Current advances in wet AMD are not enough
As the population continues to age, the need for medical advances targeted at age-related diseases is growing in tandem with no signs of slowing down. The field of ophthalmology is no exception. Serious eye disorders that can lead to blindness, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, diabetic macular edema (DME), and retinal vein occlusion are just a few. some of the areas that are the main contributors to blindness among those 65 and older. These diseases can be deeply distressing for millions of affected people, their loved ones and caregivers. And as the number of people with these disorders increases with the aging of the population, these diseases also have an increasing impact on the healthcare system as a whole and on our society.
AMD, in particular, affects up to 11 million Americans. About 15% of those affected have neovascular or wet AMD. It is a devastating disease that can lead to irreversible vision loss. In fact, wet AMD is the leading cause of blindness in people age 50 and older in the United States.
Wet AMD occurs when abnormal blood vessels grow in the back of the eye and damage the macula, due to an abnormal increase in vascular endothelial growth factor (VEGF) in the retina. VEGF in the retina can be produced in response to a compromised blood supply leading to poor oxygen supply to cells within. As a result, these blood vessels leak fluid and sometimes whole blood into the retina, causing damage to the retinal structure and scarring of its layers. Without early and frequent treatment, a gradual reduction or complete loss of central vision over time can occur.
Symptoms of wet AMD can include blurring in the center of vision, straight lines that appear wavy, colors that appear dull and washed out, blotches or blind spots as well as objects that appear further away than they appear to be. are actually. Complete blindness is rare, but there is a reduction or loss of central vision over time. Additionally, there are a variety of factors that put individuals at increased risk of developing wet AMD, such as age, ethnicity (seeming to be more prevalent among Caucasians), genetics/family history, smoking, alcohol and cardiovascular disease.
Trends, challenges and solutions in the treatment of wet AMD
There is vast room for improvement in the existing treatment landscape for wet AMD. Currently, most wet AMD patients are treated monthly or bimonthly with eye injections. This intense treatment regime is an ongoing challenge for patients, caregivers and physicians.
Although there are a number of medications available that are deemed effective in this space – requiring regular and continuous intraocular injections – they are often seen as uncomfortable, intimidating and impractical to the point that compliance can become an issue. And we know, from large databases of information that have been studied, that for many patients over time, their serious eye conditions continue to deteriorate – not because of therapeutic effectiveness, but because of due to lack of adherence to treatment.
For example, the most common approach today to managing wet AMD involves anti-vascular endothelial growth factor (anti-VEGF) therapy, which works by blocking the growth of abnormal blood vessels and decreasing leakage. Regular treatments of anti-VEGF therapy can help lessen or stop the causes of vision loss associated with wet AMD. Currently, there are a variety of anti-VEGF treatments on the market. It is recommended that these treatments be given by intravitreal injection (into the back of the eye) approximately every month for the first three months, followed by an intravitreal injection once every eight weeks.
Current anti-VEGF treatments are effective and safe, but they are not as durable and long-acting as patients really need given the burden of having to see their doctor as often as monthly or every two for eye injections for the rest of their lives. Lives. We know that in the real world, a year or two into their disease, patients can lose a lot of the visual gains they get from these drugs because they can’t come back for visits as often as necessary or that treatment intervals have been extended beyond what they should be.
New treatments on the horizon
New solutions are being developed aimed at maintaining the gains that anti-VEGF drugs provide to patients over the long term. EYP-1901, an investigational anti-VEGF treatment from EyePoint Pharmaceuticals currently being studied in wet AMD, is a potential therapy under development. This investigational therapy is sustained-release, which means it can maintain the treatment interval of the majority of wet AMD patients for up to six months or more after a single injection. Another similar treatment therapy is the OTX-TKI from Ocular Therapeutics. They use a hydrogel encapsulating an anti-VEGF drug and also aim to support patients for up to six months.
Additionally, there are other therapeutic and drug delivery systems on the horizon with the potential to reduce treatment burden and improve outcomes. Gene therapies, including Regenxbio’s RGX-314, an anti-VEGF treatment that can block VEGF for years after surgery, and AdVM-022 from Adverum Biotechnologies, which can be injected via an in-office procedure , show promise in clinical trials. Other treatments, including research into pan-VEGF (multiple target VEGF) inhibition and other anti-VEGF therapies, represent the next wave of innovation in serious eye disorders focused on increasing longevity of action and durability of treatment, relieving patients and their caregivers of the burden of seeing their doctor every month or every two months, while maintaining their vision.
As we look to the future, I am energized by the many advances being made in ophthalmology to combat the most serious eye diseases that can cause blindness. As the prevalence of these diseases continues to grow with our aging population, they represent an opportunity for the biopharmaceutical industry to continue to follow the science to demonstrate the value of these treatments to providers and the healthcare system as a whole. And above all, to have an impact on the lives of patients and their loved ones affected by these devastating diseases.
Photo: KAREN BLEIER/AFP, Getty Images