- Parameswaran G Sreekumar
- The Stephen J. Ryan Initiative for Macular Research (RIMR), Doheny Eye Institute, Los Angeles, CA, 90033, USA
| | - Ram Kannan
- The Stephen J. Ryan Initiative for Macular Research (RIMR), Doheny Eye Institute, Los Angeles, CA, 90033, USA; Stein Eye Institute, Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
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7
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Gil-Martínez M, Santos-Ramos P, Fernández-Rodríguez M, Abraldes MJ, Rodríguez-Cid MJ, Santiago-Varela M, Fernández-Ferreiro A, Gómez-Ulla F. Pharmacological Advances in the Treatment of Age-related Macular Degeneration. Curr Med Chem 2020; 27:583-598. [PMID: 31362645 DOI: 10.2174/0929867326666190726121711] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration is an acquired degenerative disease that is responsible for severe loss of vision in elderly people. There are two types: dry age-related macular degeneration and wet age-related macular degeneration. Its treatment has been improved and tries to be tailored in the future. The aim of this review is to summarize the pharmacological advances in the treatment of age-related macular degeneration. Regarding dry AMD, there is no effective treatment to reduce its progression. However, some molecules such as lampalizumab and eculizumab were under investigation, although they have shown low efficacy. Herein, in an attempt to prevent dry AMD progression, the most important studies suggested increasing the antioxidants intake and quitting the smoke habit. On the other hand, wet AMD has more developed treatment. Nowadays, the gold standard treatment is anti-VEGF injections. However, more effective molecules are currently under investigation. There are different molecules under research for dry AMD and wet AMD. This fact could help us treat our patients with more effective and lasting drugs but more clinical trials and safety studies are required in order to achieve an optimal treatment.
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Affiliation(s)
- María Gil-Martínez
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Paz Santos-Ramos
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Maribel Fernández-Rodríguez
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maximino J Abraldes
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria José Rodríguez-Cid
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Santiago-Varela
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department and Pharmacology Group, Univ Hospital of Santiago de Compostela (SERGAS) and Health Research Intitute (IDIS), Santiago de Compostela, Spain
| | - Francisco Gómez-Ulla
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
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8
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Veritti D, Sarao V, Samassa F, Danese C, Löwenstein A, Schmidt-Erfurth U, Lanzetta P. State-of-the art pharmacotherapy for non-neovascular age-related macular degeneration. Expert Opin Pharmacother 2020; 21:773-784. [PMID: 32153203 DOI: 10.1080/14656566.2020.1736557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the industrialized world. While effective treatment is available for neovascular AMD, no therapy is successful for the non-neovascular form. Herein, the authors report the current knowledge on non-neovascular AMD pathogenesis and the promising research on treatments. AREAS COVERED In the present review, the authors summarize the most recent advances in the treatment of non-neovascular AMD and provide an update on current treatment strategies. Evidence available from preclinical and clinical studies and from a selective literature search is reported. EXPERT OPINION When investigating AMD, numerous pathological cascades and alterations of physiological processes have been investigated. It is well-known that AMD is a multifactorial disease, with environmental causes and genetics playing a role. Perturbations in multiple pathogenic pathways have been identified and this led to the development of several molecules directed at specific therapeutic targets. However, despite the huge research effort, the only proven approach so far is oral antioxidant supplementation. We believe that, in addition to successful advancement of promising drugs, further research should be directed at tailoring therapy to specific patient groups, eventually employing a combinational therapy strategy.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy.,Istituto Europeo Di Microchirurgia Oculare (IEMO) , Udine, Italy
| | - Francesco Samassa
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy
| | - Carla Danese
