Verteporfin combination regimens in the treatment of neovascular age-related macular degeneration.

Abstract

BACKGROUND:

Neovascular age-related macular degeneration is characterized by choroidal neovascularization that has a complex pathogenesis. Combining agents that have different mechanisms of action (i.e., verteporfin photodynamic therapy, antivascular endothelial growth factor, and/or anti-inflammatory therapies) could maximize clinical benefits through potential complementary effects. This review discusses findings from studies investigating this hypothesis.

METHODS:

Articles were retrieved from PubMed using relevant search terms. Abstracts from recent scientific meetings and details of ongoing trials from clinicaltrials.gov were also included.

RESULTS:

Following its approval, verteporfin was important in the management of choroidal neovascularization due to age-related macular degeneration for several years. Improved visual outcomes have now been reported with antiangiogenic agents (e.g., intravitreal ranibizumab), especially when frequently administered. Results from investigator-sponsored trials, retrospective case studies and Registries, which have provided insights into the latest findings from clinical practice in the "real-world" setting, as well as randomized controlled trials, suggest that a combination approach is generally well tolerated and may maintain improvements in visual and anatomic outcomes with fewer retreatments.

CONCLUSION:

A rationale exists for investigating combination approaches to target different processes in choroidal neovascularization pathogenesis, which may optimize treatment benefits in neovascular age-related macular degeneration. Encouraging data suggest that combination strategies are not associated with major adverse events.

• Authors: Gaurav K Shah, Delia N Sang, Mark S Hughes
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 29 Issue 2 Pg. 133-48 (Feb 2009) ISSN: 1539-2864 [Electronic] United States
• PMID: 19202423 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Aptamers, Nucleotide
• Photosensitizing Agents
• Porphyrins
• Vascular Endothelial Growth Factor A
• Verteporfin
• pegaptanib
• Bevacizumab
• Ranibizumab

Topics

• Angiogenesis Inhibitors (therapeutic use)
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Aptamers, Nucleotide (therapeutic use)
• Bevacizumab
• Choroidal Neovascularization (drug therapy)
• Drug Therapy, Combination
• Humans
• Macular Degeneration (drug therapy)
• Photochemotherapy
• Photosensitizing Agents (therapeutic use)
• Porphyrins (therapeutic use)
• Ranibizumab
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Verteporfin