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Rowe LW, Ciulla TA. Gene Therapy for Non-Hereditary Retinal Disease: Age-Related Macular Degeneration, Diabetic Retinopathy, and Beyond. Genes (Basel) 2024; 15:720. [PMID: 38927656 PMCID: PMC11203163 DOI: 10.3390/genes15060720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Gene therapy holds promise as a transformative approach in the treatment landscape of age-related macular degeneration (AMD), diabetic retinopathy (DR), and diabetic macular edema (DME), aiming to address the challenges of frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections. This manuscript reviews ongoing gene therapy clinical trials for these disorders, including ABBV-RGX-314, ixoberogene soroparvovec (ixo-vec), and 4D-150. ABBV-RGX-314 utilizes an adeno-associated virus (AAV) vector to deliver a transgene encoding a ranibizumab-like anti-VEGF antibody fragment, demonstrating promising results in Phase 1/2a and ongoing Phase 2b/3 trials. Ixo-vec employs an AAV2.7m8 capsid for intravitreal delivery of a transgene expressing aflibercept, showing encouraging outcomes in Phase 1 and ongoing Phase 2 trials. 4D-150 utilizes an evolved vector to express both aflibercept and a VEGF-C inhibitory RNAi, exhibiting positive interim results in Phase 1/2 studies. Other therapies reviewed include EXG102-031, FT-003, KH631, OLX10212, JNJ-1887, 4D-175, and OCU410. These therapies offer potential advantages of reduced treatment frequency and enhanced safety profiles, representing a paradigm shift in management towards durable and efficacious cellular-based biofactories. These advancements in gene therapy hold promise for improving outcomes in AMD and addressing the complex challenges of DME and DR, providing new avenues for the treatment of diabetic eye diseases.
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Affiliation(s)
- Lucas W. Rowe
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Thomas A. Ciulla
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Retina Service, Midwest Eye Institute, Indianapolis, IN 46290, USA
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Danzig CJ, Khanani AM, Kaiser PK, Chang MA, Kovach JL, Lally DR, Rachitskaya A, Sheth VS, Vajzovic L, Clark J, Tang J, Zhu L, Desai D, Chakravarthy U. Vision Loss Reduction with Avacincaptad Pegol for Geographic Atrophy: A 12-Month Post Hoc Analysis of the GATHER1 and GATHER2 Trials. Ophthalmol Retina 2024:S2468-6530(24)00224-0. [PMID: 38719191 DOI: 10.1016/j.oret.2024.04.023] [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: 08/24/2023] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To evaluate the impact of reduction in geographic atrophy (GA) lesion growth on visual acuity in the GATHER trials using categorical outcome measures. DESIGN Randomized, double-masked, sham-controlled phase 3 trials. PARTICIPANTS Aged ≥50 years with noncenter point-involving GA and best-corrected visual acuity (BCVA) of 25 to 80 ETDRS letters in the study eye. METHODS GATHER1 consisted of 2 parts. In part 1, 77 patients were randomized 1:1:1 to avacincaptad pegol (ACP) 1 mg, ACP 2 mg, and sham. In part 2, 209 patients were randomized 1:2:2 to ACP 2 mg, ACP 4 mg, and sham. In GATHER2, patients were randomized 1:1 to ACP 2 mg (n = 225) and sham (n = 223). A post hoc analysis of 12-month data for pooled ACP 2 mg and sham groups is reported. MAIN OUTCOME MEASURES Proportion of study eyes that experienced ≥10-, ≥15-, or ≥20-BCVA ETDRS letter loss from baseline to month 12; time-to-event analysis of persistent vision loss of ≥10, ≥15, or≥ 20 BCVA letters from baseline at ≥2 consecutive visits over 12 months; proportion of study eyes with BCVA loss to a level below driving eligibility threshold at month 12 among those eligible to drive at baseline. RESULTS Lower proportions of study eyes experienced ≥10-, ≥15-, or ≥20-BCVA letter loss from baseline over 12 months with ACP 2 mg (11.6%, 4.0%, and 1.6%, respectively) versus sham (14.1%, 7.6%, and 4.5%, respectively). There was a reduction in the risk of persistent loss of ≥15 BCVA ETDRS letters with ACP 2 mg (3.4%) versus sham (7.8%) through 12 months. A lower proportion of study eyes treated with ACP 2 mg reached the threshold for driving ineligibility versus sham by 12 months. CONCLUSIONS Treatment with ACP 2 mg delayed the risk of progression to persistent vision loss (i.e., ≥10-, ≥15-, and ≥20-BCVA letter loss or BCVA loss to a level below driving eligibility threshold) versus sham over 12 months. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Carl J Danzig
- Rand Eye Institute, Deerfield Beach, Florida; Florida Atlantic University, Charles E. Schmidt School of Medicine, Boca Raton, Florida
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada; University of Nevada, Reno School of Medicine, Reno, Nevada
| | | | | | - Jaclyn L Kovach
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Lally
- New England Retina Consultants, Springfield, Massachusetts
| | | | | | | | - Julie Clark
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Justin Tang
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Liansheng Zhu
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Dhaval Desai
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Usha Chakravarthy
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, United Kingdom.
