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32 F E B R U A R Y 2 0 1 7 • O P T O M E T R I C M A N A G E M E N T . C O M CLINICAL RE TINA bevacizumab, due to potential contamination when the drug is repackaged into smaller doses to be used. Yet, in most cases of in- fection, the source is the surface of the patient's eye vs. contami- nated medication or anything else, according to Ophthalmology. Ranibizumab costs about $2,000 per treatment. Aflibercept is a VEGF trap drug, as it binds to multiple VEGF receptors, thus, likely re- quiring less frequent injections. It costs about $1,800 per treatment. e dosing regimen for all anti-VEGF drugs is monthly in- jections until VA improves and decreased retinal thickness is ob- served on OCT. Aflibercept may be dosed every two months. e treat-and-extend dosing regimen, defined as monthly injections un- til improvement on OCT, is fol- lowed by increasing intervals be- tween injections and evaluations, depending on disease activity. is treatment protocol may help reduce the treatment burden and cost associated with fixed monthly or as-needed injection protocols, according to a study in Retina. is was observed in the Aflibercept Treatment with Less- frequent Administration Study, published at the 2016 Association for Research in Vision and Oph- thalmology's Annual Meeting. Minimal differences in risk ex- ist among all three drugs, accord- ing to Ophthalmology. Complica- tions observed: • Subconjunctival hemorrhage • Red, irritated eye • Foreign body sensation • Tearing • Cataract • Cornea problems (abrasions) • Elevation in eye pressure • Inflammation (uveitis or vitritis) • Intraocular infection Anti-VEGF Therapies on the Horizon The three anti-VEGF drugs that are in the pipeline: • Abicipar Pegol (Abicipar, Allergan). is is a mono-DARpin that inhibits VEGF-A and thus, is being evaluated for the treatment of wet AMD and diabetic macular edema. A Phase II trial on DME patients reveals the mean BCVA change from baseline aer 28 weeks to 7.1 letters, 4.9 letters and 7.2 letters for abicipar pegol 2mgQ8, abicipar pegol 1mgQ8 and abicipar pegol 2mgQ12, respec- tively, compared with 9.6 letters for ranibizumab. Recruitment for a Phase III trial is currently in progress. • ALG-1001 (Luminate, Allegro Ophthalmics). is integrin peptide therapy focuses on the integrin receptors in cell sig- naling and regulation and in the development of new and aberrant blood vessels in vitreoretinal diseases. A Phase IIb trial shows the therapy was non-inferior to bevacizumab in the treatment of diabetic macular edema. Specifically, patients who took 1.0mg injections of ALG-1001 once a month for three months and then 12 weeks off achieved a mean BCVA gain of 5.2 letters vs. a mean BCVA gain of 7.0 letters in patients who took 1.25mg of bevacizumab once a month for six months. Also, non-inferiority to bevacizumab was noted in central macular thickness. • OHR-102 (Squalamine lactate ophthalmic solution, 0.2%, OHR Pharmaceutical, Inc.). is is a small molecule that inhibits multiple growth factors and path- ways responsible for angiogenesis. It not only works against VEGF, but also platelet-derived growth factor, which is involved in the develop- ment of the pericytes that help in the maturation of neovascular vessels, and basic fibroblast growth factor, a cytokine that has angiogenic and inflammatory effects. A Phase II study reveals that 40% of those with occult choroidal neo- vascularization less than 10mm2 who were treated with a combination of OHR-102 and ranibizumab, gained three or more lines of vision vs. 26% of those who took ranibizumab alone. Further, those who took the combination treatment gained 11.0 let- ters vs. 5.7 letters with ranibizumab alone. Phase III clinical trials are in progress.