2021 Retina Pipeline: A View Into Ongoing Innovation [Interactive]

Knowing where everything stands helps prepare you for the next era.

Content guidance and source: Peter K. Kaiser, MD

This content originally ran as a poster in the November/December issue. Check out the print publication to view the full size poster.

Wet AMD Pipeline

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Dry AMD Pipeline

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Kaiser Headshot

“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 hope you use this poster to understand where we stand in clinical development for AMD treatment as we enter 2021.”

Peter K. Kaiser, MD

Watch as Peter K. Kaiser, MD, explains the poster and follow along with graphics below.

In designing the second edition of Retina Today’s pipeline poster for wet and dry age-related macular degeneration (AMD), we focused largely on expanding the schematic used to illustrate the complement system. For many of us, the complement system is a relic of our medical training, something to be dusted off when conversation turns down a more erudite path. In the coming years, however, the complement system may well be key to unlocking therapies for dry AMD that could affect millions of patients.

In a way, we have attempted the impossible by illustrating the complement pathway. An artistic representation of a cascade that takes place on the cellular surface must (by virtue of graphic limitations) be depicted away from that surface, giving the impression that the events occur in some vacuous space between cells. They do not. Still, we know that our readers understand this and are even more certain that a detailed map of the complement system’s steps is more important than a strict biologic geography lesson.

This edition of this poster consists of more than just cosmetic changes. We eliminated failed drugs, added new therapeutic candidates, and enlarged the complement system illustration to include new therapeutic targets.

Meetings might be paused for the foreseeable future, but that doesn’t mean that education has stopped. Turn to this poster (and its digital interactive facsimile, found at bit.ly/retina-pipeline) to keep yourself sharp.

And remember: this poster is for you. Tear it out. Mark it up. Send us suggestions for how to improve it. We’re already thinking about ways to develop it for next year’s edition, and we need to hear from our audience about what works and what doesn’t.

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Retina Pipeline: Wet AMD

Retina Pipeline: Wet AMD

Continue to scroll to see the each pathway displayed in the diagram to the left.

Extracellular VEGF Pathways

  • pegaptanib (Valeant) FDA-approved
  • ranibizumab (Genentech/Roche) FDA-approved
  • bevacizumab (Genentech/Roche) Off-label
  • brolucizumab (Novartis) FDA-approved
  • abicipar pegol (Allergan)
  • KSI-301 (Kodiak Sciences)
  • PF582 (biosimilar) (Pfenex/Pfizer)
  • razumab (biosimilar) (Intas)
  • CHS3551 (biosimilar) (Coherus Biosciences)
  • SB-11 (biosimilar) (Samsung Bioepis)
  • FYB201 (biosimilar) (Formycon/Bioeq)
  • ONS-510 (biosimilar) (Outlook Therapeutics)
  • Xlucane (biosimilar) (Xbrane)
  • PD807 (biosimilar) (Biopharm)
  • SBS7001 (biosimilar) (Siam Bioscience)
  • ○ ▴ aflibercept (Regeneron/Bayer) FDA-approved
  • ○ ▴ KNP-301 (Kanaph Therapeutics)
  • ○ ▴ conbercept (Kanghong Biotech)
  • ○ ▴ AG-73305 (Allgenesis Biotherapeutics)
  • ○ ▴ CHS-2020 (biosimilar) (Coherus Biosciences)
  • ○ ▴ SOK583A1 (biosimilar) (Sandoz/Hexal)
  • ○ ▴ MYL1710 (biosimilar) (Mylan/Momenta)
  • ○ ▴ ALT-L9 (biosimilar) (Alteogen)
  • OPT-302 (Opthea)

Tyrosine Kinase inhibitor (TKi) Pathways

  • OTX-Tki/axitinib (Ocular Therapeutix)
  • KPI-285 (Kala)
  • GB-102/sunitinib (Graybug)
  • PAN 90806 (Panoptica)
  • SK-1011 (Sanwa Kagaku)
  • X-82/sunitinib (Tyrogenex)
  • axitinib (Clearside Biomedical)

TIE2 Activation Pathways

  • faricimab (Genentech/Roche)
  • AG-73305 (Allgenesis Biotherapeutics)
  • BI 836880 (Boehringer Ingelheim)

Integrin Pathways

  • volociximab (iveric bio)
  • ❖ ★ OTT116 (OcuTerra)
  • ❖ ★ AG-73305 (Allgenesis Biotherapeutics)
  • AXT107 (AsclepiX Therapeutics)
  • PAN
  • risuteganib (Allegro/Senju)
  • THR-687 (Oxurion)

Gene Therapy

  • RGX-314 (RegenxBio)
  • ▴ ○ ADVM-022 (Adverum)

Other Pathways

  • CVX-51401 (CavtheRx) Caveolin Modulator
  • Ref-1 Inhibitor (Ocuphire) Ref-1 Inhibitor
  • AR-13503 (Aerie Pharmaceuticals) Rho kinase (ROCK) inhibitor
  • EXN407 (Exonate) SRPK1 Inhibitor
  • aganirsen (Gene Signal)Inhibition of insulin receptor substrate 1 (IRS-1)