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Ehlers JP, McConville C, Yordi S, Cetin H, Cakir Y, Kalra G, Amine R, Whitney J, Whitmore V, Bonnay M, Reese J, Clark J, Zhu L, Luo D, Jaffe GJ, Srivastava SK. Correlation Between Blue Fundus Autofluorescence and SD-OCT Measurements of Geographic Atrophy in Dry Age-Related Macular Degeneration. Am J Ophthalmol 2024; 266:92-101. [PMID: 38719131 DOI: 10.1016/j.ajo.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE To compare fundus autofluorescence (FAF) and spectral domain optical coherence tomography (OCT) measurements of geographic atrophy (GA) area and to analyze lesion area changes measured by spectral domain OCT in GATHER1. DESIGN An assessment reliability analysis using prospective, randomized, double-masked phase 2/3 clinical trial data. METHODS GATHER1 examined the efficacy and safety of avacincaptad pegol (ACP) for GA treatment. A post hoc analysis was performed to identify correlations between FAF- and OCT-based measurements of GA. GA area was measured on blue-light FAF images using semiautomatic segmentation software with support from OCT and near-infrared imaging. Machine-learning enhanced, multilayer segmentation of OCT scans were reviewed by human readers, and segmentation errors were corrected as needed. GA area was defined as total RPE loss on cross-sectional B scans. Time points included Months 0, 6, 12, and 18. Additionally, OCT-based GA-area changes between ACP and sham were analyzed. RESULTS There was a strong correlation (r = 0.93) between FAF and OCT GA area measurements that persisted through 18 months. Mean (SD) differences between OCT and FAF GA measurements were negligible: 0.11 mm2 (1.42) at Month 0, 0.03 mm2 (1.62) at Month 6, -0.17 mm2 (1.81) at Month 12, and -0.07 mm2 (1.78) at Month 18. OCT assessments of GA growth revealed a 30% and 27% reduction at Months 12 and 18, respectively, between ACP and sham, replicating FAF measurements from GATHER1. CONCLUSIONS The strong correlation between blue FAF and OCT measurements of GA area supports OCT as a reliable method to measure GA lesion area in clinical trials.
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Affiliation(s)
- Justis P Ehlers
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA.
| | - Conor McConville
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Sari Yordi
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Hasan Cetin
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Yavuz Cakir
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Gagan Kalra
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Reem Amine
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Jon Whitney
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Victoria Whitmore
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Michelle Bonnay
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Jamie Reese
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Julie Clark
- Iveric Bio, An Astellas Company (J.C., L.Z., D.L.), Parsippany-Troy Hills, New Jersey, USA
| | - Liansheng Zhu
- Iveric Bio, An Astellas Company (J.C., L.Z., D.L.), Parsippany-Troy Hills, New Jersey, USA
| | - Don Luo
- Iveric Bio, An Astellas Company (J.C., L.Z., D.L.), Parsippany-Troy Hills, New Jersey, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University (G.J.J.), Durham, North Carolina, USA
| | - Sunil K Srivastava
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
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Gupta U, Maatouk CM, Markle JC, Talcott KE, Singh RP, Rachitskaya AV. Characterizing the Journey of Geographic Atrophy Patients in Routine Ophthalmic Practice. Ophthalmic Surg Lasers Imaging Retina 2024; 55:204-210. [PMID: 38319056 DOI: 10.3928/23258160-20240123-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Geographic atrophy (GA) is a form of late-stage age-related macular degeneration (AMD). This study aims to characterize the journey of patients with GA in real-world ophthalmology practice. PATIENTS AND METHODS This is a retrospective cohort study of 100 patients with GA and 100 with intermediate AMD (iAMD). RESULTS Approximately one-third of GA patients' eyes had GA at the time of their initial AMD diagnosis, and nearly half of the iAMD patients' eyes had iAMD at that time. When holding confounders constant, GA patients experienced significantly worse visual acuity outcomes, and a significantly higher proportion required referrals for low vision evaluation, needed assistance for activities of daily living, failed to meet driving standards, and met criteria for legal blindness when compared to iAMD controls. CONCLUSIONS Many patients have already progressed to GA by the time they receive an AMD diagnosis, emphasizing the importance of providing early detection and intervention, especially considering novel treatment options. [Ophthalmic Surg Lasers Imaging Retina 2024;55:204-210.].
