Verteporfin combination regimens in the treatment of neovascular age-related macular degeneration.
BACKGROUND
Neovascular age-related macular degeneration is characterized by choroidal neovascularization that has a complex pathogenesis. Combining agents that have different mechanisms of action (i.e., verteporfin photodynamic therapy, antivascular endothelial growth factor, and/or anti-inflammatory therapies) could maximize clinical benefits through potential complementary effects. This review discusses findings from studies investigating this hypothesis.


METHODS
Articles were retrieved from PubMed using relevant search terms. Abstracts from recent scientific meetings and details of ongoing trials from clinicaltrials.gov were also included.


RESULTS
Following its approval, verteporfin was important in the management of choroidal neovascularization due to age-related macular degeneration for several years. Improved visual outcomes have now been reported with antiangiogenic agents (e.g., intravitreal ranibizumab), especially when frequently administered. Results from investigator-sponsored trials, retrospective case studies and Registries, which have provided insights into the latest findings from clinical practice in the "real-world" setting, as well as randomized controlled trials, suggest that a combination approach is generally well tolerated and may maintain improvements in visual and anatomic outcomes with fewer retreatments.


CONCLUSIONS
A rationale exists for investigating combination approaches to target different processes in choroidal neovascularization pathogenesis, which may optimize treatment benefits in neovascular age-related macular degeneration. Encouraging data suggest that combination strategies are not associated with major adverse events.
Shah
Gaurav K
GK
Barnes Retina Institute, Washington University School of Medicine, St. Louis, Missouri, USA.
Sang
Delia N
DN
Hughes
Mark S
MS
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000627:therapeutic use; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D000077362:Verteporfin
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D017319:Photosensitizing Agents; D011166:Porphyrins; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab