2022 Retina Pipeline: A View Into Ongoing Innovation [Interactive]

A new layout of the complement cascade highlights the major changes to this year’s two-sided poster.

Content guidance and source: Peter K. Kaiser, MD; Marielle Mahan, MD

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

Dry AMD Pipeline

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Wet AMD Pipeline

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Kaiser Quote Headshot

“The year 2021 saw development for plenty of pipeline candidates in the wet AMD and geographic atrophy spaces: two new technologies received FDA approval for the treatment of wet AMD, and a drug in the geographic atrophy space showed evidence of safety and efficacy in a pair of phase 3 clinical trials. We expect this momentum to continue into 2022, and look forward to you referring to this poster as developments occur.”

Peter K. Kaiser, MD

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

The retina community should be proud that it continues to educate itself rather than rest on the educations we received in our training. Yes, it comes naturally to us—we’re a scientifically curious group by nature, and there is no shortage of vitreoretinal mysteries waiting to be unlocked—but it also requires time and effort. With this year’s iteration of the annual age-related macular degeneration (AMD) pipeline poster, we hope to make that education a bit easier.

It became clear that a deepened understanding of the complement cascade will be foundational for our practice if a therapy for geographic atrophy is approved by regulatory bodies, so we thought it was best to create a more specific schematic for readers this year (Figure).

The limitations of a 2-dimentional illustration of the complement cascade should be noted; we addressed them the best we could. For example, the alternative pathway reactions occur on the surface of a cell, not in the extracelluar space around it. Still, we think this year’s depiction of the complement cascade will provide an excellent reference point for readers who need a refresher on a biologic cascade many of us haven’t considered at length since our medical training.

The next generation of ophthalmologists will be instrumental to continuing the tradition of continued education. To that end, Marielle Mahan, MD, joined the team responsible for creating the poster this year. As an ophthalmology resident with a talent for artistic depictions, Dr. Mahan led the charge in redesigning the complement cascade schematic. Her future in ophthalmology is bright, and we’re happy to have her included on the team this year.

Remember that the drugs listed in this poster are not exhaustive. If there is a drug that you think we should include in next year’s poster, email us at cdeming@bmctoday.com.

Figure. Drs. Kaiser (left) and Marielle Mahan (right) meet with Retina Today at the famous Café du Monde in New Orleans to sketch the pipeline poster.

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Retina Pipeline: Dry AMD

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While a larger screen will make it easier to navigate and visualize the Suppress Inflammation diagram below, the mobile experience contains the same content.

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[A] Suppress Inflammation

Hover the numbers in the diagram or in the list below to see where each therapy suppresses inflammation along the pathway.

See the diagram below showing where each therapy suppresses inflammation along the pathway.

  • 1

    IBI302 (Innovent Biologics)

    sCR1 Inhibition/Anti-VEGF

  • 2

    OMS721 (Omeros)

    Blocks MASP-2

  • 3

    OMS906 (Omeros)

    MASP-3

  • 4

    ANX007 (Annexon)

    C1q Inhibition

  • 5

    pegcetacoplan (Apellis)

    C3 Inhibition

  • 6

    CB-2783-PEG (Catalyst/Biogen)

    C3 Protease

  • 7

    NGM621 (NGM Biotherapeutics)

    C3 Inhibition

  • 8

    Ionis-FB-LRx (Ionis/Roche)

    Complement Factor B Inhibition

  • 9

    TT30 (Alexion)

    Blocks C3 Osponization

  • 10

    ALXN2040 (Alexion Pharmaceuticals/AstraZeneca)

    Complement Factor D Inhibition

  • 11

    KNP-301 (Kanaph Therapeutics)

    Blocks C3b/Anti-VEGF

  • 12

    avacincaptad pegol (Iveric Bio)

    C5 Convertase Inhibition

  • 13

    ALXN1720 (Alexion)

    C5 Inhibition

  • 14

    HMR59 (Hemera/Janssen)

    MAC Inhibition Gene Therapy

  • 15

    GEM103 (Gemini)

    Recombinant Complement Factor H Therapy

  • 16

    AVD-104 (Aviceda Therapeutics)

    Enhances CFH Binding to C3b

  • 17

    GT005 (Gyroscope)

    Complement Factor I Gene Therapy

  • 18

    CB-4332 (Catalyst)

    Recombinant Complement Factor I

  • TMi-018 (Translatum Medicus Inc)

