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.

Current and emerging treatment options for myopic choroidal neovascularization

“…68 3) Palomid 529 is an investigational medication involving the immune Akt/mTOR pathway and unique in dissociating both targets of rapamycin complexes TORC1 and TORC2. 69 4) KH902 has similar properties as aflibercept. 70 5) Intravitreal injection of adeno-associated virus-2 vector is being used to deliver an anti-VEGF molecule, sFLT01.…”

mTOR in health and in sickness

“…However, mTOR inhibitors may benefit also patients with other disorders. For example, clinical trials have generated encouraging results for Palomid 529, a PI3K/mTOR dual inhibitor, in the treatment of age-related macular degeneration [135]. mTOR inhibitors conceptually could be used to treat neurodegenerative diseases and ASD.…”

Res-529

“…RES-529 is an orally administered compound that has good blood–brain penetration and lacks affinity to ATP-binding cassette, subfamily B, member 1 (ABCB1) and ATP-binding cassette, subfamily G, member 2 (ABCG2) drug efflux transporters 86 . RES-529 has been evaluated in two phase I open-label trials in patients with neovascular age-related macular degeneration (NCT01271270 and NCT01033721) 87 – 89 . In these clinical studies, RES-529 was administered as an ocular injection.…”