EyeWorld Asia-Pacific December 2015 Issue

61 EWAP PHARMACEUTICALS December 2015 Anti-VEGFs in the spotlight by Maxine Lipner EyeWorld Senior Contributing Writer Update for the cataract surgeon O ne of the biggest events in ophthalmology in 100 years was when Napoleone Ferrara purified cloned VEGF and made antibodies against it, according to Steve Charles, MD , clinical professor of ophthalmology, University of Tennessee, and founder of Charles Retina Institute, Germantown, Tenn. While all that was hoped for was that this would slow the rate of vision loss, it exceeded expectations. “Not only did they stop it dead in its tracks in 75% of patients, but 40% of people saw visual improvement,” Dr. Charles said. Here’s the latest on what these drugs have to offer. There are several reasons why patients slated to undergo cataract surgery may be on anti-VEGF therapy, said David S. Boyer, MD , clinical professor of ophthalmology, Keck School of Medicine, University of Southern California, and partner at Retina Vitreous Associates, Torrance, Calif. “Anti-VEGF therapy has been shown to improve age- related macular degeneration, diabetic retinopathy, retinal vein occlusions, and many other forms of leakage in the posterior pole, all of which may coexist in patients with cataracts,” he said. Anti-VEGF arsenal Currently, there are 3 anti- VEGF agents in use: Lucentis (ranibizumab, Genentech, South San Francisco), Eylea (aflibercept, Regeneron, Tarrytown, NY), and Avastin (bevacizumab, Genentech). Dr. Boyer relies on each of these for different reasons. “There has been only one head-to-head study where all 3 drugs were utilized, and that’s the Protocol T from the Diabetic Retinopathy Clinical Research Network,” he said. Results were connected to the patient’s vision. “If vision was 20/40 or better, all drugs seemed to act similarly; if vision was 20/50 or worse, it seemed that aflibercept had a bigger advantage in improving vision,” Dr. Boyer said, adding that this seems to cause a better drying effect. However, it was the group of patients who were severely edematous and who had very poor vision in the study who responded better with aflibercept. Dr. Charles pointed out that many in the cataract community erroneously believe that the drug of choice is Avastin. “That is the least effective drug for diabetic retinopathy,” he said. “It finished last in a head-to-head trial with Lucentis.” Likewise, when it came to AMD in the Comparison of AMD Treatments Trials, which also compared Lucentis to Avastin, Lucentis was a bit better. “OCT findings of subretinal fluid as well as visual outcomes showed that Lucentis won by a little bit,” Dr. Charles said. On the podium this tends to be presented as the two being substantially equivalent, but Medicare pays just US$40 or US$50 for Avastin, Eye of a patient with stable proliferative diabetic retinopathy that has received multiple intravitreal bevacizumab injections Source: David S. Boyer, MD continued on page 62