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Anti-growth factor drugs raise hope and concern for treatment of children's eye diseases
August 03, 2009A new class of antibody drugs may provide a powerful new tool for the treatment of eye diseases in children, but specialists need to be alert for the possibility of serious side effects, according to an editorial in the August Journal of AAPOS (American Association for Pediatric Ophthalmology and Strabismus), published by Elsevier.
Dr. Robert L. Avery of Santa Barbara, Calif., discusses issues related to the use of antibodies against vascular endothelial growth factor (VEGF) in pediatric ophthalmology. The two anti-VEGF antibodies available so far-bevacizumab and ranibizumab-have been rapidly adopted for the treatment of age-related macular degeneration (AMD), the leading cause of vision loss in older adults. The antibodies work by blocking the development of new blood vessels (angiogenesis).
Anti-VEGF antibodies were originally approved for use in cancer treatment, and there have been some safety concerns, including a possible increase in stroke risk. However, at the much smaller doses used in eye diseases, the two antibodies appear to be safe. However, in discussing the growing use of anti-VEGF antibodies in children, Dr. Avery sounds a cautious note. One study, also published in the August Journal of AAPOS, found that bevacizumab treatment in one eye of a child with eye disease also improved the condition in the other eye. This, along with other limited reports, suggests that the antibodies might leave the eye and enter the bloodstream, where they could potentially lead to side effects and complications.
Side effects are a special concern in children, who might be at higher risk because of their smaller size. Used in premature infants with an eye disease called retinopathy of prematurity, anti-VEGF antibodies could have the potential for harm to still developing organs.
These issues are particularly difficult because the anti-VEGF antibodies are not approved for use in children. Because of the urgent need for treatment of serious but relatively rare eye diseases in children, "off-label" use of drugs-for purposes other than those which the drugs are approved-is common in pediatric ophthalmology.
A study is being performed to compare the two anti-VEGF antibodies in adults with AMD. Because ranibizumab stays in the body for a shorter time than bevacizumab, it might be a better choice for use in treating eye diseases. However, the upcoming study may not be large enough to detect small differences in side effects, and in any case the results may not be applicable to children.
Meanwhile, Dr. Avery urges pediatric ophthalmologists using anti-VEGF antibodies to watch carefully for any possible side effects in their young patients. "Bevacizumab and ranibizumab have provided us with a great opportunity to improve the treatment of a variety of retinal diseases," he concludes. "Hopefully, the dramatic improvements in outcomes we have seen in adults will extend into pediatric diseases, but further study is clearly needed to assess the safety and efficacy of these drugs in this population."
Elsevier
Side effects are a special concern in children, who might be at higher risk because of their smaller size. Used in premature infants with an eye disease called retinopathy of prematurity, anti-VEGF antibodies could have the potential for harm to still developing organs.
These issues are particularly difficult because the anti-VEGF antibodies are not approved for use in children. Because of the urgent need for treatment of serious but relatively rare eye diseases in children, "off-label" use of drugs-for purposes other than those which the drugs are approved-is common in pediatric ophthalmology.
A study is being performed to compare the two anti-VEGF antibodies in adults with AMD. Because ranibizumab stays in the body for a shorter time than bevacizumab, it might be a better choice for use in treating eye diseases. However, the upcoming study may not be large enough to detect small differences in side effects, and in any case the results may not be applicable to children.
Meanwhile, Dr. Avery urges pediatric ophthalmologists using anti-VEGF antibodies to watch carefully for any possible side effects in their young patients. "Bevacizumab and ranibizumab have provided us with a great opportunity to improve the treatment of a variety of retinal diseases," he concludes. "Hopefully, the dramatic improvements in outcomes we have seen in adults will extend into pediatric diseases, but further study is clearly needed to assess the safety and efficacy of these drugs in this population."
Elsevier
Eye Diseases Current Events and Eye Diseases News RSSExperimental treatments restore partial vision to blind people
Two experimental treatments, a retinal prosthesis and fetal tissue transplant, restored some vision to people with blinding eye diseases. The findings, presented at Neuroscience 2009, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news on brain science and health, may lead to new treatments for the blind.
Genetic sleuth solves glaucoma mystery
Dr. Michael Walter is one good gumshoe. The University of Alberta medical geneticist has cracked the case of WDR36, a gene linked to glaucoma.
'Dark Cells' of Living Retina Imaged for the First Time
A layer of "dark cells" in the retina that is responsible for maintaining the health of the light-sensing cells in our eyes has been imaged in a living retina for the first time.
ORNL, UT project could save vision of millions
In the blink of an eye, people at risk of becoming blind can now be screened for eye diseases such as diabetic retinopathy and age-related macular degeneration.
Team led by Scripps Scientists increases understanding of two types of blindness
Though based on mouse studies, the research bolsters the idea that humans suffering from these and other eye conditions may be able to help preserve function by adding antioxidants to their diet, and explains why this would work. The team also devised a new cell-based gene therapy technique that could eventually offer another option for arresting vision loss from these diseases.
New technique captures high-res images of full retina
Researchers used a new imaging technique to take high quality color photographs of the clinical stages of ocular inflammation in mice, and the technology could help in the monitoring and treatment of diseases of the eye that may cause blindness.
Man's best friend recruited in the hunt for disease genes
For centuries man has had a uniquely close relationship with dogs - as a working animal, for security and, perhaps most importantly, for companionship. Now, dogs are taking on a new role - they are helping in the hunt for genetic mutations that lead to diseases in humans.
Glaucoma procedure now available at Mayo Clinic aims to prevent further eye damage
For the first time in Florida, patients with glaucoma have a new treatment option known as the Trabectome.
Moran Eye Center researchers find gene linked to severe diabetic eye and kidney diseases
Researchers at the John A. Moran Eye Center at the University of Utah and collaborative institutions have identified a gene called erythropoietin (EPO) that contributes to increased risk of severe diabetic eye and kidney diseases, called retinopathy and nephropathy.
Blood vessel protein reverses macular degeneration, diabetic retinopathy in mice
Two major eye diseases and leading causes of blindness-age-related macular degeneration and diabetic retinopathy-can be reversed or even prevented by drugs that activate a protein found in blood vessel cells, researchers at the University of Utah School of Medicine and several other institutions have announced in a new study.
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