Intravitreal treatment for geographic atrophy: coming soon to a patient near you?

Dinah, Christiana; Enoch, Jamie; Ghulakhszian, Arevik; Taylor, D. Wayne; Crabb, David P.

doi:10.1038/s41433-021-01591-1

Cited by 5 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, new therapies for GA are currently in development which could transform treatment pathways for people living with the condition. 4 In Phase 2 trials, two intravitreal injection treatments have been shown to slow the average rate of GA growth by up to 30% when delivered monthly. 5 , 6 One of these treatments, pegcetacoplan, has met its primary endpoint at 24 months in a global phase 3 trial, demonstrating a reduction in GA lesion growth by 22%.…”

Section: Introductionmentioning

confidence: 99%

Towards a Therapy for Geographic Atrophy: A Patient’s Experience

Enoch¹,

Ghulakhszian²,

Sekhon³

et al. 2023

PPA

Self Cite

View full text Add to dashboard Cite

Purpose Geographic atrophy (GA) is the advanced form of the non-neovascular (dry) type of age-related macular degeneration. Presently, GA cannot be treated. However, new therapies administered by intravitreal injection are in late-stage development. These can slow down, but do not stop or reverse, GA progression. The acceptability of these emerging therapies to people with GA is currently unknown. The present case study explores the perspectives of a person living with GA who took part in the terminated Phase 3 clinical trial of Lampalizumab, a candidate intravitreal treatment for GA. We explored this patient’s perspective on the retrospective acceptability of regular Lampalizumab injections, and the prospective acceptability of future intravitreal therapies for GA. Patients and Methods A 78-year-old woman living in the UK was recruited as part of a mixed-methods pilot study and interviewed by telephone, regarding: her experience of the Lampalizumab trial injections; and her thoughts regarding emerging intravitreal therapies for GA. The Framework Method was used for initial inductive analysis of the interview transcript. Subsequently, deductive analysis was undertaken, informed by the Theoretical Framework of Acceptability (TFA). Results For this participant, intravitreal injections in the Lampalizumab trial were acceptable, although streamlining processes within the clinic would have improved the patient experience. Regarding prospective acceptability of new intravitreal therapies, the participant considered a delay in progression of GA a valuable goal. Potential discomfort, anxiety and inconvenience associated with regular intravitreal injections would be acceptable in the context of preserving her vision for as long as possible. Conclusion Analysis of one participant’s experience demonstrates the value of exploring GA patients’ unique views on the acceptability of new intravitreal treatments. Larger prospective studies will provide more insight that help to optimise treatment design and delivery, thereby maximising likelihood of adherence and persistence when these therapies eventually arrive in clinic.

show abstract

Section: Introductionmentioning

confidence: 99%

Towards a Therapy for Geographic Atrophy: A Patient’s Experience

Enoch¹,

Ghulakhszian²,

Sekhon³

et al. 2023

PPA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Geographic Atrophy (GA) is the advanced form of the non-neovascular (‘dry’) type of age-related macular degeneration (AMD), affecting 276,000 people in the UK [ 1 ]. While there are now approved treatments for wet AMD, until recently there has been no therapy for GA, a significant unmet need [ 2 ]. Even before the foveal centre is involved, GA can have significant impact on functional activities and vision-related quality-of-life [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Dysregulation of the complement cascade has been implicated in the pathogenesis of GA, and there are now two intravitreal complement inhibitors in late-stage development for the treatment of GA [ 2 ]. Regular intravitreal injections are the standard of care for wet AMD, and a common mode of delivery in the current pipeline of treatments for GA in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Exploring patient acceptability of emerging intravitreal therapies for geographic atrophy: A mixed-methods study

