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    Sonepcizumab combination therapy may offer long-term visual acuity stabilization

    Take-home: Sonepcizumab alone or in combination with anti-VEGF does not provide any short-term benefit to the visual acuity in patients with wet AMD, who were considered to be subresponders to anti-VEGF therapy. The combination of high-dose sonepcizumab with anti-VEGF therapy may provide long-term, visual acuity stabilization and further investigation may be warranted. 

    Thomas Ciulla, MD, MBAIndianapolis––Sonepcizumab (iSONEP, Lpath), a monoclonal antibody, did not meet expectations for improving the visual acuity in age-related macular degeneration (AMD) patients. However, further analysis from the Nexus Study offers hope for long-term stabilization of visual acuity in some patients.

    Sonepcizumab reportedly did not improve the visual acuity at the primary day-120 time point when used alone or with adjunctive anti-vascular endothelial growth factor (anti-VEGF) treatments in patients with exudative AMD. 

    When a post-hoc analysis of the 9-month results from the Nexus Study was conducted, it found a progressive decrease in the lesion size in the arms containing sonepcizumab, which correlated with maintenance of best-corrected visual acuity (BCVA) gains.

    “When considered in the context of the recent Comparison of AMD Treatments Trials 5-year data that highlighted the limitations of current anti-VEGF therapies, there may be rationale for further study of sonepcizumab and other new agents with mechanisms of action that could extend the durability of anti-VEGF therapeutic responses,” said Thomas Ciulla, MD, MBA, who is in private practice in Indianapolis.  

    The Nexus Study, which was designed to evaluate the efficacy of the drug in patients with wet AMD, was a multicenter, double-masked, prospective, randomized trial that included 160 patients who had not responded as well as hoped to 3 or more anti-VEGF injections

    Sphingosine-1-phosphate (S1P) is a bioactive phospholipid that is derived from retinal pigment epithelial cells in patients with AMD and is involved in angiogenesis, fibrosis, and inflammation, according to Dr. Ciulla.

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