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy
| | - Anat Löwenstein
- Division of Ophthalmology, Tel Aviv Medical Center , Tel Aviv, Israel
| | | | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy.,Istituto Europeo Di Microchirurgia Oculare (IEMO) , Udine, Italy
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9
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Guo MY, Cheng J, Etminan M, Zafari Z, Maberley D. One year effectiveness study of intravitreal aflibercept in neovascular age-related macular degeneration: a meta-analysis. Acta Ophthalmol 2019; 97:e1-e7. [PMID: 30030923 DOI: 10.1111/aos.13825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
The current body of evidence on the efficacy and safety of aflibercept for age-related macular degeneration (AMD) is steadily growing as large clinical trials and observational studies are continually completed. Our aim was to analyse 1-year visual acuity (VA) outcomes in response to aflibercept therapy and identify factors affecting treatment response using evidence generated from a pooled analysis of current studies. A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) revealed 12 studies meeting inclusion and exclusion criteria for statistical analysis. Treatment posology, baseline patient characteristics, study type, sample size and 12-month change in VA were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and posology in subgroup analyses. A meta-regression was conducted to regress 12-month VA change against posology, baseline VA and age. Users of aflibercept experienced an overall increase of 7.37 letters (95% confidence interval: 6.27-8.48, p heterogeneity: <0.001) in VA at 12 months of follow-up. In subgroup analyses, mean VA change was higher for randomized control trials and cohorts following regular posology (>7 injections/year) compared to observational studies and irregular posology. The meta-regression showed larger VA gains with regular posology compared to an irregular posology, and decreased effect size as age increased. This meta-analysis strongly suggests improved VA outcomes at 12 months in patients with wet AMD for 2.0 mg aflibercept, comparable to but slightly lower than landmark trials. Increased injection frequency and younger age demonstrates a trend with improved outcomes.
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Affiliation(s)
- Michael Y. Guo
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Jasmine Cheng
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
| | - Zafar Zafari
- University of Maryland School of Pharmacy; Baltimore MD USA
| | - David Maberley
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
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10
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Guo MY, Etminan M, Cheng JZ, Zafari Z, Maberley DAL. One-Year Effectiveness Study of Intravitreous Ranibizumab in Wet (Neovascular) Age-Related Macular Degeneration: A Meta-Analysis. Pharmacotherapy 2018; 38:197-204. [PMID: 29286545 DOI: 10.1002/phar.2079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The clinical efficacy of ranibizumab has been examined by a large number of prospective and retrospective studies to date. This meta-analysis was conducted to summarize the current body of evidence on visual acuity (VA) changes with use of ranibizumab in the treatment of wet (neovascular) age-related macular degeneration (wAMD). METHODS A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) was conducted to find randomized controlled trials (RCTs) and observational studies that reported changes in VA while patients with wAMD were on ranibizumab. Study factors analyzed were baseline patient characteristics, study type, sample size, and 12-month change in VA. Data were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and a meta-regression was conducted to assess 12-month VA change against baseline VA and age. RESULTS A total of 42 studies were included for analysis. An overall increase of 5.58 letters (95% confidence interval [CI]: 4.42-6.75; p heterogeneity, < 0.001) was shown with use of ranibizumab compared to baseline. Improvements in VA were larger for RCTs, at 7.71 letters (95% CI: 6.66-8.76; p heterogeneity, 0.013), compared to observational studies, at 4.85 letters (95% CI: 3.32-6.38; p heterogeneity, < 0.001). The meta-regression showed a significant decrease in effect size between baseline VA and 12-month VA change. CONCLUSION This meta-analysis suggests visual improvements at 12 months of 0.5-mg ranibizumab use in patients with wAMD. A higher gain in VA was observed when pooling results from RCTs compared to those in observational studies.