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Almuiña-Varela P, García-Quintanilla L, Rodríguez-Cid MJ, Gil-Martínez M, Abraldes MJ, Gómez-Ulla F, Estany-Gestal A, Alcántara-Espinosa JM, Fernández-Rodríguez M, Fernández-Ferreiro A. Relationships between Patient-Reported Outcome Measures and Clinical Measures in Naïve Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Ranibizumab. Pharmaceuticals (Basel) 2024; 17:157. [PMID: 38399372 PMCID: PMC10893278 DOI: 10.3390/ph17020157] [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: 12/10/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Our objective was to evaluate changes in patient-reported outcome measures using the NEI-VFQ 25 questionnaire during a treat and extend regimen in naive neovascular Age-Related Macular Degeneration patients, and its correlation with anatomical and functional data. We conducted a prospective observational study. Patients underwent a treat and extend regimen with intravitreal ranibizumab for neovascular Age-Related Macular Degeneration. Initial response was evaluated at 4th month, and subsequently in every follow-up visit. If a clinical response was achieved, the injection interval was extended in two-week increments, up to a maximum of 12 weeks. Quality of life was assessed using the NEI-VFQ 25 questionnaire at baseline, 4th months, and 12th months. Patients were categorized as good or poor responders based on Best corrected visual acuity, central foveal thickness, intraretinal fluid, or subretinal fluid. Treatment with ranibizumab led to a significant improvement in quality of life, with a mean increase in NEI-VFQ 25 score of 4.27 points in the 12th month. No significant differences in improvement were observed between good and poor responders. Quality of life scores in neovascular Age-Related Macular Degeneration patients improved with intravitreal treatment regardless of the clinical response. The early response following the loading phase could indicate better quality of life after one year of treatment, with Best corrected visual acuity being the clinical parameter with the greatest influence on quality of life.
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Affiliation(s)
- Pablo Almuiña-Varela
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - Laura García-Quintanilla
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - María José Rodríguez-Cid
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
| | - María Gil-Martínez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - Maximino J. Abraldes
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Instituto Oftalmológico Gómez-Ulla, 15706 Santiago de Compostela, Spain;
- Department of Surgery, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | | | - Ana Estany-Gestal
- FIDIS-Unidad de Epidemiología e Investigación Clínica, 15706 Santiago de Compostela, Spain; (A.E.-G.); (J.M.A.-E.)
| | | | - Maribel Fernández-Rodríguez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Instituto Oftalmológico Gómez-Ulla, 15706 Santiago de Compostela, Spain;
- Department of Surgery, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
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Krogh Nielsen M, Hinnerskov JMV, Sørensen TL. Geographic atrophy - Signs, symptoms, and quality of life. Acta Ophthalmol 2023; 101:896-902. [PMID: 37933609 DOI: 10.1111/aos.15794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023]
Abstract
Geographic atrophy (GA) is a prevalent cause of vision loss among elderly and is associated with a significant loss of function. We reviewed the current literature to assess the effect of GA on patients' daily lives and well-being. We record and organize the signs, symptoms, and impacts that are important in life with GA. Further, we examined the impact of GA on vision-related quality of life. The main complaint among patients was difficulties regarding daily tasks, especially reading and other near activities. However, a large proportion of patients also reported fear, frustration, and anxiety as salient symptoms with large impact. Many patients do not have adequate information about their condition as well as the prognosis. The most commonly used measure of patient-reported outcome measure (PROM) is the National Eye Institute Visual Function Questionnaire (VFQ), that reflects the severity of impact on 12 subscales, from where near activities, general vision, mental health, and role difficulties had the lowest scores. Longitudinal studies of GA and the impact of low-vision rehabilitation efforts on health-related quality of life are sparse but suggest a significant improvement on several items. PROM is included in clinical trials, and so far, no drug has shown to improve the functional outcome in terms of PROM.
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Affiliation(s)
- Marie Krogh Nielsen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | | | - Torben Lykke Sørensen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Heier JS, Lad EM, Holz FG, Rosenfeld PJ, Guymer RH, Boyer D, Grossi F, Baumal CR, Korobelnik JF, Slakter JS, Waheed NK, Metlapally R, Pearce I, Steinle N, Francone AA, Hu A, Lally DR, Deschatelets P, Francois C, Bliss C, Staurenghi G, Monés J, Singh RP, Ribeiro R, Wykoff CC. