IMPORTANCE: Neovascular age-related macular degeneration (AMD) is managed with intravitreal anti-vascular endothelial growth factor therapy; however, the burden of care is high and alternate approaches could be beneficial. OBJECTIVE To identify an acceptable dose of oral pazopanib for investigation in AMD. DESIGN, SETTING, AND PARTICIPANTS: Fourteen-day, placebo-controlled, dose-rising study in 72 healthy participants and 28-day phase 2a open-label study in 15 patients with subfoveal choroidal neovascularization secondary to AMD at a clinical unit for healthy participants and outpatient for patients with AMD. INTERVENTION: Oral pazopanib tablets, 5 to 30 mg daily (healthy participants) and 15 mg daily (patients with AMD). MAIN OUTCOMES AND MEASURES: Safety, pharmacokinetics, best-corrected visual acuity, central retinal lesion thickness, and central retinal thickness at day 29. RESULTS:Oral pazopanib up to 30 mg daily in healthy participants and 15 mg daily in patients with AMD was well tolerated. Six of 15 patients received rescue therapy before day 29; all had the CFH Y402H CC "high-risk" genotype for AMD. Nine patients completed the study without rescue with improvements from baseline in best-corrected visual acuity (8 Early Treatment Diabetic Retinopathy Study letters), central retinal lesion thickness (-50.94 µm), and central retinal thickness (-50.28 µm). There was a trend for association between the CFH Y402H T allele ("low risk" for AMD, n = 6) and improvement. CONCLUSIONS AND RELEVANCE: Oral pazopanib (15 mg daily) was well tolerated and resulted in improvements in mean best-corrected visual acuity, central retinal lesion thickness, and central retinal thickness at day 29 in a per-protocol, nonrescued AMD population (n = 9). It is postulated that CFH Y402H genotype may help predict which patients respond to pazopanib. The size and length limitations of this study warrant further investigation to determine if oral pazopanib may be an appropriate treatment for a subset of neovascular patients with AMD or as an adjunct to standard of care. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01051700 and NCT01154062.
RCT Entities:
IMPORTANCE: Neovascular age-related macular degeneration (AMD) is managed with intravitreal anti-vascular endothelial growth factor therapy; however, the burden of care is high and alternate approaches could be beneficial. OBJECTIVE To identify an acceptable dose of oral pazopanib for investigation in AMD. DESIGN, SETTING, AND PARTICIPANTS: Fourteen-day, placebo-controlled, dose-rising study in 72 healthy participants and 28-day phase 2a open-label study in 15 patients with subfoveal choroidal neovascularization secondary to AMD at a clinical unit for healthy participants and outpatient for patients with AMD. INTERVENTION: Oral pazopanib tablets, 5 to 30 mg daily (healthy participants) and 15 mg daily (patients with AMD). MAIN OUTCOMES AND MEASURES: Safety, pharmacokinetics, best-corrected visual acuity, central retinal lesion thickness, and central retinal thickness at day 29. RESULTS: Oral pazopanib up to 30 mg daily in healthy participants and 15 mg daily in patients with AMD was well tolerated. Six of 15 patients received rescue therapy before day 29; all had the CFHY402H CC "high-risk" genotype for AMD. Nine patients completed the study without rescue with improvements from baseline in best-corrected visual acuity (8 Early Treatment Diabetic Retinopathy Study letters), central retinal lesion thickness (-50.94 µm), and central retinal thickness (-50.28 µm). There was a trend for association between the CFHY402H T allele ("low risk" for AMD, n = 6) and improvement. CONCLUSIONS AND RELEVANCE: Oral pazopanib (15 mg daily) was well tolerated and resulted in improvements in mean best-corrected visual acuity, central retinal lesion thickness, and central retinal thickness at day 29 in a per-protocol, nonrescued AMD population (n = 9). It is postulated that CFHY402H genotype may help predict which patients respond to pazopanib. The size and length limitations of this study warrant further investigation to determine if oral pazopanib may be an appropriate treatment for a subset of neovascularpatients with AMD or as an adjunct to standard of care. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01051700 and NCT01154062.
Authors: Timothy L Jackson; David Boyer; David M Brown; Nauman Chaudhry; Michael Elman; Chris Liang; Denis O'Shaughnessy; Edward C Parsons; Sunil Patel; Jason S Slakter; Philip J Rosenfeld Journal: JAMA Ophthalmol Date: 2017-07-01 Impact factor: 7.389
Authors: Liisa M Hirvonen; Gilbert O Fruhwirth; Nishanthan Srikantha; Matthew J Barber; James E Neffendorf; Klaus Suhling; Timothy L Jackson Journal: Pharm Res Date: 2016-05-25 Impact factor: 4.200