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Affiliation(s)
- Michael Y Guo
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Z Cheng
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zafar Zafari
- Mailman School of Public Health, Columbia University, New York, New York
| | - David A L Maberley
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Shatz W, Aaronson J, Yohe S, Kelley RF, Kalia YN. Strategies for modifying drug residence time and ocular bioavailability to decrease treatment frequency for back of the eye diseases. Expert Opin Drug Deliv 2018; 16:43-57. [PMID: 30488721 DOI: 10.1080/17425247.2019.1553953] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Treating posterior eye diseases has become a major area of focus for pharmaceutical and biotechnology companies. Current standard of care for treating posterior eye diseases relies on administration via intravitreal injection. Although effective, this is not without complications and there is great incentive to develop longer-acting therapeutics and/or sustained release delivery systems. Here, we present an overview of emerging technologies for delivery of biologics to the back of the eye. AREAS COVERED Posterior eye diseases, intravitreal injection, age-related macular degeneration, anti-VEGF, ocular pharmacokinetics, novel technologies to extend half-life, in vivo models, translation to the clinic, and hurdles to effective patient care. EXPERT OPINION Posterior eye diseases are a worldwide public health issue. Although anti-VEGF molecules represent a major advance for treating diseases involving choroidal neovascularization, frequent injection can be burdensome for patients and clinicians. There is a need for effective and patient-friendly treatments for posterior eye diseases. Many technologies that enable long-acting delivery to the back of the eye are being evaluated. However, successful development of novel therapies and delivery technologies is hampered by a multitude of factors, including patient education, translatability of in vitro/in vivo preclinical data to the clinic, and regulatory challenges associated with novel technologies.
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Affiliation(s)
- Whitney Shatz
- a Department of Protein Chemistry , Genentech , South San Francisco , CA , USA.,b School of Pharmaceutical Sciences , University of Geneva & University of Lausanne , Geneva , Switzerland
| | - Jeffrey Aaronson
- c Department of Drug Delivery , Genentech , South San Francisco , CA , USA
| | - Stefan Yohe
- c Department of Drug Delivery , Genentech , South San Francisco , CA , USA
| | - Robert F Kelley
- c Department of Drug Delivery , Genentech , South San Francisco , CA , USA
| | - Yogeshvar N Kalia
- b School of Pharmaceutical Sciences , University of Geneva & University of Lausanne , Geneva , Switzerland
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12
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Tochitsky I, Kienzler MA, Isacoff E, Kramer RH. Restoring Vision to the Blind with Chemical Photoswitches. Chem Rev 2018; 118:10748-10773. [PMID: 29874052 DOI: 10.1021/acs.chemrev.7b00723] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Degenerative retinal diseases such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD) affect millions of people around the world and lead to irreversible vision loss if left untreated. A number of therapeutic strategies have been developed over the years to treat these diseases or restore vision to already blind patients. In this Review, we describe the development and translational application of light-sensitive chemical photoswitches to restore visual function to the blind retina and compare the translational potential of photoswitches with other vision-restoring therapies. This therapeutic strategy is enabled by an efficient fusion of chemical synthesis, chemical biology, and molecular biology and is broadly applicable to other biological systems. We hope this Review will be of interest to chemists as well as neuroscientists and clinicians.
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Affiliation(s)
- Ivan Tochitsky
- F.M. Kirby Neurobiology Center , Boston Children's Hospital , Boston , Massachusetts 02115 , United States.,Department of Neurobiology , Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Michael A Kienzler
- Department of Chemistry , University of Maine , Orono , Maine 04469 , United States
| | - Ehud Isacoff
- Department of Molecular and Cell Biology , University of California , Berkeley , California 94720 , United States.,Helen Wills Neuroscience Institute , University of California , Berkeley , California 94720 , United States.,Bioscience Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
| | - Richard H Kramer
- Department of Molecular and Cell Biology , University of California , Berkeley , California 94720 , United States.,Helen Wills Neuroscience Institute , University of California , Berkeley , California 94720 , United States
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13
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Kataja M, Hujanen P, Huhtala H, Kaarniranta K, Tuulonen A, Uusitalo-Jarvinen H. Outcome of anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration in real-life setting. Br J Ophthalmol 2017; 102:959-965. [PMID: 29074495 PMCID: PMC6047152 DOI: 10.1136/bjophthalmol-2017-311055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 12/04/2022]
Abstract
Aims To evaluate outcome of anti-vascular endothelial growth factor (VEGF) therapy for the treatment of neovascular age-related macular degeneration (nAMD) in the real-life setting and to compare incidence of ocular serious adverse events (SAE) after injections administered by nurses and physicians. Methods Retrospective, single-centre study. Medical records of patients receiving anti-VEGF treatment for nAMD between 2008 and 2013 with three-loading-dose regimen were evaluated. Outcome measures were baseline visual acuity (VA), change in VA, number of intravitreal injections, incidence of ocular SAE and patients’ baseline characteristics affecting VA change. In addition, the number of injections per 1000 citizens living in the serving area and per individuals over 65 years old were estimated. Results 1349 eyes in 1117 patients received a total of 11 562 intravitreal anti-VEGF injections. Twenty-one per cent of patients received treatment for both eyes. The mean baseline Snellen VA was 0.32. The mean change of VA from baseline was +2, +2 and ±0 Early Treatment Diabetic Retinopathy Study letters and the mean numbers of injections were 5.7, 4.7 and 4.9 at years 1, 2 and 3, respectively. There was a negative correlation between baseline VA and change of VA. Incidence of endophthalmitis was 0.086%. No difference in the incidence of ocular SAE was identified between injections given by nurses or by physicians. The number of intravitreal injections per all citizens was 9 per 1000 inhabitants and 45 per 1000 inhabitants over 65 years. Conclusion The VA was maintained at the baseline level (±0 letters) with the mean of 15.3 anti-VEGF injections in real-world clinical practice during 3-year follow-up.
