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Retina Corner: Highlights from the 2018 American Society of Retina Specialists Meeting

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The 36th Annual Meeting for the American Society of Retina Specialists has concluded after a wonderful week of events in beautiful Vancouver, Canada.

My colleagues at Retina Consultants San Diego and I had the privilege of attending and participating in the meeting. Both Dr. Anne Hanneken and I presented original research and conducted an educational dinner meeting on OCT angiography. In addition, I participated in an investigator meeting for an exciting, new investigational drug for geographic atrophy associated with macular degeneration.

It was a busy week filled with fascinating information from our speciality, so I would like to summarize some of the most interesting data.

While we have excellent drugs currently available to treat exudative macular degeneration, there is still a need for improved durability and visual outcomes. One possibly contender for this is brolucizumab. The HAWK and HARRIER studies examined the efficacy of this tiny 26 kilodaltin antiVEGF molecule, in neovascular age-related macular degeneration (AMD). Given the size of the molecule, the same dose volume provides 11–22 times the molar equivalent of current drugs, including Lucentis, ranibizumab and Eylea.

In the HAWK and HARRIER studies, brolucizumab was compared to Eylea, and had a significantly better effect on eliminating fluid, which is the main factor we consider when deciding whether or not to treat patients with neovascular AMD. Interestingly, the drug was also able to be given every 12 weeks in 50% of patients with non-inferior visual acuity outcomes compared to Eylea. There were no new safety concerns and the drug is currently in the hands of the FDA (and may be available sometime next year).

On another note, early results for another antiVEGF medication called abicipar were announced in a press release from Allergan. Similar to brolucizumab, abicipar is touted to have a potential 3-month durability. Indeed, the phase III trials showed 91% of patients were able to maintain their vision on a q12 week injection cycle. Moreover, patients in the abicipar group required substantially fewer injections to achieve the same visual result compared to ranibizumab (Lucentis).

On the down side, the drug was associated with a fairly substantial incidence of intraocular inflammation in about 15% of patients treated with abicipar. This goes to show you how high the bar has been set with current anti-VEGF drugs and how unlikely we are to see such a paradigm shift as we did back in 2005 with the pivotal Lucentis studies.

On the final day of the conference as a late breaking presentation, Genentech presented the results of their LADDER study, which looked at a port-delivery system for ranibizumab. This is a tiny, surgically-implanted reservoir that promises extended deliver of antiVEGF medications for AMD patients, compared to the nearly monthly injections that patients currently require. In the data presented, nearly 80% of patients were able to go 6 months or longer before requiring a refill of the reservoir. This is potentially a game changer and I am excited to see the official data.

Dr. Nikolas London is the director of clinical research and partner with Retina Consultants San Diego.

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