Intravitreous anti-VEGF for diabetic retinopathy: hopes and fears for a new therapeutic strategy |
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Authors: | R Simó C Hernández |
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Institution: | (1) Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM. Carlos III Health Institute) and Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;(2) Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Pg Vall d’Hebron 119-129, 08035 Barcelona, Spain |
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Abstract: | Vascular endothelial growth factor (VEGF) plays a key role in the development of both proliferative diabetic retinopathy (PDR)
and diabetic macular oedema (DMO). In recent years, anti-VEGF agents have emerged as new approaches to the treatment of these
devastating diabetic complications. Although Phase III studies in the diabetic population are needed, intravitreal anti-VEGF
therapy is currently being used in clinical practice. Intravitreal injection is an effective means of delivering anti-VEGF
drugs to the retina. However, this is an invasive procedure associated with potentially serious complications, such as endophthalmitis
or retinal detachment, which may be significant for patients requiring serial treatment over many years. In addition, although
delivered within the vitreous, anti-VEGF drugs could pass into the systemic circulation, which could potentially result in
hypertension, proteinuria, increased cardiovascular events and impaired wound healing. Pegaptanib, ranibizumab and bevacizumab
are the currently available anti-VEGF agents. Ranibizumab and bevacizumab block all VEGF isoforms, thus impairing both physiological
and pathological neovascularisation. Pegaptanib only blocks the VEGF165 isoform, and would therefore seem the best option for avoiding systemic adverse effects in diabetic patients, although this
remains to be demonstrated in clinical trials. In this regard, head-to-head studies designed to evaluate not only the efficacy,
but also the systemic adverse effects of these drugs in a high-risk population such as diabetic patients are warranted. |
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Keywords: | Bevacizumab Diabetic retinopathy Pegaptanib Ranibizumab VEGF inhibitors VEGF isoforms |
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