Dexamethasone Implant With Anti-VEGF Explored for Wet AMD

by: Laird Harrison
Used in combination with antivascular endothelial growth factor (anti-VEGF) therapy, dexamethasone implants (0.7 mg Ozurdex, Allergan) may help some patients with neovascular age-related macular degeneration (nAMD) that is resistant to anti-VEGF monotherapy, researchers say.
In a group of patients with a disappointing response to anti-VEGF treatment, the implants improved anatomical signs of disease, reduced the number of injections needed, and showed a trend toward improved visual acuity, say Bozho Todorich, MD, PhD, from Associated Retinal Consultants in Royal Oak, Michigan, and colleagues.
“Earlier treatment with dual therapy may be beneficial to maximize anatomic and visual outcomes in these patients,” the researchers write in an article published in the January/February issue of the Journal of VitreoRetinal Diseases.
Although injections with the anti-VEGF treatments bevacizumab (Avastin, Genentech), ranibizumab (Lucentis, Genentech), and aflibercept (Eylea, Regeneron) improve the eyesight of most patients with nAMD, some do not respond.
Corticosteroids may suppress inflammatory processes involved in the disease, stabilizing vascular tight junctions and decreasing leakage, producing apoptosis of peripheral T-cells and eosinophils, and possibly blocking fibroblast activation and proliferation, Dr Todorich and colleagues write. In addition, glucocorticoids directly inhibit VEGF production, they add.
Dexamethasone is a potent steroid, but it clears rapidly from the vitreous cavity. In contrast, an intravitreal implant, Ozurdex, emits dexamethasone steadily during a period of up to 6 months.
The US Food and Drug Administration has approved the implant for the treatment of diabetic macular edema, cystoids, macular edema associated with retinal vein occlusion, and noninfectious uveitis.
Therefore, Dr Todorich and colleagues wanted to see whether the implant combined with an anti-VEGF treatment could benefit patients whose nAMD had not responded well to anti-VEGF treatment alone.
They recruited 18 consecutive of patients with a mean age of 81.5 years who were diagnosed with nAMD with active subfoveal choroidal neovascularization and best-corrected visual acuity of 20/30 to 20/800.
All the patients had shown resistance after receiving at least 2 anti-VEGF injections with a minimum follow-up of 3 months. They had received a mean of 26.3 anti-VEGF injections (range, 2 – 56).

The researchers defined treatment resistance as persistent intraretinal or subretinal fluid despite monthly injections, no improvement in central foveal thickness and macular cube volume in response to anti-VEGF therapy, and new or worsening subretinal hemorrhage despite monthly anti-VEGF injections.

Two patients had undergone photodynamic therapy, and two had tried intravitreal triamcinolone acetonide……
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Source: Medscape