Daniel Kiernan, MD: Developing Effective AMD Treatments


Vitreoretinal surgeon discusses what ophthalmologists would need to see from a new treatment to replace aflibercept as first-line treatment for wet AMD.

Few therapies have cemented their role in the treatment of a specific disease as aflibercept has for the treatment of age-related macular degeneration (AMD).

Upon receiving approval for the treatment of wet AMD in November 2011, the anti-VEGF injection is the first-line therapy for most patients with the condition and for good reason.

With clinical data showcasing the ability to maintain visual acuity in 94% of patients at 1 year, the treatment has established itself as an effective treatment for almost every patient suffering from AMD, which is the leading cause of blindness in the US. Yet, even with such a powerful tool in their armamentarium, many in the field are still working towards developing a newer, more effective therapy to assume the role of first-line therapy for AMD.

While aflibercept will likely retain its role for the foreseeable future, the push for new treatment options has led to a recent surge in innovation. In late 2019 brolucizumab earned approval for the treatment of AMD—offering patients an extended gap between treatment intervals—and more treatments are in clinical trials, including faricimab and the Port Delivery System with Ranibizumab.

To get the perspective of an ophthalmologist on what it would take for a new treatment to supplant aflibercept as a first-line treatment for AMD, HCPLive® sat down with Daniel Kiernan, MD, a vitreoretinal surgeon for Ophthalmic Consultants of Long Island, to discuss the topic.

HCPLive: What would it take for a new treatment to replace aflibercept as the first-line for age-related macular degeneration?

Kiernan: I think what you need to see is data that shows that q3 or q4 month treatment is as efficacious as more frequent treatment with a different agent, whether it be every month or every other month with either ranibizumab or aflibercept.

In addition, we want to see anatomic data, structural data from OCT testing because we all use OCT, we all look for fluid. So, we want to see all that fluid dried up.

Of course, what's very important is safety data. We can't ignore potential safety risk profiles that are shown in some of the trials such as intraocular inflammation or rare events such as endophthalmitis or even the association with vascular problems such as heart attack or stroke that can be associated with systemic anti-VEGF agents.

All those things are important to realize. Those are on the label for our intraocular injections of anti-VEGF agents and sometimes have to be taken to account because we do have an older population that's at risk for diseases such as those.

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