Retina Pipeline: A View Into Ongoing Innovation [Interactive Pipeline]

Retina specialists have relied on anti-VEGF therapy for more than a decade to treat the wet age-related macular degeneration (AMD) patients we encounter daily. Pegaptanib (Macugen, Bausch + Lomb) was the first anti-VEGF agent on the scene, and it was quickly followed by the more effective ranibizumab (Lucentis, Genentech). Off-label use of bevacizumab (Avastin, Genentech) was soon embraced due to its lower cost and similar efficacy. All three of these agents bind to VEGF isoform VEGF-A. Aflibercept (Eylea, Regeneron), which binds to VEGF-A and B as well as placental growth factor, was the next anti-VEGF agent approved, allowing clinicians to use a drug with expanded VEGF inhibition and longer durability. In October 2019, the US FDA approved the VEGF-A binding agent brolucizumab (Beovu, Novartis) for the treatment of wet AMD.

As we approach 2020, research in wet AMD therapy has made strides in the inhibition of other disease pathways and improvement in existing VEGF pathway blockade. Drugs that interact with angiopoietin, tyrosine kinase, and integrins have entered the scene at various development stages. Combination therapy, too, may be on the horizon, as faricimab (Genentech/Roche) makes its way through phase 3 trials. Finally, sustained delivery strategies and gene therapy are being explored to reduce treatment burden.

Our field has not had the same luck with dry AMD as we have with wet AMD. Numerous trials in dry AMD therapy have failed, but there is cause for hope as several drugs in the pipeline may finally unlock a pharmacotherapy for dry AMD.

Keeping an eye on drug development in AMD is difficult. Therapeutic options move from one phase to the next at different times and at different rates, and drugs may start their path in one disease only to find success treating another.

We’re here to help it keep all straight. Attached in this issue of Retina Today is a poster you can use as a quick reference guide, a snapshot of the pipeline as it stands as of the time of publication. Head into 2020 with this useful chart at the ready.