EyeWorld India March 2012 Issue

53 EW RETINA March 2012 closely examined how these two valuable agents stack up against one another. The two drugs tended to be administered differently from the start, according to Daniel F. Martin, MD, chairman, Cole Eye Institute, Cleveland Clinic, Ohio, USA. Lucentis had been studied as a monthly injection, while the predominant treatment pattern for Avastin was on an as-needed basis. In CATT both drugs fared similarly. “We showed that Lucentis and Avastin were nearly identical for all visual acuity metrics that we looked at, at 1 year,” Dr. Martin said. “We also showed that PRN dosing could produce an excellent visual result, but on average it was about two letters less than was achieved with monthly dosing.” Another finding was that both drugs produced an immediate and substantial decrease in fluid on OCT, but there was a slight difference between the two. “At 1 year there were more eyes that were completely dry with Lucentis than eyes treated with Avastin,” Dr. Martin said. “The absolute difference in the number of those eyes was small and the average amount of fluid that remained was extremely small— its clinical relevance was not clear.” Dr. Martin stressed that it remains unclear whether the two-letter difference between PRN and monthly dosing will be wider at follow-up or whether the fact that there was a difference in the amount of fluid between Lucentis and Avastin treated eyes will ultimately matter. In terms of safety, CATT found no difference in terms of death, myocardial infarction, or stroke. However, there were more patients who received Avastin who experienced a serious adverse event (SAE). The difference in SAEs was 24% for Avastin and 19% for Lucentis. “This may be due to chance, it may be due to an imbalance at baseline, or it may represent a real risk that we still don’t understand,” Dr. Martin said. “We’re looking forward to a second year of follow-up and to the results of other worldwide trials comparing Lucentis and Avastin.” Integrin peptide therapy Another VEGF-related type of therapy being looked at is integrin peptide therapy with Alg-1001 (Allegro Ophthalmics, San Juan Capistrano, Calif., USA) for wet AMD as well as diabetic retinopathy. The drug has a slightly different mechanism, according to Baruch D. Kuppermann, MD, PhD, chief of the retina service, and professor of ophthalmology and biomedical engineering, Gavin Herbert Eye Institute, University of California, Irvine, Calif., USA. “It does intervene with VEGF, but it also inhibits tyrosine Index to Advertisers Abbott Medical Optics (AMO) Page: 25 Phone: +1-866-427-8477 www.AbbottMedicalOptics.com , www.amo-inc.com, www.tecnisiol.com Bausch + Lomb Page: 23, 32 , Supplement Phone: +65-7834-9112 Fax: +65-6286-0448 www.bausch.com Carl Zeiss Meditec, AG Page: 19 Phone: +49 30 8540 01 0 Fax: +49 30 8540 01 123 www.meditec.zeiss.com Carl Zeiss Meditec, Asia Pacific Page: 28 Phone: +65-6741-9600 Fax: +65-6842-7117 www.zeiss.com.sg Moria Page: 35 Moria SA Phone: +33-(0)-1-4674-4674 Fax: +33-(0)-1-4674-4670 Email: moria@moria-int.com www.moria-surgical.com Moria in China Supplement Phone: +86-21-5258-5066 Fax: +86-2-5258-5067 www.moria-surgical.com.cn STAAR Surgical Page: 12 Phone: +65-64936953/ +65-97661547 Email: atan@staarag.ch www.staar.com , www.visianinfo.com Technolas Singapore Pte Ltd Page: 14, Supplement Phone: +65-6592-0792 Fax: +65-6250-1060 Email: Y.Ng@technolaspv.com , M.Soon@technolaspv.com , A.Koh@technolaspv.com www.technolaspv.com, www.intracor.net ASCRS 2012 ASCRS Chicago Page: 60 kinase and does things to the vitreous as well,” Dr. Kuppermann said. “It can cause vitreous liquefaction and that decreases intraocular VEGF levels.” In addition, it may cause a posterior vitreous detachment, which some think may inhibit progression of disease. Dr. Kuppermann cited a small phase I study conducted by Peter Campochiaro, MD, that showed promise for the drug. “This one reduced the area of neovascularization by 43%, which is similar to other anti- VEGF agents,” Dr. Kuppermann said. In the study, eight out of 15 eyes with diabetic macular edema showed a three-line improvement after monthly injections at 0, 30, and 60 days. “Within 30 days there was already a reduction in OCT thickness in the eight eyes that had a three-line improvement or more,” Dr. Kuppermann said. “After 90 days they withheld therapy, and all of the eyes were relatively stable from an OCT thickness over that subsequent 90 days.” The seven eyes that did not show a response lost no vision. A phase II trial is now being planned. Because it uses a different mechanism of action, Dr. Kuppermann thinks that it at least theoretically may be additive to the anti-VEGF compounds. There is also the hope that it may be synergistic. At the very least it seems to have potential on its own as mono- therapy, he pointed out. EW Editors’ note: Dr. Kaiser has financial interests with Bayer (Leverkusen, Germany), Genentech, Novartis (Basel, Switzerland), and Regeneron. Dr. Kuppermann has financial interests with Allegro and Ophthotech (Princeton, NJ, USA). Dr. Martin has no financial interests related to this article. Contact information Kaiser: 216-444-6702, pkkaiser@aol.com Kuppermann: 949-677-6361, bdkupper@uci.edu Martin: 216-444-0431, martind5@ccf.org