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Affiliation(s)
- Maria Kataja
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland.,Department of Ophthalmology, University of Tampere, Tampere, Finland
| | - Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland.,Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Jarvinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland.,Department of Ophthalmology, University of Tampere, Tampere, Finland
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14
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An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to 2013. Am J Ophthalmol 2017; 182:133-140. [PMID: 28784553 DOI: 10.1016/j.ajo.2017.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013. DESIGN Retrospective, cross-sectional study. METHODS A retrospective cross-sectional observational analysis was performed using publicly available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File. Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services. RESULTS In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013. CONCLUSION Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-vascular endothelial growth factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties, in which drug reimbursement represented only a small portion of Medicare reimbursement.
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15
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Cehofski LJ, Honoré B, Vorum H. A Review: Proteomics in Retinal Artery Occlusion, Retinal Vein Occlusion, Diabetic Retinopathy and Acquired Macular Disorders. Int J Mol Sci 2017; 18:ijms18050907. [PMID: 28452939 PMCID: PMC5454820 DOI: 10.3390/ijms18050907] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/08/2017] [Accepted: 04/05/2017] [Indexed: 01/26/2023] Open
Abstract
Retinal artery occlusion (RAO), retinal vein occlusion (RVO), diabetic retinopathy (DR) and age-related macular degeneration (AMD) are frequent ocular diseases with potentially sight-threatening outcomes. In the present review we discuss major findings of proteomic studies of RAO, RVO, DR and AMD, including an overview of ocular proteome changes associated with anti-vascular endothelial growth factor (VEGF) treatments. Despite the severe outcomes of RAO, the proteome of the disease remains largely unstudied. There is also limited knowledge about the proteome of RVO, but proteomic studies suggest that RVO is associated with remodeling of the extracellular matrix and adhesion processes. Proteomic studies of DR have resulted in the identification of potential therapeutic targets such as carbonic anhydrase-I. Proliferative diabetic retinopathy is the most intensively studied stage of DR. Proteomic studies have established VEGF, pigment epithelium-derived factor (PEDF) and complement components as key factors associated with AMD. The aim of this review is to highlight the major milestones in proteomics in RAO, RVO, DR and AMD. Through large-scale protein analyses, proteomics is bringing new important insights into these complex pathological conditions.
