Longer acting drugs for retinal disease
Francesco Bandello MD, FEBO
New slow-release drugs targeting a range of retinal diseases are currently finding their way into clinical practice and could herald a major change in the way patients are managed, according to Francesco Bandello MD, FEBO. “Longer lasting drugs would solve one of the real limitations of our current treatments,” Prof Bandello said in a presentation at the World Ophthalmology Congress 2020 Virtual. “Frequent intravitreal injections represent a significant treatment burden on patients. There are compliance issues, and possible objective impediments to frequent hospital trips such as the COVID-19 outbreak, as well as economic implications for healthcare systems.”
Prof Bandello highlighted three such agents which have shown particular promise in recent trials: brolucizumab, abicipar pegol, and Iluvien.
In several trials for neovascular AMD, brolucizumab showed non-inferiority to aflibercept at 48 and 96 weeks with one injection every three months. It also resulted in a significant reduction in retinal fluid. “The effect on fluid is one of the most important effects we can obtain with this new drug,” said Prof Bandello.
Some concerns about the incidence of vasculitis on patients treated with the drug will need to be explored further in future studies, said Prof Bandello.
The anti-VEGF molecule abicipar pegol has already performed well in several phase III trials, with a high percentage of patients maintaining best-corrected visual acuity at the primary endpoint.
Finally, Prof Bandello highlighted the Iluvien implant, which he said releases the active agent, fluocinolone acetonide, in a steady and continuous release without concentration spikes and with long-lasting efficacy.
“This seems a more rational approach with the steady release of drugs downgrading the release of cytokines in the eye to below the pathologic level in diseases such as diabetic macular oedema for example. This is really the type of concept that we need going forward for treating our patients,” he said.