Stereotactic low voltage x-ray radiotherapy for treating neovascular age-related macular degeneration

Abstract

Neovascular age-related macular degeneration (nvAMD) is a sight-impairing condition managed by the intraocular administration of inhibitors of VEGF, which include ranibizumab, bevacizumab and aflibercept. Because the effects of these biologicals wear off, the treatment has to be repeated as often as monthly. The disease is chronic and it is known that a proportion of patients continue to receive treatment for 5 years or more thus there are inherent burdens to the patient, provider and payer. Radiotherapy is adjunctive to anti-VEGF therapy in the control of nvAMD. There is a known synergistic effect of radiation and angiogenesis inhibitors. Radiotherapy as delivered by the Oraya IRay system is intended as a one-time therapy for the treatment of nvAMD, which has been shown to reduce the need for anti-VEGF by 32% over one year in a broad cohort of previously treated patients, and up to 55% for a well-defined subgroup. The Oraya Therapy offers an option to preserve vision while reducing the need for continuous clinic visits for monitoring and treatment.

Keywords::

• age-related macular degeneration
• radiotherapy
• wet AMD
• x-ray

Financial & competing interests disclosure

U Chakravarthy is an investigator in the INTREPID trial and a participant serving on clinical advisory boards of Oraya Therapeutics. A Czezynski is an employee of Oraya Therapeutics. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Minimization of the exudative feature of neovascular age-related macular degeneration through biologicals has yielded improved outcomes, but unmet need exists in therapies that can potentially reverse vision loss.

• Drugs and/or biologicals that specifically act to maintain neural cell and retinal pigment epithelial cellular function and morphology are needed.

• Prolonged efficacy of existing biological therapies would mitigate the burden of treatment.

• Use of physical agents such as ionizing rays to minimize fibrosis has potential, but requires close monitoring to ascertain and assess the impact of radiation-induced damage.