Regression of Some High-risk Features of Age-related Macular Degeneration (AMD) in Patients Receiving Intensive Statin Treatment

Abstract

ImportanceAge-related macular degeneration (AMD) remains the leading cause of blindness in developed countries, and affects more than 150 million worldwide. Despite effective anti-angiogenic therapies for the less prevalent neovascular form of AMD, treatments are lacking for the more prevalent dry form. Similarities in risk factors and pathogenesis between AMD and atherosclerosis have led investigators to study the effects of statins on AMD incidence and progression with mixed results. A limitation of these studies has been the heterogeneity of AMD disease and the lack of standardization in statin dosage.ObjectiveWe were interested in studying the effects of high-dose statins, similar to those showing regression of atherosclerotic plaques, in AMD.DesignPilot multicenter open-label prospective clinical study of 26 patients with diagnosis of AMD and the presence of many large, soft drusenoid deposits. Patients received 80 mg of atorvastatin daily and were monitored at baseline and every 3 months with complete ophthalmologic exam, best corrected visual acuity (VA), fundus photographs, optical coherence tomography (OCT), and blood work (AST, ALT, CPK, total cholesterol, TSH, creatinine, as well as a pregnancy test for premenopausal women).ResultsTwenty-three subjects completed a minimum follow-up of 12 months. High-dose atorvastatin resulted in regression of drusen deposits associated with vision gain (+ 3.3 letters, p = 0.06) in 10 patients. No subjects progressed to advanced neovascular AMD.ConclusionsHigh-dose statins may result in resolution of drusenoid pigment epithelial detachments (PEDs) and improvement in VA, without atrophy or neovascularization in a high-risk subgroup of AMD patients. Confirmation from larger studies is warranted.

Monomeric C-reactive protein and inflammation in age-related macular degeneration

“…Furthermore, since elevated mCRP is present in many of the examined choroids prior to the onset of AMD, its accumulation may be an early event in the pathogenesis of the disease. Interestingly, a recent study has suggested an association between statin treatment and drusen regression in a small cohort [41], and statins have separately been shown to decrease the levels of serum CRP in coronary artery disease patients [42]. Therefore, it is possible that the mCRP that we observed within drusenoid deposits is important in their growth or formation.…”

Beyond VEGF—The Weisenfeld Lecture

“…44 Of 23 patients who completed follow-up of at least 12 months, 10 showed drusen regression without atrophy; of these patients, visual acuity improved by an average of three letters, and regression was nearly complete in eight patients. No patients progressed to neovascular AMD.…”

Central Role of Oxidative Stress in Age-Related Macular Degeneration: Evidence from a Review of the Molecular Mechanisms and Animal Models

“…A direct association between AMD and increased serum cholesterol has been supported by a population-based study showing that higher serum HDL concentration in aged persons doubled their risk of developing AMD [163]. Also, the contribution of dysfunctional lipid metabolism to AMD is upheld by the finding that an intervention modulating lipid metabolism was effective in managing AMD [164]. In this follow-up study of 23 subjects diagnosed with AMD having large soft drusen, a high dose of atorvastatin treatment resulted in a regression of the drusen and vision gain in 10 patients.…”