Providing Safe and Effective Intravitreal injections - Episode 10

Future of Intravitreal Injection

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Nadia K. Waheed, MD, MPH, and David M. Brown, MD, discuss the future of intravitreal injections.

Nadia K. Waheed, MD, MPH: Finally, Dave, if you were to pull out your magic future-seeing ball, what do you think the future holds for intravitreal injections?

David M. Brown, MD: When I published the ANCHOR study (NCT00061594) in the New England Journal of Medicine in 2006, I really didn’t think it would be new injections, 20-plus years later. It’s amazing¼. I really thought somebody would come up with a better mousetrap. I love gene therapy, done a lot of work in gene therapy, developed a subretinal injector for Avalanche [Bio Gene Therapy] that’s now used by REGENXBIO, but we haven’t been able to solve inflammation and other issues or variability. Certainly, there’s a lot of shots on goal there. I haven’t given up the REGENXBIO program, the…others. I think somebody’s going to come up with a longer-acting drug. Currently, what we’ve come up with is higher Müller blockades, in other words, more drug, in the same dose, but that doesn’t necessarily mean it’s going to last longer. If you have a smaller molecule, it could actually have higher clearance. And you’d dry out more eyes initially, but it wouldn’t necessarily last longer. And hence, I think somebody’s going to figure it out. There’s certainly a lot of really bright pharmacologists and companies working on this.¼But I really don’t see anything that’s going to eliminate injections in the next five years. Thus, you’d better learn your techniques, figure out how to do them safe, because I think they’re going to be here for your patients. In one of my macular degenerations clinics, it’s a German area where it’s predominantly macular degeneration, it’s predominantly 80- and 90-year-olds. I just kind of did a mental check, and of that clinic, something like 40% to 50% have geographic atrophy concomitant with their wet AMD [age-related macular degeneration]. Thus, those patients if we get a dry AMD agent, which is looking promising, I could increase my volume 40%, 50% immediately depending on how the studies are, the indications, and that kind of thing.

Nadia K. Waheed, MD, MPH: Amazing. Excellent. Thank you so much for giving us this comprehensive guide to doing intravitreal injections in clinic, and for this discussion. It’s been wonderful chatting with you today.

Transcript Edited for Clarity