Changing paradigms of anti-VEGF in the Indian scenario

Shanmugam, P Mahesh

doi:10.4103/0301-4738.126189

Cited by 10 publications

(10 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anti‐VEGF was discussed in a few studies, with one report saying that it was available in Kenya specifically, and was available off‐label in sub‐Saharan Africa generally, if patients were able to pay for it. In India, bevacizumab was available and the most commonly‐used anti‐VEGF agent (for cost reasons) . It was unclear how widely available vitreo‐retinal surgery units are, although papers discussing the need for them suggest that they are not.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review

Lin

Ramulu

Lamoureux

et al. 2016

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

The number of people with diabetic retinopathy (DR) has increased with the increasing prevalence of diabetes mellitus worldwide, especially in developing countries. In recent years, the successful implementation of public health programs in developed countries has been thought to contribute to decreases in blindness from DR. Developing countries, however, have not seen the same improvements, and their public health interventions still face significant challenges. In this review we describe the current state of public health approaches including risk factor control, screening and treatment techniques for DR in developing countries, and suggest recommendations. While the awareness of DR is variable, specific knowledge about DR is low, such that many patients have already experienced vision loss by the time they are screened. Attempts to improve rates of screening, in particular through non-mydriatic cameras and tele-screening, are ongoing and promising, although challenges include collaboration with healthcare systems and technology failures. Laser treatment is the most readily available, with anti-VEGF therapy and vitreo-retinal surgery increasingly sought after and provided. Recommendations include the use of 'targeted mydriasis' for fundus imaging to address high rates of ungradable images, increased communication with diabetes management services to improve patient retention and mobilization of access to DR treatments.

show abstract

Section: Resultsmentioning

confidence: 99%

“…In India, bevacizumab was available and the most commonly-used anti-VEGF agent (for cost reasons). 83 It was unclear how widely available vitreo-retinal surgery units are, although papers discussing the need for them 84 suggest that they are not.…”

Section: Treatment Optionsmentioning

confidence: 99%

Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review

Lin

Ramulu

Lamoureux

et al. 2016

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

show abstract

“…These substances together satisfy the following criteria (i) under normal conditions their native form is present in the retina in low concentration; (ii) each retinal cell type has a receptor for at least one of the four peptides; (iii) the signal transduction pathways behind the retinal receptors of these substances do not ameliorate or cross each other’s action; and (iv) none of them causes unwanted side effects even if they are given in higher concentrations. Considering that anti-VEGF drugs cost over 500 million pounds in Great Britain alone in 2015 (Hollingworth et al, 2017), alternatives are definitely needed, especially in low and medium income countries (Shanmugam, 2014). Clinical trials with the combinations of the above substances could be envisioned based on the results achieved on animal models in research laboratories.…”

Section: Discussionmentioning

confidence: 99%

Neuroprotective Potential of Pituitary Adenylate Cyclase Activating Polypeptide in Retinal Degenerations of Metabolic Origin

2019

View full text Add to dashboard Cite

Pituitary adenylate cyclase-activating polypeptide (PACAP1-38) is a highly conserved member of the secretin/glucagon/VIP family. The repressive effect of PACAP1-38 on the apoptotic machinery has been an area of active research conferring a significant neuroprotective potential onto this peptide. A remarkable number of studies suggest its importance in the etiology of neurodegenerative disorders, particularly in relation to retinal metabolic disorders. In our review, we provide short descriptions of various pathological conditions (diabetic retinopathy, excitotoxic retinal injury and ischemic retinal lesion) in which the remedial effect of PACAP has been well demonstrated in various animal models. Of all the pathological conditions, diabetic retinopathy seems to be the most intriguing as it develops in 75% of patients with type 1 and 50% of patients with type 2 diabetes, with concomitant progression to legal blindness in about 5%. Several animal models have been developed in recent years to study retinal degenerations and out of these glaucoma and age-related retina degeneration models bear human recapitulations. PACAP neuroprotection is thought to operate through enhanced cAMP production upon binding to PAC1-R. However, the underlying signaling network that leads to neuroprotection is not fully understood. We observed that (i) PACAP is not equally efficient in the above conditions; (ii) in some cases more than one signaling pathways are activated; (iii) the coupling of PAC1-R and signaling is stage dependent; and (iv) PAC1-R is not the only receptor that must be considered to interpret the effects in our experiments. These observations point to a complex signaling mechanism, that involves alternative routes besides the classical cAMP/protein kinase A pathway to evoke the outstanding neuroprotective action. Consequently, the possible contribution of the other two main receptors (VPAC1-R and VPAC2-R) will also be discussed. Finally, the potential medical use of PACAP in some retinal and ocular disorders will also be reviewed. By taking advantage of, low-cost synthesis technologies today, PACAP may serve as an alternative to the expensive treatment modelities currently available in ocular or retinal conditions.

show abstract

“…The trend of treatment for AMD as observed in our study follows closely that seen in a recent hospital-based study from Singapore and India that reports increasing numbers of injections beginning 2008, with the number of injections doubling over 3 years. [ 24 ] This reflects the immense change effected by the introduction of anti-VEGF agents.…”

Section: Discussionmentioning

confidence: 99%

Retrospective hospital-based analysis of age-related macular degeneration patterns in India: 5-year follow-up

Sudhalkar

Sethi

Gogte

et al. 2015

Indian J Ophthalmol

View full text Add to dashboard Cite

Purpose:To provide a detailed analysis of age-related macular degeneration (AMD) with a 5-year follow-up at a Tertiary Eye Care Center in India.Methods:In this retrospective institutional study, 408 eyes of 204 subjects (100 males) with a diagnosis of AMD with minimum 5-year follow-up were included. Data collected included demographics, details of the ocular exam, special investigations performed, treatment offered, complications, and systemic diseases, if any.Results:The median age was 74.24 ± 8.23 years. Median follow-up was 5.77 years. The visual acuity (VA) at baseline and last visit was 0.74 ± 0.12 (Snellen's equivalent 20/100) and 0.54 ± 0.12 logarithm of the minimum angle of resolution (Snellen's equivalent 20/50; P = 0.032) in patients with choroidal neovascular membrane (CNVM). The most common complaint was decreased vision (94.5%). AMD (any stage) was found to be bilateral in 93% of patients at baseline and 197 patients (96.56%) at 5 years. Seventeen eyes had active CNVM (12 of these were occult) at presentation. At baseline, 43 eyes had a disciform scar. Three hundred twenty-one eyes had dry AMD at baseline (geographic atrophy - 12 [3.7%] eyes). Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%. Median number of anti-vascular endothelial growth factor injections administered per patient was 2.8 ± 1.2. CNVM bilaterality was low (7.5%).Conclusion:Patients with AMD in India presented later in the course of the disease. Bilateral advanced AMD and geographic atrophy were uncommon. Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%.

show abstract

Changing paradigms of anti-VEGF in the Indian scenario

Cited by 10 publications

References 76 publications

Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review

Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review

Neuroprotective Potential of Pituitary Adenylate Cyclase Activating Polypeptide in Retinal Degenerations of Metabolic Origin

Retrospective hospital-based analysis of age-related macular degeneration patterns in India: 5-year follow-up

Contact Info

Product

Resources

About