Wydanie 3/2007

Inhibitory VEGF w leczeniu neowaskularnej postaci zwyrodnienia plamki związanego z wiekiem

VEGF Inhibitors in the Treatment of Neovascular Age-Related Macular Degeneration

Halina Wykrota, Krzysztof Trzciąkowski

Samodzielny Publiczny Szpital Kliniczny Nr 5 Śląskiego Uniwersytetu Medycznego w Katowicach Dyrektor: prof. dr hab. n. med. Ariadna Gierek-Łapińska

Summary: Treatment of neovascular age-related macular degeneration (AMD) in past century was limited to thermal laser photocoagulation only. Implementation of photodynamic therapy with verteporfin in 2000 improved safety and efficacy of the treatment but still the method is based on existing fibrovascular membranes damage. Additionally none of those methods are fully effective and recurrence rate was very high as well as not all subtypes of CNV are eligible to treatment. The new approach to CNV treatment is to discover and eliminate factors, which are directly affecting CNV development. Studies on the role that angiogenesis plays in pathogenesis of the disease have allowed to employ inhibitors of vascular endothelial growth factor (VEGF) for the neovascular AMD treatment. Numerous of anti-VEGF compounds are being developed in pre-clinical or phase-1/2 clinical studies. Efficacy in CNV closure of VEGF Trap that is a high affinity antagonist of VEGF has been demonstrated recently. VEGF Trap binds to all VEGF isoforms. Small interfering RNA compound (siRNA) is under evaluation as VEGF mRNA suppressor. One molecule of siRNA may potentially silence a hundreds of VEGF mRNA. Two of anti-VEGF medicine: pegaptanib and ranibizumab that are delivered intravitreally have completed phase 3 of clinical trials. It seems that treatment that can block different isoforms of VEGF is effective in patients treated for CNV due to AMD. Further research is needed to evaluate which compound would have the best safety and efficacy profile. Implementation of anti-VEGF therapy for treatment of ocular diseases gave a new hope for patients, who previously couldn?t be treated with any method.

Keywords: age-related macular degeneration, choroidal neovascularization, vascular endothelial growth factor, pegaptanib, ranibizumab