September 1, 2019
Anti-VEGF therapy for exudative macular degeneration places a significant treatment burden both upon patients who must return frequently for intravitreal injections, and upon providers who need to provide a high volume of injections each day. Additionally, it has been shown that due to a reduced frequency of injections over time, the mean visual gain initially achieved with treatment of this condition gradually erodes. In an effort to address these issues, Genentech Inc. (South San Francisco, CA) has developed a revolutionary port delivery system to provide continuous treatment with ranibizumab. The core of the system is a refillable reservoir which is surgically implanted into the pars plana. This reservoir can then be refilled with ranibizumab in the office every few months. The system was designed to both reduce the treatment burden and to provide continuous release of anti-VEGF in the eye. In the LADDER study, patients were randomized to receive either monthly injections of 0.5 mg ranibizumab, or a formulation of 10, 40, or 100 mg/ml ranibizumab via the port delivery system. The Phase 2 results have just been released and are extremely promising, showing noninferiority to monthly 0.5 mg ranibizumab injections. As expected, the durability is longest at the highest 100 mg/ml dose. When approved, this will be the first long-term therapy available for macular degeneration. We will keep you up to date on the approval and availability of this innovative new system.