A randomized pilot study of systemic immunosuppression in the treatment of age-related macular degeneration with choroidal neovascularization

Robert B. Nussenblatt, Gordon Byrnes, H. Nida Sen, Steven Yeh, Lisa Faia, Catherine Meyerle, Keith Wroblewski, Zhuqing Li, Baoying Liu, Emily Chew, Patti R. Sherry, Penelope Friedman, Fred Gill, Frederick Ferris

Research output: Contribution to journalArticle

Abstract

Background: Age-related macular degeneration remains the leading cause of irreversible blindness in the United States and the developed world. Intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications have become standard of care for the treatment of the wet form of the disease. Recent reports have demonstrated an association with various immune factors. We aimed to investigate the effect of immunosuppressive therapy in the clinical course of the wet form of the disease. We compared anti-VEGF therapy plus one of three systemic immunosuppressive therapies versus anti-VEGF therapy alone for recurrent choroidal neovascularization associated with age-related macular degeneration. Methods: This was a pilot, Phase I/II, prospective, randomized, unmasked, single-center trial. Patients with subretinal exudation secondary to recurrent choroidal neovascularization associated with age-related macular degeneration were included in the study. Patients were randomized to 1 of 3 systemic arms immunosuppressive agents (daclizumab, rapamycin, or infliximab) for 6 months plus intraocular anti-VEGF therapy if indicated, compared with a group who received only anti-VEGF therapy if indicated. Results: The number of anti-VEGF injections per group, visual acuity, retinal thickness, and safety measures were assessed in all groups. Thirteen patients were randomized; comparing anti-VEGF injections before and during the study, a decrease in the number of injections from 0.73 injections per month to 0.42 for daclizumab and from 0.67 to 0.34 for sirolimus was seen, while no apparent decrease was seen for either infliximab or observation. Visual acuities were maintained in all groups. Conclusion: These preliminary data suggest that some immunosuppressive agents given systemically can alter the clinical course of the wet form of the disease and support the notion that more definitive clinical trials of immune mediation of age-related macular degeneration are indicated.

Original languageEnglish (US)
Pages (from-to)1579-1587
Number of pages9
JournalRetina
Volume30
Issue number10
DOIs
StatePublished - Nov 1 2010

ASJC Scopus subject areas

  • Ophthalmology

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    Nussenblatt, R. B., Byrnes, G., Sen, H. N., Yeh, S., Faia, L., Meyerle, C., Wroblewski, K., Li, Z., Liu, B., Chew, E., Sherry, P. R., Friedman, P., Gill, F., & Ferris, F. (2010). A randomized pilot study of systemic immunosuppression in the treatment of age-related macular degeneration with choroidal neovascularization. Retina, 30(10), 1579-1587. https://doi.org/10.1097/IAE.0b013e3181e7978e