Triamcinolone acetonide injectable suspension for suprachoroidal use in the treatment of macular edema associated with uveitis

ABSTRACT

Introduction

Macular edema due to noninfectious uveitis is a sight-threatening complication that is routinely treated with corticosteroids. Triamcinolone acetonide injectable suspension for suprachoroidal use (Xipere™) is an alternative treatment option for patients with noninfectious uveitis-associated macular edema.

Areas covered

This review describes the recently FDA-approved triamcinolone acetonide injectable suspension that can be injected into the suprachoroidal space. This physiological space is between the sclera and choroid. This allows for therapeutic targeting of the retina and choroid. This review highlights published clinical trials for this novel drug preparation.

Expert opinion

Suprachoroidal administration of triamcinolone acetonide has shown improvement in vision and inflammation in studies with noninfectious uveitis-associated macular edema. This unique delivery method suggests the potential to decrease side effects of anterior segment exposure such as glaucoma and cataract, but head-to-head trials are needed for further study of safety and efficacy. Additionally, there are promising prospective studies underway for utilization of the suprachoroidal space for other diseases including macular degeneration, diabetic macular edema, and ocular tumors.

KEYWORDS:

• macular edema
• noninfectious uveitis
• suprachoroidal delivery
• triamcinolone acetonide
• xipere

Article highlights

• Triamcinolone acetonide injectable suspension for suprachoroidal use (CLS-TA) has shown efficacy in treatment for noninfectious uveitis-associated macular edema with high levels of medication in posterior segment tissues compared to anterior segment structures in preclinical studies.

• The DOGWOOD trial demonstrated safety of 4.0 mg CLS-TA in patients with macular edema due to non-infectious uveitis.

• The PEACHTREE trial showed that use of 4.0 mg CLS-TA led to clinically significant improvement in vision compared to sham injection with durability of treatment as supported by the MAGNOLIA non-interventional, extension study.

• The AZALEA trial findings with 4.0 mg CLS-TA were supportive of preceding trials with a safe and tolerable adverse event profile, along with reduced anterior and posterior segment inflammation.

• Further exploration of the use of suprachoroidal drug delivery is currently underway for treatment for macular degeneration, diabetic macular edema, and ocular tumors.

• Interim data of trials studying suprachoroidal administration of RGX-314 for wet age-related macular degeneration and diabetic retinopathy demonstrates tolerability and efficacy.

Disclosure statement

The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Declaration of interest

S Yeh has acted as a consultant for Clearside Biomedical, Bausch and Lomb, Allergan, Adverum and Regenxbio. T Albini reports financial relationships including consulting or advisory board activities with the following entities: Allergan, Eyepoint, Genentech, Novartis and Bausch. 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.

Scientific accuracy review

Bausch + Lomb provided a scientific accuracy review at the request of the journal editor.

Additional information

Funding

This paper was supported by the National Eye Institute of the National Institutes of Health under award number R01 EY029594 (S Yeh). Grant support is also provided by the Macula Society Retina Research Foundation, Association for Research in Vision and Ophthalmology Mallinckrodt Young Investigator Grant, and the Stanley M Truhlsen Family Foundation, Inc.