Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options

Neovascular age-related macular degeneration (nAMD) is a common world-wide cause of visual loss. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are an effective means to treat nAMD and reduce its impact on vision compared to either sham treatment or photodynamic therapy. Cur...

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Autores principales: Tan, Colin S, Ngo, Wei Kiong, Chay, Isaac W, Ting, Dominic S, Sadda, SriniVas R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965014/
https://www.ncbi.nlm.nih.gov/pubmed/35368240
http://dx.doi.org/10.2147/OPTH.S231913
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author Tan, Colin S
Ngo, Wei Kiong
Chay, Isaac W
Ting, Dominic S
Sadda, SriniVas R
author_facet Tan, Colin S
Ngo, Wei Kiong
Chay, Isaac W
Ting, Dominic S
Sadda, SriniVas R
author_sort Tan, Colin S
collection PubMed
description Neovascular age-related macular degeneration (nAMD) is a common world-wide cause of visual loss. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are an effective means to treat nAMD and reduce its impact on vision compared to either sham treatment or photodynamic therapy. Currently, the approved anti-VEGF drugs include ranibizumab, aflibercept and brolucizumab. In addition, bevacizumab, used as an off-label drug, and has been shown to be effective in treating nAMD. While anti-VEGF agents are effective, its limitations include the requirement for frequent, often monthly injections, and the need for long-term treatment of nAMD. These present significant burdens on the healthcare system and on the patients. In addition, reviews of patients with nAMD treated with anti-VEGF have reported deterioration of vision over time with progression of geographic atrophy. These limitations are partly addressed by exploring different treatment regimens that reduce the frequency of treatments. Newer anti-VEGF drugs have been shown in Phase III clinical trials to have injection intervals as long as 12 or even 16 weeks for a proportion of patients. There is research on newer drugs that affect other pathways, such as the angiopoietin pathway, which may impact nAMD by extending the treatment interval and reducing the burden of treatment. Other measures include the use of sustained-release implants that release the drug regularly over a period of time, and can be refilled periodically, as well as hydrogel platforms that serve to release the drug. The use of biosimilars will also serve to reduce the cost of treatment for nAMD. A new frontier of gene therapy, primarily targeting genes involved in the transduction of retinal cells to produce anti-VEGF proteins intraocularly, also opens a new avenue of therapeutic approaches that can be used for treatment. This review paper will discuss both current treatment options and the newer treatments under development.
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spelling pubmed-89650142022-03-31 Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options Tan, Colin S Ngo, Wei Kiong Chay, Isaac W Ting, Dominic S Sadda, SriniVas R Clin Ophthalmol Review Neovascular age-related macular degeneration (nAMD) is a common world-wide cause of visual loss. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are an effective means to treat nAMD and reduce its impact on vision compared to either sham treatment or photodynamic therapy. Currently, the approved anti-VEGF drugs include ranibizumab, aflibercept and brolucizumab. In addition, bevacizumab, used as an off-label drug, and has been shown to be effective in treating nAMD. While anti-VEGF agents are effective, its limitations include the requirement for frequent, often monthly injections, and the need for long-term treatment of nAMD. These present significant burdens on the healthcare system and on the patients. In addition, reviews of patients with nAMD treated with anti-VEGF have reported deterioration of vision over time with progression of geographic atrophy. These limitations are partly addressed by exploring different treatment regimens that reduce the frequency of treatments. Newer anti-VEGF drugs have been shown in Phase III clinical trials to have injection intervals as long as 12 or even 16 weeks for a proportion of patients. There is research on newer drugs that affect other pathways, such as the angiopoietin pathway, which may impact nAMD by extending the treatment interval and reducing the burden of treatment. Other measures include the use of sustained-release implants that release the drug regularly over a period of time, and can be refilled periodically, as well as hydrogel platforms that serve to release the drug. The use of biosimilars will also serve to reduce the cost of treatment for nAMD. A new frontier of gene therapy, primarily targeting genes involved in the transduction of retinal cells to produce anti-VEGF proteins intraocularly, also opens a new avenue of therapeutic approaches that can be used for treatment. This review paper will discuss both current treatment options and the newer treatments under development. Dove 2022-03-25 /pmc/articles/PMC8965014/ /pubmed/35368240 http://dx.doi.org/10.2147/OPTH.S231913 Text en © 2022 Tan et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Tan, Colin S
Ngo, Wei Kiong
Chay, Isaac W
Ting, Dominic S
Sadda, SriniVas R
Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options
title Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options
title_full Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options
title_fullStr Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options
title_full_unstemmed Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options
title_short Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options
title_sort neovascular age-related macular degeneration (namd): a review of emerging treatment options
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965014/
https://www.ncbi.nlm.nih.gov/pubmed/35368240
http://dx.doi.org/10.2147/OPTH.S231913
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