EyeWorld India March 2012 Issue

52 EW RETINA March 2012 Therapy on the anti-VEGF frontier by Maxine Lipner Senior EyeWorld Contributing Editor Update on retinal sparing drugs for AMD A nti-VEGF therapy to fight neovascular eye disease recently got a boost when on 18 November 2011, EYLEA (Regeneron Pharmaceuticals, Tarrytown, NY, USA), also known as VEGF Trap-Eye, received U.S. FDA approval for wet AMD cases. This is one new anti-VEGF gaining ground in an area that has been dominated by Avastin (bevacizumab, Genentech, South San Francisco, Calif., USA) and Lucentis (ranibizumab, Genentech), considered breakthrough drugs in their own right for AMD patients. Investigators are also honing in on other drugs such as integrin peptide therapy. EyeWorld asked practitioners to offer their insights on these valuable drugs. The approval of EYLEA is considered a coupe for patients since it can be administered much less frequently than other anti-VEGFs. It has an additional mechanism of action, according to Peter K. Kaiser, MD , professor of ophthalmology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. “EYLEA is similar to other anti-VEGF agents on the market such as Lucentis and Avastin in that it blocks isoforms of VEGF, but in addition it blocks placenta growth factor, which is in and of itself an angiogenic pathway,” Dr. Kaiser said. The other difference is the way that it binds to VEGF. “It binds much tighter than Lucentis and Avastin, which theoretically would allow it to last longer in terms of its biologic activity,” he said. “That was borne out in the clinical study where it went head-to-head against Lucentis given monthly.” In the study, EYLEA was given after a loading dose just every other month and boasted equal results in vision and safety. It had essentially identical results to Lucentis given monthly. Dr. Kaiser sees this as enabling practitioners to dose patients every other month as opposed to every month or even less. “In all likelihood since most of us don’t inject Lucentis every month—we use some sort of as-needed protocol—the fact that EYLEA lasts longer will hopefully make that as-needed difference even greater,” he said. No red flags were raised in the clinical study in terms of safety. He sees approval of EYLEA as a potential boon for patients and practitioners alike. He pointed out that patients who have been taking Avastin monthly could be switched to EYLEA every other month. For practitioners, he thinks that it will unclog the clinics a bit, and for patients and their families it will ultimately mean fewer injections and fewer trips to the office. Dr. Kaiser looks to a future in which monthly anti- VEGF injections are obsolete. “Anything that reduces that treatment burden is huge,” he said. CATT and its implications Lucentis and Avastin remain key anti-VEGF players here. The recent Comparison of Age- Related Macular Degeneration Treatments Trials (CATT)