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet 2023; 402:1434-1448. [PMID: 37865470 DOI: 10.1016/s0140-6736(23)01520-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Geographic atrophy is a leading cause of progressive, irreversible vision loss. The objectives of OAKS and DERBY were to assess the efficacy and safety of pegcetacoplan compared with sham treatment in patients with geographic atrophy. METHODS OAKS and DERBY were two 24-month, multicentre, randomised, double-masked, sham-controlled, phase 3 studies, in which patients aged 60 years and older with geographic atrophy secondary to age-related macular degeneration were enrolled at 110 clinical sites and 122 clinical sites worldwide, respectively. Patients were randomly assigned (2:2:1:1) by central web-based randomisation system to intravitreal 15 mg per 0·1 mL pegcetacoplan monthly or every other month, or sham monthly or every other month using stratified permuted block randomisation (stratified by geographic atrophy lesion area at screening, history or presence of active choroidal neovascularisation in the eye not under assessment, and block size of six). Study site staff, patients, reading centre personnel, evaluating physicians, and the funder were masked to group assignment. Sham groups were pooled for the analyses. The primary endpoint was the change from baseline to month 12 in the total area of geographic atrophy lesions in the study eye based on fundus autofluorescence imaging, in the modified intention-to-treat population (ie, all patients who received one or more injections of pegcetacoplan or sham and had a baseline and at least one post-baseline value of lesion area). Key secondary endpoints (measured at 24 months) were change in monocular maximum reading speed of the study eye, change from baseline in mean functional reading independence index score, change from baseline in normal luminance best-corrected visual acuity score, and change from baseline in the mean threshold sensitivity of all points in the study eye by mesopic microperimetry (OAKS only). Safety analyses included patients who were randomly assigned and received at least one injection of pegcetacoplan or sham. The now completed studies are registered with ClinicalTrials.gov, NCT03525613 (OAKS) and NCT03525600 (DERBY). FINDINGS Between Aug 30, 2018, and July 3, 2020, 1258 patients were enrolled in OAKS and DERBY. The modified intention-to-treat populations comprised 614 (96%) of 637 patients in OAKS (202 receiving pegcetacoplan monthly, 205 pegcetacoplan every other month, and 207 sham) and 597 (96%) of 621 patients in DERBY (201 receiving pegcetacoplan monthly, 201 pegcetacoplan every other month, and 195 sham). In OAKS, pegcetacoplan monthly and pegcetacoplan every other month significantly slowed geographic atrophy lesion growth by 21% (absolute difference in least-squares mean -0·41 mm2, 95% CI -0·64 to -0·18; p=0·0004) and 16% (-0·32 mm2, -0·54 to -0·09; p=0·0055), respectively, compared with sham at 12 months. In DERBY, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth, although it did not reach significance, by 12% (-0·23 mm2, -0·47 to 0·01; p=0·062) and 11% (-0·21 mm2, -0·44 to 0·03; p=0·085), respectively, compared with sham at 12 months. At 24 months, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth by 22% (-0·90 mm2, -1·30 to -0·50; p<0·0001) and 18% (-0·74 mm2, -1·13 to -0·36; p=0·0002) in OAKS, and by 19% (-0·75 mm2, -1·15 to -0·34; p=0·0004) and 16% (-0·63 mm2, -1·05 to -0·22; p=0·0030) in DERBY, respectively, compared with sham. There were no differences in key secondary visual function endpoints at 24 months. Serious ocular treatment-emergent adverse events were reported in five (2%) of 213, four (2%) of 212, and one (<1%) of 211 patients in OAKS, and in four (2%) of 206, two (1%) of 208, and two (1%) of 206 patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. New-onset exudative age-related macular degeneration was reported in 24 (11%), 16 (8%), and four (2%) patients in OAKS, and in 27 (13%), 12 (6%), and nine (4%) patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. INTERPRETATION Pegcetacoplan, the first treatment approved by the US Food and Drug Administration for geographic atrophy, slowed geographic atrophy lesion growth with an acceptable safety profile. FUNDING Apellis Pharmaceuticals.
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Affiliation(s)
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - David Boyer
- Retina Vitreous Associates Medical Group, Los Angeles, CA, USA
| | | | | | - Jean-Francois Korobelnik
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Ophthalmology Department, University of Bordeaux, Bordeaux, France
| | - Jason S Slakter
- Department of Ophthalmology, New York University, New York, NY, USA
| | | | | | - Ian Pearce
- Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Allen Hu
- Cumberland Valley Retina Consultants, Hagerstown, MD, USA
| | - David R Lally
- New England Retina Consultants, Springfield, MA, USA
| | | | | | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science, Ospedale Luigi Sacco University of Milan, Milan, Italy
| | - Jordi Monés
- Institut de la Màcula, Centro Médico Teknon, Barcelona, Spain; Barcelona Macula Foundation: Research for Vision, Barcelona, Spain
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Cleveland, OH, USA
| | | | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX, USA; Blanton Eye Institute, Houston, TX, USA; Houston Methodist Hospital, Houston, TX, USA.
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8
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Khan AM, Shahnoor S, Khan H, Affendi M, Ghaddar SA. Celebrating a breakthrough: the first-ever FDA-approved treatment for geographic atrophy: a correspondence. Int J Surg 2023; 109:2559-2560. [PMID: 37195786 PMCID: PMC10442090 DOI: 10.1097/js9.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Abdul Moiz Khan
- Department of Internal Medicine, Ayub Medical College, Abbottabad
| | - Syeda Shahnoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hareem Khan
- Department of Internal Medicine, Ayub Medical College, Abbottabad
| | - Marium Affendi
- Department of Internal Medicine, Ayub Medical College, Abbottabad
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9
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Erginturk Acar D, Batioglu F, Idil A, Sahli E, Goksuluk D. Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life. J Ophthalmol 2023; 2023:3389750. [PMID: 37455795 PMCID: PMC10349670 DOI: 10.1155/2023/3389750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). Methods The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. Results In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Conclusions Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.