Extended Duration Options

Clearside Suprachoroidal Injection
  • axitinib (Clearside Biomedical)
  • RGX-314 (RegenxBio)
ranibizumab Port Delivery System (PDS)
Polymer Extended Release
  • OTX-TKI (Ocular Therapeutix)
  • GB-102 (Graybug Vision)
  • KSI-301 (Kodiak Sciences)
  • AR-13503 (Aerie Pharmaceuticals)

Retina Pipeline: Dry AMD

Dry AMD Emerging Treatment Strategies

  • Prevent photoreceptor and RPE loss:
    • - Neuroprotection
    • - Reduce toxic by-product accumulation
    • - Visual cycle modulation
    • - Stem Cells
  • Suppress inflammation
  • Other approaches
Dry AMD image

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© sciencesource.com

1

Neuroprotection

    Repair mitochondrial dysfunction/oxidative stress:

  • elamipretide (Stealth)
  • risuteganib (Allegro)
  • photobiomodulation (LumiThera)
  • brimonidine tartrate (Allergan)
2

Reduce toxic by-product accumulation

    Prevents Amyloid Aβ oligomer assembly:

  • GAL-101 (Galimedix)
  • ALZ-801 (Alzheon)
  • Reduce DHA peroxidation:

  • RT011 (Retrotope)
3

Visual cycle modulation

  • ALK-001 (Alkeus)
4

Stem Cells

  • Human embryonic stem cells (hESCs)(Lineage Cell Therapeutics)(Regenerative Patch Technologies)
  • Umbilical stem cells (hUTCs)
  • Human retinal progenitor cells (jCyte)
5

Other approaches

    Inflammasome Inhibition:

  • kamuvudine (Inflammasome Therapeutics)
  • Xiflam (OcuNexus)
  • Matrix Modulation:

  • doxycycline (Oracea)
  • HtrA1 inhibitor:

  • FHTR2163 (Genentech/Roche)
  • IC500 (IVERIC bio)
6

Suppress inflammation

    Targeting the Complement Cascade:

  • ANX007 (Annexon)

    C1q Inhibition

  • pegcetacoplan (Apellis)

    C3 Convertase Inhibition

  • CB2782 (Catalyst)

    C3 Convertase Inhibition

  • avacincaptad pegol (IVERIC bio)

    C5 Convertase Inhibition

  • ALXN1720 (Alexion)

    C5 Convertase Inhibition

  • HMR59 (Hemera)

    MAC Inhibition by sCD59

  • danicopan (Achillion)

    Complement Factor D Inhibition

  • Ionis-FB-LRX (Ionis)

    Complement Factor B Inhibition

  • GEM103 (Gemini)

    Complement Factor H Therapy

  • GT005 (Gyroscope)

    Complement Factor I Therapy

  • OMS721 (Omeros)

    Blocks MASP-2

  • OMS906 (Omeros)

    MASP-3

  • TT30 (Alexion)

    Blocks C3 Osponization

  • IBI302 (Innovent Biologics)

    sCR1 Inhibition/Anti-VEGF

  • TMi-018 (Translatum Medicus Inc)

    Blocks M1 Transcriptome Expression

  • AVD-104 (Aviceda Therapeutics)

    Enhances CFH Binding to C3b

  • KNP-301 (Kanaph Therapeutics)

    Blocks C3b/Anti-VEGF

Select a pathway to see it displayed in the diagram below.

All

Alternative

Classical

Lectin

supress-inflamation-key

View the full size poster from the November/December issue.

Peter K. Kaiser, MD Headshot

Peter K. Kaiser, MD

• Medical advisor, Retina Today

• Chaney Family Endowed Chair in Ophthalmology Research; Professor of Ophthalmology, Cleveland Clinic Lerner College of Medicine; staff surgeon in the vitreoretinal department at the Cole Eye Institute, Cleveland Clinic; founding director of the Digital Optical Coherence Tomography Reading Center at the Cole Eye Institute, all in Cleveland, Ohio

• pkkaiser@gmail.com

• Financial disclosure: Advisory board and consultant (Aerie, Aerpio, Alcon, Allegro, Allergan, Annexon Biosciences, AsclepiX, Bayer, Bausch + Lomb, Biogen Idec, Boerenger Ingelheim, Carl Zeiss Meditec, Clearside Biomedical, Eyevensys, Formycon/BioEq GmbH, Galecto Biotech, Galimedix, Glaukos, iRenix, jCyte, Kala Pharmaceuticals, Kanghong, Kodiak, NGM Biopharmaceuticals, Novartis, Ocugenix, Oculis, Omeros, Opthea, Oxurion [Thrombogenics], Regeneron, RegenexBio, Retinal Sciences, Roivant, Santen, SciFluor, Shire, Spark, Stealth Biotherapeutics, Takeda, Verena [Digisight])