Enoch

Ghulakhszian

Sekhon

et al. 2023

Eye

Self Cite

View full text Add to dashboard Cite

Background/Objectives The acceptability of emerging intravitreal therapies for patients with Geographic Atrophy (GA) is currently unknown. This study therefore aimed to investigate the extent to which regular intravitreal injections may be acceptable to GA patients. Subjects/Methods Thirty UK-based individuals with GA secondary to age-related macular degeneration (AMD), recruited from two London-based hospitals, were interviewed in April-October 2021 regarding acceptability of new GA treatments. Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. The Theoretical Framework of Acceptability (TFA) informed framework analysis of the qualitative data. Results Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had foveal centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41–79%)) would accept the treatment, despite awareness of potential drawbacks. Eight participants (27% (95% CI: 10–43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0–26%) would be unlikely to accept treatment. Reducing the frequency of injections from monthly to every other month increased the proportion of participants who considered the treatments acceptable. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. Misunderstandings of potential benefits indicate the need for appropriately-designed patient education tools to support decision-making. Conclusions Our study suggests a majority of participants would be positive about intravitreal treatment for GA, in spite of potential burdens.

show abstract

“…Dysregulation of the complement cascade has been implicated in the pathogenesis of GA, and there are now two intravitreal complement inhibitors in late-stage development for the treatment of GA. 16 Regular intravitreal injections are the standard of care for wet AMD, and a common mode of delivery in the current pipeline of treatments for GA in clinical trials. Recent positive results from phase 3 clinical trials of two intravitreal complement inhibitors (Table 1) provide hope for a treatment for GA.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15] Indeed, qualitative studies on the experience of living with GA suggest that many individuals living with the condition feel hopelessness and despair at the prospect of their vision deteriorating, particularly due to the lack of any treatment that could delay, halt or reverse this process. 12 Dysregulation of the complement cascade has been implicated in the pathogenesis of GA, and there are now two intravitreal complement inhibitors in late-stage development for the treatment of GA. 16 Regular intravitreal injections are the standard of care for wet AMD, and a common mode of delivery in the current pipeline of treatments for GA in clinical trials. Recent positive results from phase 3 clinical trials of two intravitreal complement inhibitors (Table 1) provide hope for a treatment for GA.…”

Section: Introductionmentioning

confidence: 99%

Exploring patient acceptability of emerging intravitreal therapies for Geographic Atrophy: a mixed-methods study

Enoch

Ghulakhszian

Sekhon

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Purpose: The acceptability of emerging intravitreal therapies for GA (that can slow down, but not stop or reverse, GA progression) is currently unknown. This study therefore aimed to: investigate whether regular intravitreal injections will be acceptable as treatment for GA patients; identify which attributes of current treatments in late stage development patients find less acceptable; and explore whether patient-related factors influence GA treatment acceptability. Design: Exploratory, cross-sectional, mixed-methods study. Participants: 30 UK-based individuals with GA secondary to AMD, recruited from two London-based hospitals, interviewed in April-October 2021. Methods: Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. Quantitative data were analysed using descriptive statistics and non-parametric measures of correlation. Qualitative data were analysed using the Framework Method of analysis, using the Theoretical Framework of Acceptability to guide deductive analysis. Main outcome measures: Main quantitative measures were Likert-type scale responses about acceptability of GA treatments. Qualitative outcomes of interest related to participants' hopes, concerns and understanding of the proposed new intravitreal treatments for GA. Results: Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41-79%)) would accept the treatment at any cost, despite their awareness of the drawbacks. Eight participants (27% (95% CI: 10-43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0-26%)) would be unlikely to accept treatment. Qualitative data indicated that participants' prioritisation of continuation with vision-specific activities influenced treatment acceptability. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. There were common misunderstandings regarding the likely effects of GA treatment. Conclusions: This exploratory study suggests that a majority of participants would be positive about intravitreal treatment for GA, even in spite of manifold burdens and inconveniences. Insights from this study will inform the development of a larger, UK-wide quantitative study on GA treatment acceptability.

show abstract

Intravitreal treatment for geographic atrophy: coming soon to a patient near you?

Cited by 5 publications

References 25 publications

Towards a Therapy for Geographic Atrophy: A Patient’s Experience

Towards a Therapy for Geographic Atrophy: A Patient’s Experience

Exploring patient acceptability of emerging intravitreal therapies for geographic atrophy: A mixed-methods study

Exploring patient acceptability of emerging intravitreal therapies for Geographic Atrophy: a mixed-methods study

Contact Info

Product

Resources

About