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Affiliation(s)
- Damla Erginturk Acar
- Ankara University Graduate Faculty of Health Sciences, Ankara, Turkey
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Figen Batioglu
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aysun Idil
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Esra Sahli
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Dincer Goksuluk
- Department of Biostatistics, Erciyes University Faculty of Medicine, Kayseri, Turkey
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10
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Bakri SJ, Bektas M, Sharp D, Luo R, Sarda SP, Khan S. Geographic atrophy: Mechanism of disease, pathophysiology, and role of the complement system. J Manag Care Spec Pharm 2023; 29:S2-S11. [PMID: 37125931 PMCID: PMC10408405 DOI: 10.18553/jmcp.2023.29.5-a.s2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD), characterized by atrophic lesions that first start in the outer retina and progressively expand to cover the macula and the fovea, the center of the macula, leading to irreversible loss of vision over time. GA is distinct from wet or neovascular AMD (nAMD), the other form of advanced AMD. Neovascular AMD is characterized by new invading leaky blood vessels in the macula that can lead to acute vision loss. GA and nAMD may coexist in the same eye. The underlying pathophysiology of GA is complex and thought to involve chronic inflammation due to overactivation of the complement system that leads to the loss of photoreceptors, retinal pigment epithelium (RPE), and the underlying choriocapillaris. The disappearance of these structures appears as sharply demarcated atrophic lesions that are typical of GA. Researchers have reported about 1 million reported cases of GA in the United States, and about 160,000 cases occur per year. The most important risk factors for GA are increasing age and family history. Diagnosis of GA is usually made by using multimodal imaging techniques. Lesions associated with GA are highly heterogeneous, and the growth rate may differ from patient to patient. Despite the progressive nature of GA, the fovea may be spared until much later in the disease, thereby retaining central vision in patients. With time, atrophic lesions may progressively grow to involve the fovea, thereby severely impairing central vision. Vision loss can happen rapidly once the lesions reach the fovea. However, even without the involvement of the fovea, ongoing vision impairment impacting daily life may be present. Median time from GA not involving the center of the fovea (without subfoveal involvement) to GA with lesion boundary affecting the foveal center (subfoveal involvement) ranges from 1.4 to 2.5 years. GA can greatly impact patients' functioning and quality of life and limit their independence by interfering with activities of daily living, including difficulties with reading, driving, watching television, recognizing faces, and being unable to do household chores. No treatments have been available until intravitreal pegcetacoplan was recently approved by the US Food and Drug Administration for GA secondary to AMD. DISCLOSURES: Dr Bakri serves as a consultant to Apellis Pharmaceuticals, as well as AbbVie, Adverum, Eyepoint, iLumen, Iveric Bio, Genentech, Novartis, Outlook Therapeutics, Pixium, Regeneron, Roche, and Regenxbio. Drs Sharp, Luo, and Sarda are employees of Apellis Pharmaceuticals. Dr Bektas and Ms Khan are employees of RTI Health Solutions. Apellis developed and led the concept design of this publication, review and interpretation, approval, and decision to publish. This research was developed under a research contract between RTI Health Solutions and Apellis Pharmaceuticals and was funded by Apellis Pharmaceuticals. This supplement is to describe the disease of geographic atrophy and was funded by Apellis. Apellis Pharmaceuticals has developed Syfovre (pegcetacoplan), the first and only treatment for geographic atrophy.
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Affiliation(s)
| | | | | | | | | | - Shahnaz Khan
- RTI Health Solutions, Research Triangle Park, NC
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11
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Morga A, Chamberlain CX, Meyers O, Roberts C, Gaspar L, Su J. Content Validity and Cognitive Debriefing of a Patient-Reported Outcome Instrument Evaluating Symptoms and Disease Impact in Patients with Geographic Atrophy. Ophthalmol Ther 2023; 12:1181-1193. [PMID: 36781630 PMCID: PMC10011295 DOI: 10.1007/s40123-023-00667-3] [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: 10/24/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Geographic atrophy (GA) occurs in the later stages of dry age-related macular degeneration (AMD) and impairs visual acuity, eventually causing permanent blindness in some patients and impacting patient quality of life. Patient-reported outcome (PRO) measures that assess the experience of patients with visual impairment do not sufficiently capture all concepts salient to patients with GA. In this study the experience of patients with GA secondary to dry AMD was evaluated, and items from the novel 10-item Visual Impairment Symptom Severity Assessment (VISSA-10) PRO instrument were mapped to salient symptoms to assess its content validity, ease of use, and relevance. METHODS Concept elicitation interviews were conducted with patients with GA to determine salient symptoms and impacts of GA, and a conceptual model was developed to reflect these. The items in the VISSA-10 instrument were then mapped onto the salient symptoms included in this conceptual model. Cognitive debriefing interviews were also conducted with the same cohort to determine the comprehensiveness and comprehensibility of the instrument, and to qualitatively assess levels of change considered meaningful by patients. RESULTS In total, 25 symptoms and 36 impacts were reported by 19 patients with GA, with seven symptoms and 11 impacts identified as salient. Of these, 12 symptoms and 15 impacts reported were not included in a previously published conceptual model for patients with dry AMD. Overall, eight of the ten items from the VISSA-10 instrument mapped to salient symptoms reported by patients with GA. All patients reported that the instrument was clear and easy to understand. CONCLUSIONS The VISSA-10 instrument was shown to be content valid, clear, and comprehensible, with sufficient concept coverage to measure the experience of patients with GA. Although further quantitative validation is required, this instrument has demonstrated potential for implementation in future clinical trials to evaluate the efficacy of new treatments for GA.
