Investigation of oral fenretinide for treatment of geographic atrophy in age-related macular degeneration.

Abstract

BACKGROUND:

Excessive accumulation of retinol-based toxins has been implicated in the pathogenesis of geographic atrophy (GA). Fenretinide, an orally available drug that reduces retinol delivery to the eye through antagonism of serum retinol-binding protein (RBP), was used in a 2-year trial to determine whether retinol reduction would be effective in the management of geographic atrophy.

METHODS:

The efficacy of fenretinide (100 and 300 mg daily, orally) to slow lesion growth in geographic atrophy patients was examined in a 2-year, placebo-controlled double-masked trial that enrolled 246 patients at 30 clinical sites in the United States.

RESULTS:

Fenretinide treatment produced dose-dependent reversible reductions in serum RBP-retinol that were associated with trends in reduced lesion growth rates. Patients in the 300 mg group who achieved serum retinol levels of ≤ 1 μM (≤ 2 mg/dL RBP) showed a mean reduction of 0.33 mm in the yearly lesion growth rate compared with subjects in the placebo group (1.70 mm/year vs. 2.03 mm/year, respectively, P = 0.1848). Retinol-binding protein reductions <2 mg/dL correlated with further reductions in lesion growth rates (r = 0.478). Fenretinide treatment also reduced the incidence of choroidal neovascularization (approximately 45% reduction in incidence rate in the combined fenretinide groups vs. placebo, P = 0.0606). This therapeutic effect was not dose dependent and is consistent with anti-angiogenic properties of fenretinide, which have been observed in other disease states.

CONCLUSION:

The findings of this study and the established safety profile of fenretinide in chronic dosing regimens warrant further study of fenretinide in the treatment of geographic atrophy.

• Authors: Nathan L Mata, Jay B Lichter, Roger Vogel, Yun Han, Tam V Bui, Lawrence J Singerman
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 33 Issue 3 Pg. 498-507 (Mar 2013) ISSN: 1539-2864 [Electronic] United States
• PMID: 23023528 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Retinol-Binding Proteins, Plasma
• Vitamin A
• Fenretinide

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Antineoplastic Agents (adverse effects, therapeutic use)
• Contrast Sensitivity (physiology)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Fenretinide (adverse effects, therapeutic use)
• Geographic Atrophy (blood, drug therapy, pathology)
• Humans
• Male
• Middle Aged
• Retinol-Binding Proteins, Plasma (antagonists & inhibitors)
• Surveys and Questionnaires
• Treatment Outcome
• Visual Acuity (physiology)
• Vitamin A (blood)