Emerging treatments
Stereotactic radiation therapy
Low-voltage, external-beam, stereotactic radiation therapy has been reported to reduce the number of retreatments required for neovascular AMD with ranibizumab.[100] Further studies are underway and the manufacturer has suspended commercial development until further notice. One Cochrane review has concluded that the benefits of currently available radiation therapy options is uncertain.[101]
Ranibizumab port delivery system
The port delivery system (PDS) is a drug delivery system for the continuous intravitreal delivery of a customized formulation of ranibizumab. The device consists of a reservoir implanted surgically into which ranibizumab may be injected periodically in an office setting, as required, based on disease activity.[102] Early data from the phase 3 Archway trial showed noninferiority of the PDS versus ranibizumab; at week 40, the total number of ranibizumab treatments was 2.0 (PDS) versus 10.7 (ranibizumab monthly).[103]
Complement inhibitors
Two novel complement inhibitors are approved in the US for the management of geographic atrophy: intravitreal pegcetacoplan and intravitreal avacincaptad pegol.[104][105] Randomized phase 2 trials of pegcetacoplan and avacincaptad pegol reported significant reduction of geographic atrophy growth in eyes with AMD over a 12-month period.[106][107] In a subsequent randomized, double-masked, 24-month, phase 3 trial, monthly treatment with avacincaptad pegol (a complement C5 inhibitor) slowed the growth of geographic atrophy over 12 months by a difference of 14% compared with sham treatment.[108]
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