Approved treatments for neovascular age-related macular degeneration: current safety and future directions

ABSTRACT

Introduction

Age-related macular degeneration (AMD) is a progressive retinal degenerative disease that is implicated as one of the leading causes of visual impairment in the elderly population. Vascular endothelial growth factor (VEGF) has been identified as the main driver of AMD, and various therapeutics have revolutionized the treatment and management of neovascular AMD (nAMD) with favorable visual and anatomical outcomes.

Areas covered

Physicians have a variety of approved therapeutics in their arsenal for patients with varying disease progression and patient-specific needs, with the ultimate goal of achieving optimal visual and anatomic outcomes. The literature search was conducted using PubMed, Google Scholar, and sources from companies’ websites, allowing us to locate findings recently presented at conferences.

Expert opinion

Scientific advancements in the field have led to newly approved therapeutics and devices, such as the port-delivery system with ranibizumab (PDS), and further investigation is ongoing in the realm of gene therapy for retinal diseases. In addition to efficacy and durability, newer agents must have comparable safety profiles to older agents in order to be used broadly. These options introduce a level of complexity in nAMD treatment; however, physicians to personalize treatment to improve vision in nAMD patients and reduce treatment burden overall.

KEYWORDS:

• Age-related macular degeneration (nAMD)
• safety
• vascular endothelial growth factor (VEGF)
• intravitreal injections
• treatment burden
• step therapy

Article highlights

• Age-related macular degeneration is one of the leading causes of visual impairment in the elderly population, with its prevalence only expected to increase.

• The increasing prevalence of nAMD globally and significant treatment burden associated with repeated injections has resulted in an increased focus on developing durable drugs and technologies.

• With more treatment options than ever, physicians have new factors to consider when choosing agents for their patients.

• In addition to efficacy and durability, there has been great attention to the safety of newly approved agents, which need to have a comparable safety profile to older agents in order to be used broadly.

• Newly approved treatment options for the management of nAMD are a sign of continued scientific advancements and will hopefully result in better real-world outcomes for patients suffering from nAMD.

Declaration of interest

H Khan reports other from Genentech, outside the submitted work; paid internship. A Aziz reports other from Regenxbio, outside the submitted work; paid internship. A Khanani reports personal fees from AbbVie, grants and personal fees from Adverum Biotechnologies, personal fees from AGTC, personal fees from Alimera Sciences, personal fees from Allergan, grants and personal fees from Apellis Pharmaceuticals, personal fees from Arrowhead Pharmaceuticals, personal fees and other from Aviceda Therapeutics, personal fees from Bausch & Lomb, personal fees from Broadwing Bio, personal fees from Clearside Biomedical, grants and personal fees from 4D Molecular Therapeutics, grants and personal fees from Eyepoint Pharmaceuticals, personal fees from Fronterra Therapeutics, grants and personal fees from Gemini Pharmaceuticals, grants and personal fees from Genentech, grants and personal fees from Gyroscope Therapeutics, grants and personal fees from Iveric Bio, grants and personal fees from Janssen Pharmaceuticals, personal fees from Kato Pharmaceuticals, grants and personal fees from Kodiak Sciences, grants and personal fees from Ocular Therapeutix, grants and personal fees from Oculis, grants and personal fees from Ocuterra, grants and personal fees from Opthea, grants and personal fees from Oxurion, grants and personal fees from Novartis, personal fees from Perfuse, personal fees and other from PolyPhotonix, personal fees from Ray Therapeutics, grants, personal fees and other from Recens Medical, personal fees from Regeneron Pharmaceuticals, grants and personal fees from Regenxbio, grants and personal fees from Roche, personal fees from Stealth Biotherapeutics, personal fees from Thea Pharma, grants and personal fees from Unity Biotechnology, personal fees from Vanotech, personal fee and other from Vial, grants from Annexon Biosciences, grants from Neurotech, grants from NGM Biopharmaceuticals, other from PolyPhotonix outside the submitted work. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

Hannah Khan: Conceptualization; Investigation; Methodology; Validation; Visualization; Writing Original Draft

Aamir A. Aziz: Conceptualization; Investigation; Validation; Visualization; Writing Original Draft

Zoha Khanani: Reviewing & Editing

Huma Khan: Reviewing & Editing Ohidul Mojumder: Reviewing & Editing

Greggory M. Gahn, MD: Writing Original Draft; Reviewing & Editing

Arshad M. Khanani, MD, MA: Conceptualization; Investigation; Validation; Visualization; Writing Original Draft

Additional information

Funding

This paper was not funded.