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Affiliation(s)
- Lasse Jørgensen Cehofski
- Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Bent Honoré
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
- Department of Biomedicine, Aarhus University, Ole Worms Allé 3, Building 1182, 024, 8000 Aarhus C, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
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16
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Bisht R, Jaiswal JK, Rupenthal ID. Nanoparticle-loaded biodegradable light-responsive in situ forming injectable implants for effective peptide delivery to the posterior segment of the eye. Med Hypotheses 2017; 103:5-9. [PMID: 28571808 DOI: 10.1016/j.mehy.2017.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
Diseases affecting the posterior segment the eye, such as age-related macular degeneration (AMD), are the leading cause of blindness worldwide. Conventional dosage forms, such as eye drops, have to surmount several elimination mechanisms and complex barriers to achieve therapeutic concentrations at the target site often resulting in low anterior segment bioavailability (ca. 2-5%) with generally none of the drug reaching posterior segment tissues. Thus, frequent intravitreal injections are currently required to treat retinal conditions which have been associated with poor patient compliance due to pain, risk of infection, hemorrhages, retinal detachment and high treatment related costs. To partially overcome these issues, ocular implants have been developed for some posterior segment indications; however, the majority require surgical implantation and removal at the end of the intended treatment period. The transparent nature of the cornea and lens render light-responsive systems an attractive strategy for the management of diseases affecting the back of the eye. Light-responsive in situ forming injectable implants (ISFIs) offer various benefits such as ease of application in a minimally invasive manner and more site specific control over drug release. Moreover, the biodegradable nature of such implants avoids the need for surgical removal after release of the payload. Incorporating drug-loaded polymeric nanoparticles (NPs) into these implants may reduce the high initial burst release from the polymeric matrix and further sustain drug release thus avoiding the need for frequent injections as well as minimizing associated side effects. However, light-responsive systems for ophthalmic application are still in their early stages of development with limited reports on their safety and effectiveness. We hypothesize that the innovative design and properties of NP-containing light-responsive ISFIs can serve as a platform for effective management of ocular diseases requiring long term treatment.
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Affiliation(s)
- Rohit Bisht
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand; Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
| | - Jagdish K Jaiswal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand; Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand; Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
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17
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Teh BL, Megaw R, Borooah S, Dhillon B. Optimizing cataract surgery in patients with age-related macular degeneration. Surv Ophthalmol 2016; 62:346-356. [PMID: 28012877 DOI: 10.1016/j.survophthal.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of visual impairment. The development of cataract in AMD patients poses challenges in assessing timing of surgery, predicting potential benefit to the patient of surgery, and predicting short- and long-term effects of surgery on progression of their AMD. Although traditional cataract surgery remains the mainstay of treatment, recently several devices have been developed to address the specific needs of AMD patients with cataract. We look at the associations between cataract and AMD and outline the treatment approaches to cataract surgery in AMD, looking at the potential benefits and risks of both traditional approaches and newer devices. We provide clinicians treating patients with AMD and cataract with a framework for choosing the appropriate management.
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Affiliation(s)
| | - Roly Megaw
- Princess Alexandra Eye Pavilion, Edinburgh, UK
| | | | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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18
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Vilà N, Coblentz J, Moreira-Neto C, Bravo-Filho V, Zoroquiain P, Burnier Jr. MN. Pretreatment of RPE Cells with Lutein Can Mitigate Bevacizumab-Induced Increases in Angiogenin and bFGF. Ophthalmic Res 2016; 57:48-53. [DOI: 10.1159/000449252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022]
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19
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DiPietro LA. Angiogenesis and wound repair: when enough is enough. J Leukoc Biol 2016; 100:979-984. [PMID: 27406995 DOI: 10.1189/jlb.4mr0316-102r] [Citation(s) in RCA: 340] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022] Open
Abstract
All animals heal, and the ability to heal is requisite for human health. One aspect of repair that has always been considered to be essential for adequate healing is the creation of a new vasculature via angiogenesis. As adult skin wounds heal, a period of rapid and robust capillary growth creates a vascular bed that has many fold more capillaries than does normal tissue. Over time, most of the newly formed capillaries regress, resulting in a final vascular density similar to that of normal skin. Certainly, new capillaries are necessary to bring nutrients, immune cells, and oxygen to healing wounds. Yet, the presumed functional importance of an overabundance of capillaries has recently been challenged, creating questions about whether excess capillary growth is truly necessary for healing. In particular, studies of wounds that heal exceptionally quickly and with less scar formation, such as those in fetal skin and oral mucosa, show that these tissues heal with a reduced angiogenic burst composed of more mature vessels that provide better oxygenation. The level of angiogenesis in wounds often correlates with the inflammatory response, largely because inflammatory cells produce an abundance of proangiogenic mediators. Both the selective reduction of inflammation and the selective reduction of angiogenesis have now been suggested as ways to improve scarring. These concepts link excessive inflammation and the production of a dense but poorly perfused capillary bed to inferior healing outcomes.
