Data support adding suprachoroidal injection to anti-VEGF for RVO
Additive approach augments results of intravitreal anti-VEGF with encouraging safety profile
Reviewed by David M. Brown, MD
Combination therapy with suprachoroidal triamcinolone acetonide (Zuprata, Clearside Biomedical) injection plus an intravitreal anti-vascular endothelial growth factor (VEGF) agent is a promising approach for treating eyes with macular edema and vision loss associated with retinal vein occlusion (RVO), said David M. Brown, MD.
The suprachoroidal injection is administered using a proprietary microinjector syringe featuring a proprietary short (900 μm), 30-gauge needle.
Evaluation in animal models showed the technique resulted in compartmentalization of the corticosteroid with high levels achieved in target tissues (choroid and retina) and limited penetration to the anterior segment.
In the 3-month TANZANITE trial, patients receiving a single suprachoroidal injection of triamcinolone acetonide plus intravitreal
aflibercept 2 mg (Eylea, Regeneron) had a significantly reduced need for further anti-VEGF injections compared with the control group assigned to an initial aflibercept injection plus a sham suprachoroidal procedure, explained Dr. Brown, TANZANITE investigator and clinical professor of ophthalmology, Baylor College of Medicine, Houston.
In addition, significant differences favoring the combination approach were achieved in analyses of functional and anatomic outcomes. Delivery of triamcinolone to the suprachoroidal space showed promise for mitigating corticosteroid-related ocular side effects, Dr. Brown said.
“Monotherapy with intravitreal injection of an anti-VEGF agent or triamcinolone has been shown to improve visual acuity and reduce macular edema in eyes with RVO, but only the corticosteroid has the potential to affect the acute thrombus and the secondary lymphocytic infiltration that occur with RVO,” he said.
Traditionally, corticosteroids, however, have been relegated to second-line treatment status for this indication because of their potential to induce cataract and cause IOP elevation, he noted.
“The results of the TANZANITE trial support the hypothesis that suprachoroidal injection of triamcinolone acetonide could provide the benefits of corticosteroid treatment with reduced risk,” said Dr. Brown, who is also director, Greater Houston Retina Research Center, Houston.
“They also suggest that early intervention for RVO with a corticosteroid plus anti-VEGF therapy may improve outcomes for eyes with treatment-naïve RVO,” he said.
These issues will be investigated further in phase III trials.