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Evidence needed on efficacy of PDT plus anti-VEGF therapy
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WAIKOLOA, Hawaii — More clinical information is needed to determine whether a combination of photodynamic therapy plus anti-angiogenesis therapy offers a measurable benefit for treating patients with wet age-related macular degeneration, according to a retina specialist speaking here.
Philip J. Rosenfeld, MD, PhD, urged surgeons to think carefully about the risks and benefits combining the two types of therapies for AMD. He said this is especially important now that Macugen (pegaptanib sodium injection, Eyetech Pharmaceuticals, Pfizer), an anti-vascular endothelial growth factor (VEGF) drug, has been approved by U.S. regulatory authorities.
The photodynamic therapy (PDT) drug Visudyne (verteporfin for injection, QLT, Novartis) was approved as a treatment for some types of AMD in 2000. Another PDT drug, Photrex (rostaporfin, Miravant Medical Technologies) has been recommended for approval for use in AMD by a U.S. regulatory advisory panel.
Speaking at Retina 2005, held here in conjunction with Hawaii 2005, The Royal Hawaiian Eye Meeting, Dr. Rosenfeld said that, to justify combining PDT with Macugen, “the potential benefits must outweigh the risks” of vision decrease following PDT.
If leakage can be stopped using anti-VEGF therapy, and the only indication for using PDT is leakage, then the benefit of adding PDT to the treatment protocol must be clearly demonstrated, he said.
Evidence that might help surgeons sort through these options is still lacking, he added.
In contrast, Dr. Rosenfeld said there is a body of evidence supporting a combination of PDT plus intravitreal triamcinolone acetate injection. “The question becomes: Are the benefits of PDT plus Kenalog [triamcinolone acetonide, Bristol-Myers Squibb] worth the increased risk? Right now they are. But with Macugen, we still need to know,” he said.