Alay S. Banker, MD: Dosing Strategies for Retina Disease


How come treat-and-extend may not be the most ideal therapy regimen for retina disease, and how biologics change physicians' perspective on dosing.

Reported news at the American Society of Retinal Specialists (ASRS) Annual Meeting in Vancouver, BC, was promising for patients' budgets.

New intravitreal biosimilar anti-vascular endothelial growth factor (VEGF) therapies bevacizumab and ranibizumab have been proven to be effective and safe for nearly a half-dozen retina conditions, according to new data presented by Alay S. Banker, MD, of the Bankers Retina Clinic & Laser Center, India.

Banker sat down with MD Magazine® to discuss how biosimilars could influence the standard of retina therapy regimen.

Does the introduction of cheaper biosimilars to the market give clinicians more incentive to increase retina patient dosing?

Absolutely. I mean, I think the most common treatment method followed in the world is the treat-and-extend regime, which is still not the idea when compared the monthly regime of recent trials. But yes, I think if we have good biosimilars, which are cheaper. I think patients won't mind taking more frequent injections if they are maintaining good visual acuity.

What are your thoughts on the treat-and-extend regimen strategy?

I think the treat-and-extend is still not probably the ideal therapy because we are still looking for some therapies or some molecules which would have an extended duration of activity, which would reduce the number of injections. With treat-and-extend, you know, there are issues of how you would monitor these patients, the increased number of frequency versus the number of injections. And these are the issues which are taken into consideration.

There's a lot of office visits, office work—it's a big burden, not only to the patient but also to the support group of the patient’s relatives. And you have to come down, and travel long distances. So I think issues are still there. So we're looking for molecules which would give us longer divertability, and then we could go into a more fixed regime with those molecules rather than a treat-and-extend regime.

What will the near future of retina care look like?

We are probably looking at some sustained-release delivery devices or implants where we could just put in these anti-VEGFs injected into the eye, and have a very long sustained duration of action. I think that's the way to go. I mean, I'm sure there are a lot of opportunities for that in the future and some implants in the pipeline. too. So I think that's very exciting to know.

In the future I think it's not just going to be one drug. I think we're going to play around with multiple drugs and combinations and the best way for that particular patient—which could provide the best results, with the least number of injections and the least number of clinic visits.

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