Monoclonal antibodies in diabetic retinopathy

ABSTRACT

Introduction

Diabetic retinopathy (DR), as one of the main complications of diabetes, is among the leading causes of blindness and visual impairment worldwide.

Areas covered

Current clinical therapies include photocoagulation, vitrectomy, and anti-vascular endothelial growth factor (VEGF) therapies. Bevacizumab and ranibizumab are two monoclonal antibodies (mAbs) inhibiting angiogenesis. Intravitreal ranibizumab and bevacizumab can decrease the rate of blindness and retinal thickness, and improve visual acuity whether as monotherapy or combined with other treatments. They can increase the efficacy of other treatments and decrease their adverse events. Although administered intravitreally, they also might enter the circulation and cause systemic effects. This study is aimed to review our current knowledge about mAbs, bevacizumab and ranibizumab, in DR including superiorities, challenges, and limitations. Meanwhile, we tried to shed light on new ideas to overcome these limitations. Our latest search was done in April 2021 mainly through PubMed and Google Scholar. Relevant clinical studies were imported.

Expert opinion

Future direction includes detection of more therapeutic targets considering other components of DR pathophysiology and shared pathogenesis of DR and neurodegenerative diseases, such as Parkinson<apos;>s disease and Alzheimer<apos;>s disease, the treat-and-extend regimen, and new ways of drug delivery and other routes of ocular drug administration.

KEYWORDS:

• Bevacizumab
• ranibizumab
• monoclonal antibody
• diabetic retinopathy
• anti-VEGF
• intravitreal injection

Article highlights

• Ranibizumab and bevacizumab improve visual outcomes in diabetic retinopathy (DR)

• Despite intravitreal injection, they also cause systemic adverse events

• Targeting other components of DR pathogenesis may bring up new antibodies

• Shared pathogenesis of DR and neurodegenerative diseases may imply novel targeted therapies

• New routes and ways of drug delivery might solve some challenges with current therapies

Declaration of interest

The authors have 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.

Reviewer disclosures

One peer reviewer has received consultation honoraria and lecture fees from Allergan/Abbvie, Alimera, Bayer, Boehringer Ingelheim, Novartis, NovoNordisk, MSD, Roche/Genentech and Oxurion. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.