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Affiliation(s)
- Antonia Morga
- Astellas Pharma Europe Ltd, 300 Dashwood Lang Road, Bourne Business Park, Addlestone, Surrey, KT15 2NX, UK.
| | | | - Oren Meyers
- IQVIA, 300 Vesey St 13th floor, New York, USA
| | | | | | - Jun Su
- Astellas Pharma US Inc., 9 Technology Drive, Westborough, MA, USA
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12
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Edmonds R, Steffen V, Honigberg LA, Chang MC. The Role of the Complement Pathway in Clinical Progression of Geographic Atrophy: Analysis of the Phase 3 Chroma and Spectri Trials. OPHTHALMOLOGY SCIENCE 2023. [DOI: 10.1016/j.xops.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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13
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Dry Age-Related Macular Degeneration: Distribution of Visual Acuity and Progression Risk in a Large Registry. Ophthalmol Ther 2023; 12:325-340. [PMID: 36369619 PMCID: PMC9834463 DOI: 10.1007/s40123-022-00583-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Understanding the progression to geographic atrophy (GA) in late dry age-related macular degeneration (dAMD) can support development opportunities for dAMD treatments. We characterized dAMD by distribution of visual acuity (VA) categories and evaluated VA progression risk by disease stage. METHODS This retrospective observational study used data from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) to identify patients diagnosed with dAMD in ≥ 1 eye from January 2016 through December 2019 (index date) with ≥ 1 visit and ≥ 1 VA measurement recorded post-index date. Patients were followed until the date of last visit, last contribution for diagnosing provider, or diagnosis of neovascular AMD post-index. Models were utilized to describe the distribution of VA categories and progression to worsening VA. RESULTS Data from 593,277 patients were analyzed. At baseline, 64.4% had mild disease, 29.4% intermediate, and 2.9%/3.3% had GA with/without subfoveal involvement. Most patients with mild (88.4%) and intermediate (79.7%) disease and GA without subfoveal involvement (57.1%) had baseline VA ≥ 20/63 in the study eye; 72.0% of patients with GA with subfoveal involvement had VA < 20/63. Modeled results showed lower VA with more progressive stage at baseline. Annual probability of stable dAMD based on baseline stage ranged from 82.1% (GA without) to 92.3% (GA with subfoveal involvement). Annual progression probability to GA without/with subfoveal involvement was 0.4% for mild and 5.5% for intermediate disease and from dry to neovascular AMD, 0.5% for mild and 8.0% for intermediate disease. CONCLUSIONS Results from this analysis of a large database of electronic health records complement those from randomized trials and show that patients with more advanced dAMD have lower VA at baseline and that VA progression is generally faster with each progressive stage. Together these findings highlight the disease burden and trajectory of dAMD as well as opportunities for addressing unmet needs.
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Three-Month Safety and Efficacy Outcomes for the Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT™). J Clin Med 2023; 12:jcm12020518. [PMID: 36675446 PMCID: PMC9865521 DOI: 10.3390/jcm12020518] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023] Open
Abstract
The smaller-incision new-generation implantable miniature telescope (SING IMT™) is the second generation of the IMT™, a telescope prosthesis that is indicated for monocular implantation in patients with stable vision impairment caused by bilateral central scotomas associated with end-stage Age-related macular degeneration (AMD). This non-comparative retrospective study is the first and largest single-surgeon case series to evaluate the short-term (3 months) safety and efficacy of the device in patients with disciform scars or geographic atrophy at baseline. The main outcome measures included best-corrected distance and near visual acuity (CDVA and CDNVA, respectively), endothelial cell density (ECD) loss, and the incidence of complications. At postoperative month 3 in the study eyes, mean CDVA and CDNVA improved by +14.9 ± 7.1 letters and +7.7 ± 3.2 Jaeger levels, respectively. Importantly, 70.83% of patients gained ≥ 2 lines, 58.33% ≥ 3 lines, and 25.00% ≥ 4 lines of CDVA. From baseline, ECD loss in the study eyes was 10.4 ± 13.3% at 3 months, however, ECD was comparable between the study and fellow eyes at all time points. The most common complication was corneal edema. In all, these short-term outcomes suggest that the SING IMT™ delivers lower ECD loss than the first-generation IMT ™, but similar visual outcomes and safety.
