Advances in Anti-VEGF Administration: From Port Delivery to Subcutaneous

The anti-VEGF drug class has been in a state of pharmacologic refinement for nearly a decade now; since the first-in-class drugs became available for management of retina disease via intravitreal injection, investigators and clinicians have been tinkering and assessing varying dosing regimens, schedules and strategies for the individual patient.

But it’s only been recent that innovation has reshaped its means of administration.

In the second segment of an interview with HCPLive during the Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting this week, Veeral S. Sheth, MD, MBA, Director of Clinical Research at the University of Retina and Macula Associates, discussed the state of anti-VEGF administration research—from topical and subcutaneous agents, to systemic forms of the leading treatment.

“And it always comes back to these local therapies,” Sheth explained. “Why? Because we can get really good, effective doses to the eye—and they’re safe, so we’re preventing this systemic exposure to agents.”

That said, Sheth is as aware as any of his colleagues that intravitreal injections are not favored by patients. “When you tell a patient they have to get an injection in their eye, each time, the look that you get is not surprising,” he said. “If you’ve got other ways of giving patients the therapeutic…I think it’s not a bad thing to explore as long as we think it’s safe.”

Late last year, the US Food and Drug Administration (FDA) approved ranibizumab delivered via Port Delivery System (PDS)—a novel, permanent implantation device that simplifies the administration of anti-VEGF therapy for patients with age-related macular degeneration (AMD). On the subject of early PDS rollout, implantation and follow-up with patients, Sheth said patient approval is overwhelming.

“Anybody we have that’s gotten the PDS implant in a clinical trial, they’re ecstatic with it,” he said. “If you look at satisfaction rates, they’re greater than 90% across the board for these trials. And it’s because patients don’t have to get monthly injections or even injections 2-3 months.”

At the same time, PDS has resulted in an adjustment period for ophthalmologists tasked with implanting and refilling the platform; Sheth likened his team’s review of best practices to professional athlete’s game-film analysis.

“It’s not like the usual surgical cases that we do, and because of that, there’s this little bit of education and knowledge that has to be passed on to make sure that our safety is there and we’re not having complications,” Sheth said.

Regarding 6-month refill appointments, Sheth said there’s room for more individual nuances. “A lot of it is where you place the implant, the patient characteristics and the easiest access to the implant. It’s not like a standard intravitreal injection,” he explained.

Sheth also discussed the prospect of using tailored PDS to deliver differing anti-VEFG agents or doses, or even treatment for other chronic retina diseases including geographic atrophy. In the shorter future, he looks forward to a time when he and his patients feel less burdened by the current requirements of monthly intravitreal injections.

“I think in reality, we’ll be able to follow these patients a little less often—and that’s what I’m really looking forward to,” Sheth said. “Once you get a good feel for what’s happening, see these patients maybe monthly for a few months but then say ‘Hey, they’re doing well’ and space their visits out, that’s when you’re really going to get that (positive) patient feedback.”