title: Subconjunctival Palomid 529 in the treatment of neovascular age-related macular degeneration.
abstract: BACKGROUND
  Recent evidence suggests that neovascular age-related macular degeneration (AMD) may have an immune mediated component. Palomid 529, an investigational medication involving the immune Akt/mTOR pathway, is unique in dissociating both targets of rapamycin complexes TORC1 and TORC2. This small short-term pilot study assesses the safety of subconjunctival Palomid 529 in the treatment of neovascular AMD, with some limited efficacy information.
  
  
  METHODS
  In this 12-week phase I open-label prospective pilot study, five participants with neovascular age-related macular degeneration that were refractory to intravitreal anti-vascular endothelial growth factor (VEGF) received three serial monthly subconjunctival doses of 1.9 mg Palomid 529. All participants were also offered concomitant monthly intravitreal anti-VEGF injections. Safety was monitored via adverse events recording. Additional outcome measures included visual acuity, optical coherence tomography, fluorescein angiography, indocyanine green angiography and fundus photography.
  
  
  RESULTS
  The study drug was well-tolerated by all participants. There were no drug-related adverse events and no serious adverse events. A depot formed at the injection site, which persisted at the end of the study. In these anti-VEGF refractory patients, no clinically important changes in best-corrected visual acuity, fluorescein leakage pattern, choroidal neovascularization size on indocyanine green angiography, or autofluorescence pattern on fundus autofluorescence were observed compared to baseline. The fluid status, assessed with optical coherence tomography showed that central retinal thickness and macular volume remained stable in three participants, while the other two participants clinically progressed.
  
  
  CONCLUSIONS
  Serial subconjunctival injections of Palomid 529 were well-tolerated and resulted in depot formation. There were no concerns for any ocular or systemic toxicity during this small short-term study. Larger randomized studies are required to determine efficacy.
authors.affiliation: Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Dalal
authors.forename: Naima
authors.initials: N
authors.lastname: Jacobs-El
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nicholson
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Tuo
authors.forename: Emily
authors.initials: E
authors.lastname: Chew
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Chan
authors.forename: Robert
authors.initials: R
authors.lastname: Nussenblatt
authors.forename: Frederick
authors.initials: F
authors.lastname: Ferris
authors.forename: Catherine
authors.initials: C
authors.lastname: Meyerle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001578:Benzopyrans / Q000627:therapeutic use*; D004396:Coloring Agents; D003228:Conjunctiva; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D000076222:Mechanistic Target of Rapamycin Complex 1; D000076225:Mechanistic Target of Rapamycin Complex 2; D046912:Multiprotein Complexes / Q000037:antagonists & inhibitors; D010865:Pilot Projects; D011446:Prospective Studies; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D001578:Benzopyrans; D004396:Coloring Agents; D004791:Enzyme Inhibitors; D046912:Multiprotein Complexes; D000076222:Mechanistic Target of Rapamycin Complex 1; D000076225:Mechanistic Target of Rapamycin Complex 2; D058570:TOR Serine-Threonine Kinases; D007208:Indocyanine Green; C533469:palomid 529