EURETINA 2024: New therapeutics for wet AMD address the broader VEGF family

At this year's EURETINA Congress, Timothy L Jackson PhD, MB ChB, FRCOphth, stopped by the Ophthalmology Times Europe booth to discuss recent research in neovascular (wet) age-related macular degeneration (AMD).

Prof Jackson is a professor of retinal research and consultant ophthalmic and retinal surgeon at King's College London. In this video, he speaks about VEGF-A/C/D inhibition with sozinibercept and ranibizumab, providing subgroup analysis of a phase 2b study to assess the angiographic predictors of response.

Editor's note: The below transcript has been lightly edited for clarity.

Timothy L Jackson PhD, MB ChB, FRCOphth: So I'm Tim Jackson. I'm a professor of retinal research at Kings College in London. So the talk I was just giving is essentially about anti-VEGF-C and -D, which is a new sort of avenue of inquiry. Essentially, we've been suppressing VEGF-A for treatment of wet AMD for a very long time now. We're all terribly familiar with the drugs that we've used to treat it. The issue is that it pushes down VEGF-A very effectively, but we have an elevation in VEGF-C.

VEGF-C is already elevated in wet AMD, but if you push down VEGF-A, you'd have a reciprocal increase in VEGF-C; VEGF-C and -D, at the minute, are not being treated, so we're really treating part of the VEGF family. So the idea of the new treatment is that we're basically going to add an anti-VEGF-C and -D drug alongside VEGF-A. So it's an adjunctive treatment. It's not given on its own. It's given in conjunction with ranibizumab or aflibercept or whatever your anti-VEGF-A agent is. And the idea being is that it will get right across the VEGF family, we're going to have a better effect.

We see good results on the phase 2b studies; it was a randomised, double-masked, sham control trial. What it showed was that superior visual versus just a ranibizumab monotherapy control. That's relatively exciting. Most of the treatments we've got at the minute are about fewer injections and non-inferiority of terms of acuity, but there's nothing else I'm aware of, at least that's setting the bar high enough to actually aim for superior visual acuity output.

I think the key elements that we'll hopefully see, as I say, we've got to get the phase 2b studies completed now, but we've now got a massive phase 3 trial underway. It's almost 2,000 patients in the COAST and SHORE studies. They combine the OPT-302, with ranibizumab in one of the trials, and aflibercept in the other. If the phase 2b results are replicated in the phase 3 trial, then we will have a new string to our bow. We can't implement it yet, because it's still subject to investigations, but let's be positive. Let's assume that the results are as good in phase 3 as they are in phase 2, in which case, then we'll have something to offer our patients, rather than just fewer injections, we should be able to offer them, hopefully, better acuity.