Clinical Scorecard: Novel Therapeutics for Neovascular AMD

At a Glance

Key Highlights

• Current treatments target VEGF-A but face challenges with treatment burden and recalcitrant fluid.
• New therapeutics include tyrosine kinase inhibitors (TKIs) with pan-VEGFR blockade and other pathway targets.
• Phase 3 trials underway for sustained-release implants (EYP-1901, OTX-TKI) showing promising reductions in injection frequency and maintained visual acuity.

Guideline-Based Recommendations

Diagnosis

• Diagnosis based on clinical examination and imaging including optical coherence tomography (OCT) to assess choroidal neovascular membranes and fluid.

Management

• Use of anti-VEGF agents remains standard; emerging therapies include sustained-release implants and novel TKIs targeting multiple VEGF receptors and pathways.
• Consider enrollment in clinical trials for novel agents such as EYP-1901, OTX-TKI, and others for eligible patients.

Monitoring & Follow-up

• Regular assessment of best-corrected visual acuity (BCVA) and OCT imaging to monitor treatment response and fluid status.
• Monitoring for need of rescue injections as per trial protocols or clinical judgment.

Risks

• Potential risks include adverse events related to intravitreal injections and implant procedures.
• Long-term safety data for novel agents are pending from ongoing phase 3 trials.

Patient & Prescribing Data

Patients with neovascular AMD, including those previously treated and treatment-naïve

Sustained-release implants like EYP-1901 and OTX-TKI have demonstrated up to 85-89% reduction in treatment burden with comparable visual acuity outcomes; rescue aflibercept injections remain an option.

Clinical Best Practices

• Load patients with standard anti-VEGF therapy before initiating novel sustained-release implants as per trial protocols.
• Tailor treatment intervals based on individual response and need for rescue injections.
• Utilize multimodal imaging including OCT to guide treatment decisions and monitor anatomical outcomes.
• Consider patient preference and treatment burden when selecting therapeutic options.

References

• LUCIA Trial - EYP-1901 Phase 3 Study
• LUGANO Trial - EYP-1901 Phase 3 Study
• SOL-1 Trial - OTX-TKI Phase 3 Study
• SOL-R Trial - OTX-TKI Phase 3 Study
• ODYSSEY Trial - CLS-AX Phase 2b Study