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15
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Different impact of early and late stages irreversible eye diseases on vision-specific quality of life domains. Sci Rep 2022; 12:8465. [PMID: 35589884 PMCID: PMC9120442 DOI: 10.1038/s41598-022-12425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
To determine the differential impact of the irreversible eye diseases on vision-related quality of life (VRQoL) in a multi-ethnic Asian population. 2652 participants from the Singapore Epidemiology of Eye Disease Study, with any of the following early and late-stage eye conditions including age-related macular degeneration (AMD, n = 158), diabetic retinopathy (DR, n = 105; non vision threatening [non-VTDR]; VTDR), glaucoma (n = 57) and myopic macular degeneration (MMD, n = 106), or none of the above (controls, 2226 [83.9%]) were included. Rasch-scaled scores of the Emotional well-being Mobility and Reading subscales of the Impact of Vision Impairment (IVI) questionnaire, collectively referred to as "VRQoL" were assessed. Multivariable linear regression analyses and pairwise comparisons adjusting for age, gender, ethnicity, socio-economic status, BMI, smoking, alcohol use, presence of systemic diseases and presenting VI were performed to assess and compare the impact of the presence and severity of each eye condition on the three IVI domains. Multivariable adjusted pairwise comparisons of VRQoL between early stages of the four eye diseases showed no significant differences (all P > 0.05). For late stage diseases, individuals with VTDR had significantly larger decrements in Emotional well-being compared to glaucoma (β - 0.81; 95% CI - 1.47 to - 0.16) and MMD (β - 1.17; 95% CI - 2.16 to - 0.18); and Reading decrements compared to glaucoma (β - 0.66; 95% CI - 1.22 to - 0.11). When compared to late glaucoma, individuals with late AMD (β - 0.76; 95% CI - 1.50 to - 0.01) had significantly larger IVI Mobility subscale decrements. VTDR and late AMD, appear to have the greatest impact on VRQoL, compared to late glaucoma and MMD, suggesting a differential impact of late-stage eye disease categorization on VRQoL.
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Wykoff CC, Hershberger V, Eichenbaum D, Henry E, Younis HS, Chandra P, Yuan N, Solloway M, DePaoli A. Inhibition of Complement Factor 3 in Geographic Atrophy with NGM621: Phase 1 Dose-Escalation Study Results. Am J Ophthalmol 2022; 235:131-142. [PMID: 34509438 DOI: 10.1016/j.ajo.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the safety and tolerability of single and multiple intravitreal injections of NGM621 in patients with geographic atrophy (GA) and to characterize the pharmacokinetics and immunogenic potential. DESIGN Multicenter, open-label, single- and multiple-dose phase 1 study. METHODS Fifteen patients enrolled at 4 sites in the United States. Participants had GA secondary to age-related macular degeneration, lesion size ≥2.5 mm2, best-corrected visual acuity of 4 to 54 letters (20/80 to 20/800 Snellen equivalent) in the study eye, and no history of choroidal neovascularization in either eye. Patients who met eligibility criteria were treated in a single ascending-dose phase (2 mg, 7.5 mg, and 15 mg) or received 2 doses of NGM621 (15 mg) 4 weeks apart in the multidose phase and were monitored for 12 weeks (85 days). Assessments included adverse events, best-corrected visual acuity, low-luminance visual acuity, vital signs, clinical laboratory evaluations, GA lesion area as measured by fundus autofluorescence, spectral domain optical coherence tomography, and pharmacokinetic, immunogenicity, and pharmacodynamic assessments. RESULTS All 15 participants completed the 12-week study. There were no serious adverse events, no drug-related adverse events, and no choroidal neovascularization developed in either eye. Mean visual acuity and GA lesion area appeared stable through week 12 for all cohorts. Pharmacokinetic analyses indicated that NGM621 serum exposures appeared to be dose proportional, and no antidrug antibodies were identified at any of the evaluated time points. CONCLUSIONS In this small, open-labeled, 12-week phase 1 study, NGM621 was safe and tolerable when administered intravitreally up to 15 mg.<END ABSTRACT>.
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Sarda SP, Heyes A, Bektas M, Thakur T, Chao W, Intorcia M, Wronski S, Jones DL. Humanistic and Economic Burden of Geographic Atrophy: A Systematic Literature Review. Clin Ophthalmol 2021; 15:4629-4644. [PMID: 34916775 PMCID: PMC8667751 DOI: 10.2147/opth.s338253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Geographic atrophy (GA), the advanced form of dry age-related macular degeneration, can result in irreversible blindness over time. We performed a systematic literature review to assess the humanistic and economic burden of GA. METHODS Predefined search terms were used to identify studies in PubMed, Embase, and Cochrane Library; conference abstracts also were searched. RESULTS Of 1111 unique studies identified, 25 studies on humanistic burden, 4 on economic burden, and 3 on both humanistic and economic burden of GA were included. Vision-related functioning and health-related quality of life (HRQOL) are poor in patients with GA. HRQOL is commonly measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25); patients with GA have significantly lower composite and subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision than individuals without GA. Driving is a particular concern, and inability to drive affects dependency. Vision-related quality of life (VRQOL) declines as GA progresses. While we identified only 7 reports describing the economic burden of GA, its direct costs may be substantial. In a US study, mean cost to the payer per patient with GA was $11,533 in the year after diagnosis. A multinational study estimated annualized total direct costs of €1772 per patient with GA, mainly driven by diagnostic tests and procedures (€1071). Patients with GA are at increased risk of falls and fractures, potentially increasing direct costs. Only one study evaluated indirect costs, estimating ~$24.4 billion in yearly lost wages among people with severe vision loss due to GA or drusen ≥125 μm. CONCLUSION GA represents a significant humanistic burden. Evidence on the economic impact of GA is limited; characterizing the economic burden of GA requires further research. Interventions that reduce GA-related disability may improve HRQOL and reduce indirect costs.
