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Anti-VEGF Therapy as an Emerging Treatment for Diabetic Retinopathy

417

in retinal thickening of central subfield and retinal volume (measured by OCT) as well as number of injections in the first year. Safety outcomes will include injection-related events, ocular drug-related events, and systemic drug-related events.

SUMMARY

Treatment of DME is complex and involves both systemic and ocular therapies. Although focal laser photocoagulation is considered the gold standard for the treatment of macular edema, novel therapies directed at decreasing vascular permeability at the molecular level with anti-VEGF agents have shown beneficial effects in early clinical trials. Results from phase 2 clinical studies should provide further information on the efficacy and safety of VEGF inhibitors in diabetic retinopathy. Inhibitors of VEGF are likely to play a therapeutic role for the treatment of both DME and proliferative diabetic retinopathy.

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18 Clinical Trials in Protein Kinase C-β Inhibition in Diabetic Retinopathy

Jennifer K. Sun, Rola Hamam,

and Lloyd P. Aiello

CONTENTS

INTRODUCTION

PROTEIN KINASE C-β

PKC INHIBITION WITH RUBOXISTAURIN

EARLY CLINICAL TRIALS WITH RBX

RBX EFFECTS ON VISUAL OUTCOMES AND DIABETIC MACULAR

EDEMA

RBX AND PROGRESSION OF DIABETIC RETINOPATHY

ONGOING TRIALS WITH RBX

RBX AND OTHER, NONOCULAR COMPLICATIONS OF DIABETES

SAFETY PROFILE OF RBX

CLINICAL STATUS OF RBX

CONCLUSIONS

REFERENCES

ABSTRACT

Protein kinase C (PKC) activation plays a key role in the development of microvascular complications in diabetes, including diabetic retinopathy. Vision loss in patients with diabetes stems from the development of ocular complications that include diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR). Even with timely intervention, a large number of patients lose vision from diabetic eye disease each year, necessitating an ongoing effort toward exploring new and more effective approaches for the prevention and treatment of diabetic retinopathy (DR). Clinical trials of PKC inhibition for diabetic retinopathy have focused largely on the oral PKC-β inhibitor, ruboxistaurin (RBX). Preclinical studies of RBX in animal models demonstrated amelioration of diabetes-induced abnormalities in retinal circulation, vascular permeability, and leukocyte adhesion. Subsequent clinical studies, consisting of multiple multicenter, double-masked, randomized, placebo-controlled trials have consistently demonstrated

From: Contemporary Diabetes: Diabetic Retinopathy

Edited by: E. Duh © Humana Press, Totowa, NJ

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