Thursday, June 14, 2012

AMD Update 19: Combination Therapy May Be A “Game Changer” for Wet AMD

You may have seen or heard the news that a new drug, Fovista, from Ophthotech, when used in combination with Lucentis (and probably Avastin), has the potential to greatly improve the outcomes now experienced with anti-VEGF monotherapy. The results from a Phase 2b clinical study of 449 patients showed that the combination therapy resulted in a gain of 10.6 letters of vision on the ETDRS standardized chart at 24 weeks, a 62% increase over the 6.5-letter gain from Lucentis monotherapy.

Fovista is a novel anti-platlet-derived growth factor therapy. 

I did not understand the implication of this combined therapy until I read Dr. Pravin Dugel’s blog in the June 14th issue of OSN Online. Now that I’ve read this blog I understand the importance of this combined therapy and would like to share it with you.

I have asked OSN for permission to reproduce Dr. Dugel’s article, and when it comes, I will reproduce the full article in this space. In the meantime, here are excerpts from the blog.

Anti-PDGF, anti-VEGF combination may be game changer in wet AMD treatment

Pravin U. Dugel, MD

Published in Ocular Surgery News Online June 14, 2012

As noted above, I had requested permission from the editor and publisher of OSN to reproduce Dr. Dugel’s writeup in this space. That permission was denied. The reason given was that “Google severely punishes” OSN if someone duplicates their content. I hardly think that could be the case in this case, with their 30,000 subscribers compared to my 100 to 200 visitors per day, but so be it, I have complied with their demand to remove my reproduction of their article which I posted last evening.

So, I now urge you to follow the link shown above and read this important writeup on the OSN site. However, if you cannot access the OSN site, I have reproduced what Dr. Dugel’s writeup would have looked like on this site in a pdf file which I will be happy to send to anyone requesting it. Just use the “Email Me” link to the right and request AMD Update 19.

To summarize what Dr. Dugel wrote: “Anti-VEGF monotherapy will go down in history as a treatment that was both insurmountable and unsustainable.”

Tremendous gains were made in using both Lucentis and Avastin in saving, preserving, and even improving vision in people with wet AMD that previously to anti-VEGF monotherapy use would have gone blind. “We went from essentially not being able to treat our patients at all and watching them go blind, to being able to maintain vision in 90% of our patients ... we were able to improve vision in 30% to 40% ... with anti-VEGF monotherapy.”

However, with its use, it was learned that the treatment was unsustainable to achieve the best results possible – “the treatment burden (of monthly treatment) was simply too great.”

An answer was found in studying treatments for oncology. The use of an anti-PDGF treatment combined with anti-VEGF treatment is being found to provide better visual outcomes than the use of monotherapy alone. Please read Dr. Dugel’s article to find out why.

And that, ladies and gentlemen, is what Dr. Dugel had to say. Wow! Does this mean that fewer injections will be needed in the future and provide even better results? I’ve asked this question of Dr. Dugel and if he responds, I will provide his answer as a supplement to this writeup.

Editors Note: As I said upfront, I asked permission to reproduce the complete writeup and it was denied. So, it is up to you to find and read Dr. Dugel's excellent writeup.


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