Response to AREDS formulation depends on genotype

Issue: January 2015

CHICAGO – The response to AREDS supplementation in patients with age-related macular degeneration varies greatly based on CFH and ARMS2 risk, according to a speaker here.

Perspective from Pravin U. Dugel, MD

In a statistical genetic analysis published in Ophthalmology, Carl C. Awh, MD, and colleagues delineated risk of AMD progression in genotype subgroups culled from the AREDS cohort.

Carl C. Awh

“We predicted an adverse response to AREDS formulation or zinc in patients with two CFH and zero ARMS2 risk alleles,” Awh said at Retina Subspecialty Day preceding the American Academy of Ophthalmology meeting.

Awh and fellow authors elucidated AMD progression risk in four distinct genotype groups with higher or lower ARMS2 and CFH risk. Patients with high ARMS2 and low CFH risk responded well to the AREDS formulation or zinc.

“However, those with high CFH and no ARMS2 risk had an opposite response to the AREDS formulation or zinc and had much higher progression,” Awh said.

Using the AREDS Study Group genotyping, it’s easy to identify patients in genotypes group one, two, three and four,” he said. “So, we know which patients fall into which genotype group. We know how many patients are in each group and we know how many patients progressed to advanced AMD at 7 years.”

Disclosure: Awh has financial relationships with Arctic Dx, Bausch + Lomb, Genentech, GlaxoSmithKline, Katalyst, Notal Vision, Regeneron, Synergetics Inc. and Volk Optical.

Perspective

Pravin U. Dugel, MD

Dr. Awh’s presentation is fascinating and extremely important. It is also valuable to keep in mind that it is a hypothesis-building study. It is certainly not a definitive study. I think that it ought to be confirmed by a larger study. I truly hope that Dr. Awh and the National Eye Institute work together to give us more information regarding this hypothesis.

It is potentially a “game changer,” and it needs to be examined. My point is that it is important to distinguish definitive data from hypothesis-building data. It does not demean one or the other. I think it is fair to say, and I think that Dr. Awh would agree, that this is hypothesis-building data. It is not definitive data. However, it is interesting enough and it is relevant enough that I think that it ought to be further studied. My hope is that the two expert groups in this particular field, Dr. Awh and his colleagues, and Drs. Chew and Ferris and their colleagues at the National Eye Institute, will get together and study this together in a cooperative fashion so that whatever data they get will be definitive data that will influence how we treat our patients.

Pravin U. Dugel, MD

OSN Retina/Vitreous Board Member

Disclosures: Dugel is a consultant for ArcticDx.