An Overview of the Fovista and Rinucumab Trials and the Fate of Anti-PDGF Medications

The vitreoretinal community will remember 2016 as the year that unfavorable anti–platelet-derived growth factor (anti-PDGF) clinical trial results ended the development of Fovista (pegpleranib; Ophthotech, New York, NY) and Rinucumab (Regeneron, Tarrytown, NY). The failure of these trials reaffirmed how important the innovations made in 2006 with anti-vascular endothelial growth factor (anti-VEGF) were to our field and our patients. Evan N. Dunn, MD, and Veeral S. Sheth, MD, were tasked with analyzing and dissecting the anti-PDGF clinical trials — beginning with the basic science behind anti-PDGF. They will also review novel, multitarget approaches to our diseases, as well as unique routes of delivery such as topical and suprachoroidal administration. Reading this article leads one to appreciate how high the anti-VEGF class of molecules has set the bar for the treatment of vitreoretinal disease. Although recent clinical trial results have been a disappointment to our community (and our patients), we should be reassured by the fact that many development programs are strongly underway investigating novel approaches to treat back-of-the-eye disorders. Drs. Dunn and Sheth's insights will be highly valued by our community

Epidemiology of the Association between Anticoagulants and Intraocular Hemorrhage in Patients with Neovascular Age-Related Macular Degeneration

Purpose: To determine the cumulative and annual incidence of intraocular hemorrhage (subretinal hemorrhage or vitreous hemorrhage) in patients with neovascular age-related macular degeneration (neovascular AMD) and association with daily antiplatelet or anticoagulant (AP/AC) medication usage (aspirin, clopidogrel and warfarin), age, gender, hypertension, diabetes mellitus or bilateral neovascular AMD. Design: Retrospective, cross-sectional study in a tertiary University setting. Methods: Data on one hundred and ninety-five eyes of 195 patients without prior intraocular hemorrhage examined over seventy-three months was reviewed. Results: Ninety-six of 195 (49.2%) patients were taking daily AP/ACs. 63.5% of patients taking daily AP/AC agents had hemorrhage compared to 29.2% of patients not taking (OR= 4.21, 95% CI=1.42-8.46, p<0.001). The overall annual incidence of intraocular hemorrhage was 0.14% per year. Among patients taking daily AP/AC, the cumulative incidence (61/96, 63.5%) and annual incidence (0.10%) of concurrent intraocular hemorrhage was significantly greater compared to patients not taking them (29/99, 29.2% and 0.04%, respectively, p<0.0001). Fourteen of 18 (77%) patients taking more than one daily AP/AC had occurrence of intraocular hemorrhage. AP/AC usage was an independent risk factor for the development of intraocular hemorrhage. The use of any agent resulted in a significantly increased risk of developing intraocular hemorrhage. Additionally, presence of bilateral neovascular AMD was a significant association in those taking daily AP/ACs, whereas age was a significant association in those not taking daily AP/AC agents. Conclusions: All three daily AP/AC types were significantly associated with an increased risk of the development intraocular hemorrhage in patients with neovascular AMD, whereas gender, hypertension and diabetes were not. Age was not significantly associated with hemorrhage in patients taking daily AP/AC agents whereas the presence of bilateral neovascular AMD was. These findings indicate that the AP/AC use may predispose neovascular AMD patients to intraocular hemorrhage more so than age and duration of disease alone. While the risk that discontinuing these medicines would pose to the patients' health may be too great to justify, ensuring that an appropriate medication dosage is maintained should be a priority within this patient population