Investigational drugs for retinal vein occlusion

ABSTRACT

Introduction: Retinal vein occlusion (RVO) is the second most common retinal vascular disorder. This multifactorial disease frequently leads to visual impairment. Some risk factors for RVO can be managed prophylactically. Given the complex physiopathology of RVO, most of the latest therapeutic strategies focus on secondary clinical features (such as macular oedema and neovascularization).

Areas covered: This author reviews ongoing, prospective, open-label Phase I and Phase II clinical trials of novels treatments for RVO (primarily intravitreal steroids and anti-VEGF agents). Specifically, they review the pharmacokinetics, safety profile, study design and adverse events associated with innovative drugs in clinical development.

Expert opinion: A number of innovative, early-phase clinical trials are based on combination therapy with an anti-VEGF agent and steroids. There is good evidence that early treatment of RVO has clinical benefits. Larger, randomized studies are now required for a better understanding of patient selection, treatment timing and dosing, and thus the optimized use of novel drugs and medical devices.

KEYWORDS:

• Retinal vein occlusion
• anti-VEGF therapy
• intravitreal steroids
• macular oedema
• neovascularization
• Phase I/II clinical trial
• dexamethasone

Article highlights

• Retinal vein occlusion (RVO) is the second most common retinal vascular disorder after diabetic retinopathy.

• Cases of RVO can be classified as central retinal vein occlusion (CRVO, which affects the entire retina) or branch retinal vein occlusion (BRVO, when one or more the central vein’s branches is occluded).

• Most studies of CRVO have reported a poor visual outcome.

• Macular oedema and ischemic forms of RVO may create severe complications, including anterior and posterior neovascularization.

• Dexamethasone implants and ranibizumab are the primary treatments for visual impairment caused by RVO-associated macular oedema.

• Combination therapies and new therapeutics are being evaluated with a view to greater clinical efficacy and less frequent drug administration.

This box summarizes key points contained in the article.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.