Cenegermin-bkbj 0.002% ophthalmic solution, a recombinant form of human nerve growth factor, is the first specific medical therapy for treating neurotrophic keratitis
This article was reviewed by Giacomina Massaro-Giordanao, MD
Cenegermin-bkbj 0.002% ophthalmic solution (Oxervate, Dompé Farmaceutici SpA), a recombinant form of human nerve growth factor, is the first such medicaltherapy to receive FDA approval to treat neurotrophic keratitis, a rare degenerative vision-threatening disease resultingin nerve malfunction and loss of corneal sensation.
This drug is also the first topical biologic medication approved for use in ophthalmology.
The importance of the availability of such a treatment cannot be overemphasized. Before cenegerminwas developed, surgery, artificial tears, or antibiotics may have been the only recourse for these patients, and in many cases there was no real long-term relief.
Cenegermin is a topical drug instilled onto the cornea and as such works to heal damage on the ocular surface. It also can promote tear production.
“The cornea is the first line of ocular defense,” said Giacomina Massaro-Giordano, MD. “Corneal innervation originates from the ophthalmic division of the trigeminal nerve. Nerve growth factor, a naturally occurring neurotrophin, is involved in the differentiation, growth, maintenance of neurons, and corneal integrity.”
Dr. Massaro-Giordano is co-director, Penn Dry Eye and Ocular Surface Center, and professor of Clinical Ophthalmology, Scheie Eye Institute University of Pennsylvania, Philadelphia.
Neurotrophic keratitis is classifiedbased on the severity/stage of the disease, and treatment corresponds to the severity. However, diagnosis can be tricky because neurotrophic keratitis can mimic other ocular disorders.
The presence of punctate keratopathy, epithelial irregularity, superficial neovascularization, and stromal scarring characterizestage I disease; a persistent defect of the epitheliumcharacterizes stage II; and stromal involvement with corneal ulceration with possible perforation or stromal melting characterizes stage III. A step-ladder approach is needed to treat neurotrophic keratitis, according to Dr. Massaro-Giordano.
“While treatments are based on disease severity, the treatments are not mutually exclusive of one another, many times a combination of approaches is required,” she said.