Aganirsen antisense oligonucleotide eye drops inhibit keratitis-induced corneal neovascularization and reduce need for transplantation: the I-CAN study.

Abstract

OBJECTIVE:

Eye drops of aganirsen, an antisense oligonucleotide preventing insulin receptor substrate-1 expression, inhibited corneal neovascularization in a previous dose-finding phase II study. We aimed to confirm these results in a phase III study and investigated a potential clinical benefit on visual acuity (VA), quality of life (QoL), and need for transplantation.

DESIGN:

Multicenter, double-masked, randomized, placebo-controlled phase III study.

PARTICIPANTS:

Analysis of 69 patients with keratitis-related progressive corneal neovascularization randomized to aganirsen (34 patients) or placebo (35 patients). Patients applied aganirsen eye drops (86 μg/day/eye) or placebo twice daily for 90 days and were followed up to day 180.

MAIN OUTCOME MEASURES:

The primary end point was VA. Secondary end points included area of pathologic corneal neovascularization, need for transplantation, risk of graft rejection, and QoL.

RESULTS:

Although no significant differences in VA scores between groups were observed, aganirsen significantly reduced the relative corneal neovascularization area after 90 days by 26.20% (P = 0.014). This improvement persisted after 180 days (26.67%, P = 0.012). Aganirsen tended to lower the transplantation need in the intent-to-treat (ITT) population at day 180 (P = 0.087). In patients with viral keratitis and central neovascularization, a significant reduction in transplantation need was achieved (P = 0.048). No significant differences between groups were observed in the risk of graft rejection. However, aganirsen tended to decrease this risk in patients with traumatic/viral keratitis (P = 0.162) at day 90. The QoL analyses revealed a significant improvement with aganirsen in composite and near activity subscores (P = 0.039 and 0.026, respectively) at day 90 in the per protocol population. Ocular and treatment-related treatment-emergent adverse events (TEAEs) were reported in a lower percentage with aganirsen compared with placebo. Only 3 serious TEAEs (2 with aganirsen and 1 with placebo) were considered treatment-related.

CONCLUSIONS:

This first phase III study on a topical inhibitor of corneal angiogenesis showed that aganirsen eye drops significantly inhibited corneal neovascularization in patients with keratitis. The need for transplantation was significantly reduced in patients with viral keratitis and central neovascularization. Topical application of aganirsen was safe and well tolerated.

• Authors: Claus Cursiefen, Eric Viaud, Felix Bock, Bernard Geudelin, Antoine Ferry, Pavla Kadlecová, Michel Lévy, Salman Al Mahmood, Sylvie Colin, Eric Thorin, François Majo, Beatrice Frueh, Frank Wilhelm, Tobias Meyer-Ter-Vehn, Gerd Geerling, Daniel Böhringer, Thomas Reinhard, Daniel Meller, Uwe Pleyer, Björn Bachmann, Berthold Seitz
• Journal: Ophthalmology (Ophthalmology) Vol. 121 Issue 9 Pg. 1683-92 (Sep 2014) ISSN: 1549-4713 [Electronic] United States
• PMID: 24811963 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• GS 101
• Oligonucleotides
• Oligonucleotides, Antisense
• Ophthalmic Solutions

Topics

• Adult
• Aged
• Analysis of Variance
• Angiogenesis Inhibitors (therapeutic use)
• Corneal Neovascularization (drug therapy, etiology, surgery)
• Corneal Transplantation
• Double-Blind Method
• Female
• Graft Rejection
• Humans
• Keratitis (complications)
• Male
• Middle Aged
• Oligonucleotides (therapeutic use)
• Oligonucleotides, Antisense (therapeutic use)
• Ophthalmic Solutions
• Quality of Life
• Visual Acuity (drug effects)