    Blocks M1 Transcriptome Expression

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[B] Reduce Toxic By-product Accumulation

  • Prevents Amyloid Aβ Oligomer Assembly:
  • GAL-101 (Galimedix)
  • ALZ-801 (Alzheon)

  • Reduce DHA Peroxidation:
  • RT011 (Retrotope)

[C] Other approaches

  • Inflammasome Inhibition:
  • kamuvudine (Inflammasome Therapeutics)
  • Xiflam (OcuNexus)

  • Matrix Modulation:
  • doxycycline (Oracea)

  • HtrA1 inhibitor:
  • FHTR2163 (Genentech/Roche)
  • IC500 (Iveric Bio)

[D] Stem Cells

  • Human Embryonic Stem Cells (hESCs):
  • OpRegen (Lineage Cell Therapeutics)
  • CPCB-RPE1 implant (Regenerative Patch Technologies)
  • MA09-hRPE (Astellas)
  • hESC RPE sheets (Pfizer)
  • HLS001 cell sheets (Dainippon Sumitomo Pharma)

  • Umbilical stem cells (hUTCs):
  • Human retinal progenitor cells (jCyte)

[E] Neuroprotection

  • Repair mitochondrial dysfunction/ oxidative stress:
  • elamipretide (Stealth Biotherapeutics)
  • risuteganib (Allegro)
  • photobiomodulation (LumiThera)

[F] Visual cycle modulation

  • ALK-001 (Alkeus)

Retina Pipeline: Wet AMD

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

Extracellular VEGF Pathways

  • pegaptanib (Bausch + Lomb) FDA-approved
  • ranibizumab (Genentech/Roche) FDA-approved
  • bevacizumab (Genentech/Roche) Off-label
  • brolucizumab (Novartis) FDA-approved
  • abicipar pegol (Molecular Partners)
  • KSI-301 (Kodiak Sciences)
  • CHS-201 (biosimilar) (Coherus/Formycon)
  • PF582 (biosimilar) (Pfenex/Pfizer)
  • razumab (biosimilar) (Intas)
  • Byooviz (ranibizumab-nuna) (Samsung/Biogen) FDA Approved
  • Lytenava (bevacizumab 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) CDE Approved
  • ○ ▴ SOK583A1 (biosimilar) (Sandoz/Hexal)
  • ○ ▴ MYL1710 (biosimilar) (Mylan/Momenta)
  • ○ ▴ ALT-L9 (biosimilar) (Alteogen)
  • ○ ▴ SB15 (biosimilar) (Samsung Bioepis)
  • ○ ▴ ABP 938 (biosimilar) (Amgen)
  • ○ ▴ FY203 (biosimilar) (Formycon/Bioeq/Coherus)
  • OPT-302 (Opthea)

Tyrosine Kinase inhibitor (TKi) Pathways

  • OTX-Tki/axitinib (Ocular Therapeutix)
  • KPI-285 (Kala)
  • GB-102/sunitinib (Graybug Vision)
  • PAN 90806 (PanOptica)
  • SK-1011 (Sanwa Kagaku)
  • X-82/sunitinib (Tyrogenex)
  • axitinib (Clearside Biomedical)
  • EYP-1901/vorolanib (EyePoint Pharmaceuticals)

TIE2 Activation Pathways

  • faricimab (Genentech/Roche)
  • BI 836880 (Boehringer Ingelheim)
  • provalent (RevOpsis)
  • ASKG-712 (AskGene Pharma)

Integrin Pathways

  • volociximab (Iveric Bio)
  • ☉ ❖ △ OTT166 (OcuTerra Therapeutics)
  • ❖ ★ 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)
  • PL9654 (Palatin) melanocortin agonist

Other Approaches

suprachoroidal-injection
Suprachoroidal Injection
  • axitinib (Clearside Biomedical)
  • RGX-314 (RegenxBio)
Port Delivery System (PDS) With Ranibizumab
Polymer-Based
  • OTX-TKI (Ocular Therapeutix)
  • GB-102 (Graybug Vision)
  • KSI-301 (Kodiak Sciences)
  • AR-13503 (Aerie Pharmaceuticals)
  • EYP-1901 (EyePoint Pharmaceuticals)
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])



Marielle Mahan, MD Headshot

Marielle Mahan, MD

Ophthalmology Resident, MedStar Georgetown University

Hospital/Washington Hospital Center, Washington, D.C.