There is no denying that the anti-vascular endothelial growth factor A (anti-VEGF-A) monotherapy has “absolutely revolutionized our treatment of diabetic macular edema (DME).” However, there is a subset of patients in whom the anti-VEGFs are not an optimal treatment, according to Pravin U. Dugel, MD.
That subset of patients “with resistant or persistent disease” form the impetus for new treatment strategies, including next-generation anti-VEGF-A and new classes of drugs, said Dr. Dugel, managing partner, Retinal Consultants of Arizona, Phoenix, and clinical professor, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles.
Here is a list of potential treatment candidates that may lead that paradigm shift:
Brolucizumab (Alcon Laboratories/Novartis) represents “the smallest active unit of antibody that allows for concentrated molar dosing: 22 times that of ranibizumab (Lucentis, Genentech) and more than 11 times that of aflibercept (Eylea, Regeneron Pharmaceuticals),” Dr. Dugel said.
Two phase III studies compared brolucizumab to aflibercept in patients with neovascular age-related macular degeneration (AMD), with non-inferiority found for the primary endpoint and superiority in key retinal health outcomes.
“DME trials with brolucizumab are currently being planned,” Dr. Dugel said.