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Affiliation(s)
- Luisa A DiPietro
- Center for Wound Healing and Tissue Regeneration, University of Illinois at Chicago, Chicago, Illinois
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20
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Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CMG. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res 2016; 53:107-139. [PMID: 27094371 DOI: 10.1016/j.preteyeres.2016.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly people globally. It is estimated that there will be more Asians with AMD than the rest of the world combined by 2050. In Asian populations, polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative AMD, while choroidal neovascularization secondary to AMD (CNV-AMD) is the typical subtype in Western populations. The two subtypes share many common clinical features and risk factors, but also have different epidemiological and clinical characteristics, natural history and treatment outcomes that point to distinct pathophysiological processes. Recent research in the fields of genetics, proteomics and imaging has provided further clarification of differences between PCV and CNV-AMD. Importantly, these differences have manifested as disparity in response to intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) treatment between PCV and CNV-AMD, emphasizing the need for accurate diagnosis of PCV and in distinguishing PCV from CNV-AMD, particularly in Asian patients. Current clinical trials of intravitreal anti-VEGF therapy and photodynamic therapy will provide clearer perspectives of evidence-based management of PCV and may lead to paradigm shifts in therapeutic strategies away from those currently employed in the treatment of CNV-AMD. Further research is needed to clarify the relative contribution of specific pathways in inflammation, complement activation, extracellular matrix dysregulation, lipid metabolism and angiogenesis to the pathogenesis of PCV. Findings from this research, together with improved diagnostic technology and new therapeutics, will facilitate more optimal management of Asian AMD.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yasuo Yanagi
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Won-Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University, Nagoya, Japan
| | - Ian Yeo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
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21
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Demirel S, Bilici S, Batıoğlu F, Özmert E. Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study. Ophthalmic Res 2016; 56:35-40. [DOI: 10.1159/000444497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/07/2016] [Indexed: 11/19/2022]
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22
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Bisht R, Jaiswal JK, Chen YS, Jin J, Rupenthal ID. Light-responsive in situ forming injectable implants for effective drug delivery to the posterior segment of the eye. Expert Opin Drug Deliv 2016; 13:953-62. [DOI: 10.1517/17425247.2016.1163334] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rohit Bisht
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jagdish Kumar Jaiswal
- Auckland Cancer Society Research Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ying-Shan Chen
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jianyong Jin
- School of Chemical Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Ilva Dana Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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23
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Eandi CM, Alovisi C, De Sanctis U, Grignolo FM. Treatment for neovascular age related macular degeneration: The state of the art. Eur J Pharmacol 2016; 787:78-83. [PMID: 26948315 DOI: 10.1016/j.ejphar.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/01/2016] [Accepted: 03/01/2016] [Indexed: 01/07/2023]
Abstract
With the introduction in the clinical practice of drugs inhibiting vascular endothelial growth factor (VEGF) the visual outcomes of patients with neovascular age related macular degeneration (AMD) dramatically improved. Since 2006 repeated intravitreal injections of anti-VEGF became the standard of care for the treatment of neovascular AMD. This review provides an overview of available data form clinical trials supporting the use of anti-VEGF molecules for the treatment of this condition. Several questions remain open, in particular the regimen of treatment, the frequency of injection, the safety of the different drugs, and the poor response to the treatment in some cases. Therefore, new agents and alternative delivery are currently under evaluation.
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Affiliation(s)
- Chiara M Eandi
- Department of Surgical Science, Eye Clinic, University of Torino, Via Juvarra 19, 10122 Torino, Italy.
| | - Camilla Alovisi
- Department of Surgical Science, Eye Clinic, University of Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Ugo De Sanctis
- Department of Surgical Science, Eye Clinic, University of Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Federico M Grignolo
- Department of Surgical Science, Eye Clinic, University of Torino, Via Juvarra 19, 10122 Torino, Italy
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