title: Progression of macular atrophy after PDT combined with the COX-2 inhibitor Nabumetone in the treatment of neovascular ARMD.
abstract: OBJECTIVE
  To evaluate photodynamic therapy (PDT) combined with the preferential the cyclooxygenase-2 (COX-2) inhibitor, nabumetone in the treatment of the neovascular age-related macular degeneration (ARMD).
  
  
  METHODS
  A prospective, double-blind, randomized study on 60 patients with subfoveal CNV secondary to ARMD without any previous treatment. Patients were divided into a nabumetone or placebo group. The main endpoints were the change of best-corrected visual acuity (BCVA), central macular thickness (CRT) and number of required PDT treatments.
  
  
  RESULTS
  In the nabumetone group, 27 patients (90%) and 28 (93%) in the placebo group completed the follow-up of 12 months. In the nabumetone group, the mean CRT decreased from 332 μm (SD 68 μm) to 220 μm (SD 46 μm). In the placebo group, CRT decreased from 331 μm (SD 72 μm) to 254 μm (SD 61 μm). The mean BCVA was 0.68 log MAR (SD 0.22 log MAR) in the nabumetone group and 0.62 log MAR (SD 0.23 log MAR) in the placebo group at baseline. This stabilised in the placebo group to 0.66 log MAR (SD 0.33) but deteriorated in the nabumetone group to 0.86 log MAR (SD 0.41 log MAR). There was a significant reduction in the number of required PDTs in the nabumetone group, but significant progression of the RPE atrophy area.
  
  
  CONCLUSIONS
  Combined PDT with oral intake of the COX-2 inhibitor, nabumetone reduced the number of required PDT retreatments, but worsening BCVA caused by macular atrophy progression. Therefore the combination of the PDT with the nabumetone is not recommended.
authors.affiliation: Department of Ophthalmology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Sin
authors.forename: Oldrich
authors.initials: O
authors.lastname: Chrapek
authors.forename: Marta
authors.initials: M
authors.lastname: Karhanova
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Pracharova
authors.forename: Katerina
authors.initials: K
authors.lastname: Langova
authors.forename: Jiri
authors.initials: J
authors.lastname: Rehak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D002074:Butanones / Q000627:therapeutic use*; D002829:Choroid / Q000098:blood supply; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008268:Macular Degeneration / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D000077430:Nabumetone; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D011446:Prospective Studies; D000077362:Verteporfin; D014792:Visual Acuity
chemical_list: D002074:Butanones; D052246:Cyclooxygenase 2 Inhibitors; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D000077430:Nabumetone