Home » Therapeutic approaches for dry AMD / Are there chances of preserving vision?

Therapeutic approaches for dry AMD / Are there chances of preserving vision?

by admin
Therapeutic approaches for dry AMD / Are there chances of preserving vision?

Professional association of ophthalmologists in Germany. registered association

Düsseldorf (ots)

Age-related macular degeneration (AMD) is one of the main causes of visual impairment and blindness in Germany and worldwide. Almost seven million people in Germany are affected by an early stage, late stages can be found in around 480,000 people in this country. It is to be expected that due to increasing life expectancy, the number of people affected by AMD will continue to increase. While there are now established treatment options for the rapidly progressing neovascular late form of AMD (also known as “wet AMD”), there is still no way of stopping the slower progressing dry late form of AMD, geographic atrophy.

However, there could soon be a therapy for geographic atrophy that can at least slow down its growth. Approval has already been applied for for two active ingredients, Pegcetacoplan and Avacincaptad pegol. The US Food and Drug Administration (FDA) approved Pegcetacoplan for this indication at the end of February. A decision on this drug is expected in Europe in 2024. In addition, further studies are underway, including for gene therapies, which could expand the treatment options in the future.

Early and late forms of AMD

AMD has multifactorial causes. However, the term “age-dependent” already mentions an important risk factor: age. The disease begins insidiously and is initially characterized by deposits on the posterior pole of the eye, which are referred to as drusen. At this early stage, patients often notice few to no symptoms. If blood vessels grow under the retina and fluid leaks from these newly formed vessels, vision can suddenly drop.

For 15 years, effective drugs have been available in the form of VEGF inhibitors, which can slow down vision loss and even improve vision again.

Even without newly formed blood vessels, vision can be threatened: by a progressive destruction of pigment epithelial cells and the light-sensitive cells of the retina, the photoreceptors. This late form of macular degeneration is known as geographic atrophy. It leads to a gradual loss of vision. If the center of the macula, the fovea, is affected, a blind spot develops in the middle of the visual field. The external field of vision is preserved, so that those affected can usually orientate themselves further in space. For example, reading or recognizing faces is no longer possible. The disease can progress to blindness within the meaning of the law. A balanced Mediterranean diet and not smoking have a positive effect on the course of the disease. However, no approved therapy is available to date.

See also  When mosquito bites make you blind / The CBM distributes medicines in poor, remote ...

Multimodal imaging helps to understand AMD

In order to find new treatment options for a disease, it is first necessary to better understand the processes that cause the disease. Modern multimodal imaging, in which optical coherence tomography (OCT) plays a special role, has enabled enormous learning progress in recent years. International groups of scientists have jointly defined biomarkers that are important for the classification of AMD and help to assess the individual risk for disease progression.

While imaging provides objective findings that can be used as a criterion in studies to assess the effectiveness of a treatment, central visual acuity in geographic atrophy is only partially suitable as a clinical endpoint for therapy studies. After all, early AMD does not cause any or only minor impairments in visual acuity. A significant drop in visual acuity only occurs when the point of sharpest vision is affected by the atrophy.

One starting point for dry AMD: the complement system

A few years ago it became apparent that the complement system plays an important role in the development of dry AMD. The complement system is part of the immune system. It includes more than 30 proteins. Their task is to cover the surface of pathogens so that they can be reliably recognized and destroyed by scavenger cells. The complement system also triggers inflammatory responses that help fight infection. When the complement system is out of balance, it can be involved in various diseases and can be responsible for tissue damage. This is also the case with geographic atrophy. The two new drugs target components of the complement system to block its effects.

See also  THANKS TO THE FINANCIAL GUARD AND THE AIL ASSOCIATION, GIFTS ARRIVE FOR CHILDREN IN PEDIATRIC DEPARTMENTS

Possibly the first approval of a therapy for the treatment of geographic atrophy

The synthetic molecule pegcetacoplan binds to complement factor C3. Putting it inside the eye monthly or every two months slows down the growth of geographic atrophy. This has been proven in phase III studies over a period of 24 months. The active substance Avacinacaptad pegol starts with the complement factor C5. Phase III study data are also available for this drug, which show that the growth of geographic atrophy is slowed down. A functional benefit could not be proven in previous studies, but slowing down the growth of an atrophy can give patients, for example, valuable time with preserved reading ability before the visual center is affected by the disease. There is a prospect that these two drugs will soon be approved in Germany. They must be eyed at regular intervals.

Challenge for ophthalmological care

As positive as the news is that there are new ways to preserve vision – it’s a big challenge for eye care. The drugs must be placed in the eye at regular intervals of one to two months. The method of intravitreal surgical drug administration (IVOM) has been tried and tested for years. However, the frequent check-ups and treatments are time-consuming for the patients. Ophthalmology practices and clinics are faced with the task of creating the necessary capacities for a large number of patients who could not be treated before. After all, the healthcare system must also provide the necessary financial resources for this.

Further therapeutic approaches under investigation

See also  Targeted diet with psychobiotics reduces stress and anxiety - Lifestyles

There are other therapeutic approaches that working groups are researching around the world. These include treatments aimed at protecting nerves (neuroprotection), affecting the visual cycle (visual cycle inhibitors), reducing inflammation (anti-inflammatory therapy), retinal implants, and finally gene therapy approaches. The latter have been researched as a remedy for chronic diseases since the 1990s. The eye is particularly well suited for the use of gene therapies because only a small amount of tissue needs to be treated and because it is comparatively easy to deliver the drug to its target site. GT-005 is currently being investigated in phase I and phase II studies. This drug aims to ensure that an active substance is produced in the eye that keeps the complement system in balance. This approach would have the advantage that a one-time treatment has a long-term effectiveness.

Conclusion

Age-related macular degeneration is the most common cause of visual impairment and blindness in Germany. So far, effective treatments have only been available for late-stage neovascular AMD, but the first therapies for dry AMD could also be approved in the near future. The first active ingredient has already been approved in the USA, and a decision on this is expected in Europe in 2024. The aim is to slow down the growth of geographic atrophy and thus preserve existing vision for longer. This also poses major challenges for the healthcare system.

Prof. Dr. Sandra Liakopoulos

Goethe University Frankfurt and Cologne Image Reading Center Clinic for Ophthalmology

Tel: 0221-478 4313

eMail: [email protected]

Press contact:

Professional association of ophthalmologists in Germany
Tersteegenstr. 12
D-40474 Düsseldorf
Tel. 0211 – 4 30 37 00
E-mail contact for press inquiries: [email protected]
www.augeninfo.de
www.aad-kongress.de/pressekonferenzen/pressekonferenz-2023/

Original content from: Professional association of ophthalmologists in Germany. eV, transmitted by news aktuell

You may also like

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More

Privacy & Cookies Policy