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Verteporfin for age-related macular degeneration
1Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.
Objective:
To review the pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug-drug interactions, and the therapeutic issues concerning the use of verteporfin in patients with age-related macular degeneration (AMD).
Data Sources:
Published articles and abstracts in English were identified by MEDLINE (1990-August 2000) searches using the search terms verteporfin, treatment of age-related macular degeneration, and photodynamic therapy (PDT). Additional references were identified from the bibliographies of the retrieved articles. Data were also obtained from approved product labeling.
Data Extraction:
The literature was assessed for adequate description of patients, methodology, and outcomes.
Data Synthesis:
Verteporfin is a synthetic benzoporphyrin derivative and a cytotoxic photosensitizing agent, which is one component of PDT. PDT involves administration of verteporfin for injection and nonthermal red light at a wavelength of 689 nm. It is metabolized, to a small extent, to its diacid metabolite by liver and plasma esterases. Information concerning drug interactions is limited. In clinical trials, verteporfin was effective in patients with wet AMD as demonstrated in standard visual acuity scores. Adverse events were related to injection site reactions and visual disturbances.
Conclusions:
Verteporfin is a welcome alternative to laser photocoagulation, which can result in damage to the retina and lead to visual loss. Although long-term trials have not been performed in humans, results from monkeys indicate possible improvement in vision following PDT with verteporfin.