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Affiliation(s)
| | - Anne Heyes
- RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - Meryem Bektas
- RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - Tanvee Thakur
- RTI Health Solutions, Research Triangle Park, NC, 27709, USA
| | - Wendy Chao
- Apellis Pharmaceuticals, Waltham, MA, 02451, USA
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Caswell D, Caswell W, Carlton J. Seeing Beyond Anatomy: Quality of Life with Geographic Atrophy. Ophthalmol Ther 2021; 10:367-382. [PMID: 34089491 PMCID: PMC8319273 DOI: 10.1007/s40123-021-00352-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 10/28/2022] Open
Abstract
Quality of life (QoL) is a complex idea without a clear consensus definition. Generally speaking, QoL refers to several subjective measures of wellbeing that vary by individual and circumstance. QoL can decline noticeably as a disease progresses. This is particularly true for geographic atrophy (GA), an advanced form of age-related macular degeneration. GA leads to vision loss for which there is no currently approved pharmacological treatment. There is a lack of qualitative, patient-driven research on QoL in GA. There is also limited information available to both patients and physicians about GA, existing support groups and available assistive technologies. To address this, we have collated the experiences of a person with GA and those of her partner and carer with the current literature on QoL in GA. We have also outlined some of the wide range of developing technologies available to help people with GA carry out daily tasks and hobbies. It is clear that support, whether through informal or structured care, is vital to the wellbeing of people with GA. Despite this, the general public are often unaware of care work, which may result in this integral role being undervalued and under acknowledged. Furthermore, it is apparent that the general public have fundamental misunderstandings around what vision loss entails and are unaware that blindness is a vast spectrum. This feeds into the seemingly paradoxical mix of isolation and dependence on others that often results from GA and vision loss. Through this qualitative examination of a patient's experiences, we hope to inform and educate both patients and physicians about GA as well as precipitate discussion around the frameworks that should be in place to support both newly diagnosed and long-term patients with GA and other retinal diseases. Seeing beyond anatomy: quality of life with geographic atrophy (WMV 29479 kb).
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Affiliation(s)
- Dolores Caswell
- Canadian National Institute for the Blind, Toronto, Ontario, Canada
- Patient author, Vancouver, British Columbia, Canada
| | | | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Scholl HPN, Boyer D, Giani A, Chong V. The use of neuroprotective agents in treating geographic atrophy. Ophthalmic Res 2021; 64:888-902. [PMID: 34153966 DOI: 10.1159/000517794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
| | - Andrea Giani
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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Yu HJ, Wykoff CC. Investigational Agents in Development for the Treatment of Geographic Atrophy Secondary to Age-Related Macular Degeneration. BioDrugs 2021; 35:303-323. [PMID: 33893984 DOI: 10.1007/s40259-021-00481-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/13/2022]
Abstract
Geographic atrophy (GA) is an advanced form of age-related macular degeneration, a late-onset, complex, genetic degenerative disease of the retina. Multiple environmental and genetic factors have been implicated in the development of GA, a pathology ultimately defined by loss of photoreceptors and the underlying retinal pigment epithelium and choriocapillaris. The personal burden of GA has been documented to have a substantial negative impact on quality of life, with progressive and cumulative loss of visual function each year. Currently, there are no treatments to prevent or slow the development or progression of GA. Multiple genetic and histopathologic studies have implicated dysregulation of the complement cascade in GA pathogenesis, leading to the development of several investigational pharmaceuticals targeting key factors in this inflammatory pathway. Several other biochemical pathways have also been implicated in GA development and progression, such as mitochondrial components, mediators of apoptosis and molecules involved in extracellular matrix remodeling, many of which are also being investigated for their potential value as therapeutic targets for GA treatment. Recent advancements in our understanding of GA pathogenesis and the progression of multiple potential therapeutics into later-stage human clinical trials hold great promise for a clinically effective therapeutic for patients with GA to emerge within the near future.
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Affiliation(s)
- Hannah J Yu
- Retina Consultants of Texas, Retina Consultants of America, 4460 Bissonnet St., Suite 200, Bellaire, Texas, 77401, United States
| | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, 4460 Bissonnet St., Suite 200, Bellaire, Texas, 77401, United States.
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
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