Topical therapy for CNV on the horizon

Topical therapy to treat posterior segment disease is possible despite the limitations of theblood-retinal barrier. The effective route of drug penetrance of topical therapy is either by thetranscorneal route or by the transscleral/conjunctival route, said Baruch Kuppermann, MD, PhD, atRetina Subspecialty Day. He is chief of the Retina Service, Department of Ophthalmology, Universityof California, Irvine.

A few such drugs are currently under development, and the hope is that they will eliminate thecomplications associated with intravitreal injections of drugs, he said.

• 801 kinase inhibitor (TargeGen) has activity against vascular endothelial growth factor(VEGF) receptor/PDGF receptor/Src family kinases and stops leakage, angiogenesis, and inflammation.In animal studies, the drug has been shown to have high concentrations in the anterior segment, lowereffective concentrations in the posterior segment, very low concentrations in the aqueous andvitreous, and extremely low concentrations in the plasma.

• ATG2 (mecamylamine) (CoMentis) is a powerful nonselective nAChR antagonist that has reducedangiogenesis in animal models and inhibits VEGF synthesis/release and responses. Topical mecamylaminewas seen to penetrate the retina-choroid in mice, probably by the transscleral-conjunctivalroute.

• OC-10X (Ocucure) is a nontoxic vascular targeting agent with selective tubulin inhibition.The agent is lipid soluble and crosses the human cornea; it achieves therapeutic concentrations atthe retina-choroid. In rats, the drug, when given once every hour for 4 hours, achieved a corneallevel of 100%, a lens/vitreous level of 11%, and a retina-choroid-sclera level of 83%.

• OT-551 (Othera) catalytic antioxidant has multiple modes of action, i.e., antioxidant,antiangiogenic, and anti-inflammatory. The agent penetrates the cornea and sclera and reaches theretina. It also suppresses photo-oxidative damage in the retinal pigment epithelium andphotoreceptors. A phase II study is ongoing for geographic atrophy, neovascular age-related maculardegeneration, and cataract.

• Pazopanib (Glaxo-Smith-Kline) has completed a phase I trial with 38 healthy volunteers. Thiscompound has been in development to treat solid tumors, according to Dr. Kuppermann.

"Historically, we have never contemplated the use of topical therapy for posterior segment diseasebecause of poor ocular penetrance," he said. "The small molecule drugs are being developed to meetthis challenge. They have shown good posterior segment penetrance, safety, and efficacy."