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EW RETINA 118 October 2014 by Matt Young EyeWorld Contributing Writer and Eylea provides what appears to be a good solution to wet AMD at the right time. "In terms of take-up, it has been very rapid," Dr. Mitchell said. Making comparisons Historically, wet AMD treatments have made some progress against the disease. "Pfizer gave me enough [Macugen] to treat 60 patients," said Dr. Mitchell, referring to when Pfizer still had the rights to the drug. "I didn't find it worked particularly well. A few did brilliantly—but very few. People continued to lose vision, and like with PDT, there was such a fuss in doing it." PDT, or photodynamic therapy (Visudyne, Valeant), was the first drug therapy approved for wet AMD, used via arm injection and laser beam activation. Lucentis has proven better, Dr. Mitchell said. "All of us have quite a few people on monthly Lucentis," Dr. Mitchell said. "Eye docs are happy with it, but injection fatigue is a problem." Lucentis was approved for wet AMD in 2006, with monthly dosing recommended. Genentech also is promoting results of its HARBOR trial, which is based on a phase 3 study of Lucentis and found, according to the compa- ny, that less frequent than monthly dosing demonstrated clinically meaningful visual acuity gains, while acknowledging that monthly Lucentis is still more effective. If patients have good vision in one eye and problematic AMD in the other, they tend to lose interest in injection therapy, Dr. Mitchell said. Eylea provides a solution for this issue by being not only safe and efficacious, but also by reducing the frequency of injections needed. The recommended dose of Eylea is one injection monthly for the first 3 months, following by one injection every 2 months. O ver the years, wet age-related macular degeneration (AMD) has been attacked by ther- apy after therapy, and the latest to attack is Eylea (aflibe cept, Regeneron Pharmaceuticals, Tarrytown, N.Y., and Bayer, Leverkusen, Germany). With modern day therapies, the plan was—at first—to halt visual decreases. This often occurred with Macugen (pegaptanib sodium, Valeant, Montreal), for example. Then, drugs began to demonstrate significant improvements in vision. This occurred with Lucentis (ranibizumab, Genentech, South San Francisco.) Now that the disease has been halted and reversed, new therapy on the market aims to add convenience to the AMD patient and family lifestyle. That in turn may make pa- tients more willing to take the drug at the necessary intervals prescribed. Today, it all comes down to dosing intervals, according to Eylea advo- cates. "The holy grail [of wet AMD treatment] is something that is going to last longer," said Paul Mitchell, MD, professor of clinical ophthalmology and eye health, Westmead Clinical School, Westmead Millennium Institute for Medical Research, University of Syd- ney. "It's going to be some addition to the drug to prolong the life of it." While this holy grail may not yet be found, the quest is surely on, Holy grail of wet AMD treatment comes closer with Eylea Depression common in AMD patients A ccording to the National Institutes of Health (NIH, Bethesda, Md.), depression is a common risk for people who've lost vision from age-related macular degeneration (AMD); up to 25% of people with bilateral AMD develop clinical depression. However, behavior activation can cut this depression risk in half, NIH said. Barry Rovner, MD, and colleagues at Thomas Jefferson University (Philadelphia) recruited 188 participants with bilateral AMD into an NIH-funded study on behavior activation. Participants were 84 years of age on average, and 70% were women. Half of the participants lived alone. All had a best corrected vision of less than 20/70. Each had mild depressive symptoms and was considered at risk for developing clinical depression. Optometrists first evaluated the participants and prescribed lo vision devices such as handheld magnifiers. Participants wer then randomly split into 2 groups. One received behavior activation. Occupational therapists helped them use the low vision devices, make changes around the home (such as using brighter lights and highlighting objects with high-contrast tape), increase social activities, and set and achieve personal goals by breaking them down into manageable steps. People in the second group met with a support therapist to talk about their vision loss and disability. Both groups had 6 hour-long therapy sessions in their homes over a 2-month period. They were allowed to take antidepressants, but fewer than 10% did so. By 4 months, 18 in the control group (23.4%) and 11 in the behavior activation group (12.6%) developed clinical depression. Behavior activation had the most benefit for participants with the worst vision (less than 20/100), reducing the risk of depression by about 60% compared to controls. Overall, the researchers estimate that behavior activation reduced the risk of clinical depression by 50% compared to control treatment. EW Eylea vial available in the U.S. Source: Regeneron Pharmaceuticals "What Eylea offers to the patient in terms of a benefit is ve y obvious. It's a fixed dose—one injectio every 2 months. [This means] convenience and coming to see the physician less." –Dr. Foo