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Anecortave acetate: promising treatment for steroid-induced glaucoma
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SAN FRANCISCO — The anterior juxtascleral depot administration of anecortave acetate, in conjunction with other glaucoma medications, appears effective in lowering IOP in eyes with steroid-induced glaucoma, according to a presentation made here at the American Society of Cataract and Refractive Surgery meeting.
The study, presented by Alan L. Robin, MD, examined the IOP increase that is a frequent complication of treatment with intravitreal triamcinolone acetate (Kenalog, Bristol-Myers Squibb).
“The increase in IOP with triamcinolone is a problem that has become an epidemic,” Dr. Robin said.
The IOP spike associated with triamcinolone may in part be a result of changes in the trabecular meshwork, including a significant induction of myocillin. Anecortave acetate is a cortisene, and lacks the usual anti-inflammatory and immonosuppressive properties of glucocortisoids, Dr. Robin said. The drug is marketed as Retaane by Alcon; it is not yet approved for marketing in the United States.
In Dr. Robin’s study, one anterior juxtascleral depot of 24 mg of anecortave acetate was made into the sub-tenon's space of four eyes of three patients. These patients all suffered from glaucoma due to intravitreal triamcinolone, and were on an average of 3.8 glaucoma medications. Mean pre-treatment IOP was 41 mm Hg. The subjects were followed weekly for 1 month, and then once a month thereafter.
At follow-up points ranging from seven months to a year, IOP lowering seemed significant by 1 month and ranged from 32% to 54%. This IOP reduction was in addition to that produced by prior glaucoma medications. The average decrease was 48%, the effect lasted 6 months and prevented glaucoma surgery in 75% of the patients; none had any adverse events.
The study concluded that in combination with other glaucoma medications, “this administration of anecortave acetate was safe and effective in lowering IOP in patients with steroid-induced glaucoma,” Dr. Robin said. The delivery of this treatment does not require patient compliance.
“In summary, this is a new class of medicine, and a new way of delivery,” Dr. Robin said. “It lowers IOP in six out of seven eyes, and may have some potential advantage in the treatment of primary open-angle glaucoma.”