GS-101 antisense oligonucleotide eye drops inhibit corneal neovascularization: interim results of a randomized phase II trial.
OBJECTIVE
Pathologic corneal neovascularization not only reduces corneal transparency and visual acuity, but also is one of the most significant preoperative and postoperative risk factors for graft rejection after corneal transplantation. The aim of this study was to test tolerability and efficacy of gene signal (GS)-101 eye drops, an antisense oligonucleotide against insulin receptor substrate-1, versus placebo on inhibition of progressive corneal neovascularization.


METHODS
Randomized, double-blind, multicenter, phase II clinical study.


METHODS
Interim analysis on 40 patients with progressive corneal neovascularization resulting from various underlying diseases being nonresponsive to conventional therapy.


METHODS
Four groups of 10 patients were treated for 3 months in this dose-finding study comparing 3 doses of GS-101 (eye drops twice daily; 43, 86, and 172 microg/day total) with placebo (10 patients per group).


METHODS
The primary end point was the area covered by pathologic corneal blood vessels, which was measured morphometrically on digitized slit-lamp pictures using image analysis techniques.


RESULTS
GS-101 eye drops were well tolerated. All serious and 95% of all other adverse events were categorized by the investigators as unrelated. In 3 patients, there was a potentially related side effect of ocular surface discomfort. At a dose of 86 microg/day (43 microg/drop), GS-101 eye drops produced a significant inhibition and regression of corneal neovascularization (-2.04+/-1.57% of total corneal area; P = 0.0047), whereas the low dose tended to stabilize it (0.07+/-2.94%; P = 0.2088) compared with placebo (0.89+/-2.15%), where corneal neovascularization progressed in all patients. There was no apparent benefit to the higher dose (1.60+/-7.63%).


CONCLUSIONS
The interim results of this phase II study suggest that GS-101 eye drops at an optimal dose of 86 microg/day are an effective and noninvasive approach specifically to inhibit and regress active corneal angiogenesis, a major risk factor for corneal graft transplantation and graft rejection. Safety concerns were not detected.


BACKGROUND
Proprietary or commercial disclosure may be found after the references.
Cursiefen
Claus
C
Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, Germany. ccursiefen@yahoo.com
Bock
Felix
F
Horn
Folkert K
FK
Kruse
Friedrich E
FE
Seitz
Berthold
B
Borderie
Vincent
V
Früh
Beatrice
B
Thiel
Michael A
MA
Wilhelm
Frank
F
Geudelin
Bernard
B
Descohand
Isabelle
I
Steuhl
Klaus-Peter
KP
Hahn
Angela
A
Meller
Daniel
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016510:Corneal Neovascularization / Q000188:drug therapy* / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009841:Oligonucleotides / Q000008:administration & dosage* / Q000009:adverse effects; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects
D020533:Angiogenesis Inhibitors; C540750:GS 101; D009841:Oligonucleotides; D009883:Ophthalmic Solutions