Therapeutic options

There are currently no approved therapies for the treatment of geographic atrophy (GA). However, recent advances in the understanding of the disease pathways have led to the development of a wide range of new investigational therapies that may be able to prevent or slow the progression of the disease. Investigational treatments currently being evaluated include:

Complement cascade inhibitors

target different components of the alternative complement cascade, a part of the immune system that helps immune cells and antibodies to clear foreign pathogens and promotes inflammation.

Neuroprotective drugs and anti-inflammatory drugs

prevent death of retinal cells, in order to prevent or delay the progression of the disease.

Stem cell therapies

replace retinal cells via stem cell transplantation.

There are numerous clinical trials underway and in preparation for novel therapies for GA. The best source for information on clinical trials is clinicaltrials.gov

GA Clinical Trials

FOR PROFESSIONALS

In depth details of any of the GA therapies currently in development are best found in associated peer-reviewed literature. A brief description of recent development in some trials is provided.

Investigational GA Therapies

Accessing clinical trials

Clinical trials look at new ways to prevent, detect, or treat disease. Clinical trials can study new drugs or devices or combinations, new ways of doing procedures, new ways of using existing drugs or devices and new ways of changing behaviours. The goal of clinical trials is to determine if new approaches to treatment, prevention, and behaviour are safe and effective.

With no effective treatments approved for GA, clinical trials currently provide the best opportunity for people with GA to receive a novel treatment that could potentially stop or slow down the progression of their disease. It is important to note however that clinical trials may not be suitable for all people. Speak to your doctor if you are interested in participating in a clinical trial, to learn about options for participation and potential risks and benefits.

For further details on clinical trials of investigational GA therapies visit clinicaltrials.gov. This site provides the largest registry of clinical trials being conducted around the world, with tens of thousands of trials and locations in more than 200 countries. The site allows users to search by medical condition or other criteria for trials for many diseases and conditions. The site offers information about a trial’s purpose, who may participate, locations, and phone numbers for more details.

FOR PATIENTS & FAMILIES

Before engaging in a clinical trial it is important to understand the role of trials in the drug development process and how inclusion in a trial may affect your care.

Understanding Drug Development
Questions To Ask When Considering Enrolment in a Clinical Trial

There are numerous clinical trials underway and in preparation for novel therapies for GA. The best source for information on clinical trials is clinicaltrials.gov

GA Clinical Trials

Genes & Genetic Testing

Courtesy: Retina International

Genes & genetic testing

Genetic factors play a major role in determining the risk of developing AMD and progression to late- AMD (GA or neovascular AMD). People with an affected parent have approximately twice the risk of getting the disease than someone whose parents do not have AMD. Large genome-wide association studies have identified over 30 genetic variants associated with the risk of developing AMD.1 Of these, genetic variants located at 2 loci – genes associated with the complement cascade on chromosome 1, and the ARMS2/HTRA genes on chromosome 10 – are associated with significantly increased susceptibility to AMD.2 It should be noted that the presence of these genes does not mean that one will inevitably develop AMD, rather one is at higher risk of developing AMD.

Genetic Testing

Genetic testing is available to assess some of the AMD risk genes. However as treatments are limited, and treatment choice is not affected by knowledge of an individual’s genetic makeup, it is still not widely requested by Eye Care Professionals today. Nonetheless understanding your risk profile for development of a disease can, and should, guide your lifestyle choices. Additionally building a registry of genetic information helps greatly in advancing research into the field and identifying potentially relevant targets for therapy development.With the advent of cheaper and faster DNA sequencing technology (currently the whole genome can be sequenced in a few days for USD $1000!), and information about the meaning of DNA sequence changes advancing, genetic testing should become a routine element of your diagnostic work-up. Additionally, knowing your genetic profile may allow you to enrol in relevant clinical trials and gain access to new treatments as soon as they come to market.

Further information on genetic testing and its role in eye care is available on the Retina International Genetic Testing Toolkit.

Retina International Genetic Testing Toolkit
Genetic Factors & AMD

Keeping updated on GA

For patients and their families, the best way to keep up to date on developments with Geographic Atrophy is to contact local patient-led support groups in your area and to ask to join their mailing lists. Additionally contact Retina International at info@retina-international.org and ask to be added to our mailing list.

Professionals may keep up to date by being added to Retina International’s mailing list – contact us at info@retina-international.org. Additionally Professionals should consider becoming members of relevant learned organisations and  joining relevant mailing lists.

REFERENCES

  1. Fritsche LG, Igl W, Bailey JN, Grassmann F, Sengupta S, Bragg-Gresham JL, et al. A large genome-wide association study of age-related macular degeneration highlights contributions of rare and common variants. Nature genetics. 2016;48(2): 134-143.
  2. Black JR, Clark SJ. Age-related macular degeneration: genome-wide association studies to translation. Genetics in medicine: official journal of the American College of Medical Genetics. 2016;18(4): 283-289.
  1. Wong WL, Su X, Li X, Cheung CM, Klein R, Cheng CY, Wong TY. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global health. 2014;2(2): e106-116.
  2. Colijn JM, Buitendijk GHS, Prokofyeva E, Alves D, Cachulo ML, Khawaja AP, et al. Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future. Ophthalmology. 2017.
  1. Holz FG, Strauss EC, Schmitz-Valckenberg S, van Lookeren Campagne M. Geographic atrophy: clinical features and potential therapeutic approaches. Ophthalmology. 2014;121(5): 1079-1091.
  2. Wilson, JMG; Jungner, G (1968). “Principles and practice of screening for disease” (PDF). WHO Chronicle. Geneva: World Health Organization. 22 (11): 473 Public Health Papers, #34
  3. Anne Andermann, Ingeborg Blancquaert, Sylvie Beauchamp, Véronique Déry Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years: Bulletin of the World Health Organization; 2008 Volume 86, Number 4, April 2008, 241-320 http://www.who.int/bulletin/volumes/86/4/07-050112/en/ Accessed 26 October 2017.