Journal Article

Emerging therapies in the management of macular edema: a review version 1; peer review: 2 approved

Bandello, Francesco, Corbelli, Eleonora, Sacconi, Riccardo, Querques, Giuseppe, Giuffrè, Chiara, Borrelli, Enrico

2019

Overview

Macular edema (ME) is a major complication of several vascular and inflammatory retinal diseases. Multiple mechanisms are implicated in its development and lead to visual impairment that could be reversible (the acute stages) or not reversible (long-standing ME). For this reason, an effective approach to the treatment of ME is of paramount importance in order to prevent irreversible damage of visual function. In this review, we discuss the management of ME and, in particular, current data of studies and clinical trials about drugs that have already been evaluated or are under investigation in the management of ME. Although several diseases could lead to the development of ME, we focus on the three main causes: diabetic retinopathy (DR), retinal vein occlusion (RVO), and uveitis. The introduction into clinical practice of anti-vascular endothelial growth factor injections (ranibizumab and aflibercept) and dexamethasone implants has revolutionized the treatment of ME secondary to DR and RVO. However, new drugs are needed in the treatment of resistant forms of ME secondary to DR and RVO. A fluocinolone acetonide implant has been approved by the US Food and Drug Administration for the treatment of diabetic ME but not for RVO. Furthermore, brolucizumab and abicipar pegol have been shown to be effective in preliminary studies and have the chance to be approved soon for diabetic ME treatment. In ME secondary to uveitis, a crucial role is played by corticosteroids and non-biologic immunomodulatory drugs. However, several new biologic agents are under investigation in different clinical trials and could be important new therapeutic options in cases with a low response to first-line therapy. However, only a few of these drugs will enter the market after proving their safety and efficacy. Only after that will we be able to offer a new therapeutic option to patients affected by uveitic ME.

• Publisher: Faculty of 1000 Ltd,F1000 Research Limited,F1000 Research Ltd
• Subject: Antibodies, Monoclonal, Humanized - therapeutic use / Clinical medicine / Clinical trials / Clinical Trials as Topic / Corticosteroids / Dexamethasone / Dexamethasone - therapeutic use / Diabetes / Diabetes mellitus / Diabetic retinopathy / Diabetic Retinopathy - drug therapy / Drugs / Edema / FDA approval / Fluocinolone Acetonide - therapeutic use / Humans / Immunomodulation / Macular Edema - drug therapy / Management / Monoclonal antibodies / Occlusion / Ranibizumab - therapeutic use / Receptors, Vascular Endothelial Growth Factor - therapeutic use / Recombinant Fusion Proteins - therapeutic use / Retina / Retinal Vein Occlusion - drug therapy / Retinopathy / Review / Transplants & implants / Tumor necrosis factor-TNF / Uveitis / Uveitis - drug therapy / Vascular endothelial growth factor / Visual impairment / Visual perception