Aganirsen Antisense Oligonucleotide Eye Drops Inhibit Keratitis-Induced Corneal Neovascularization and Reduce Need for Transplantation The I-CAN Study

作者：Cursiefen Claus^*; Viaud Eric; Bock Felix; Geudelin Bernard; Ferry Antoine; Kadlecova Pavla; Levy Michel; Al Mahmood Salman; Colin Sylvie; Thorin Eric; Majo Francois; Frueh Beatrice; Wilhelm Frank; Meyer Ter Vehn Tobias; Geerling Gerd; Boehringer Daniel; Reinhard Thomas; Meller Daniel; Pleyer Uwe; Bachmann Bjoern; Seitz Berthold

来源：Ophthalmology, 2014, 121(9): 1683-1692.

DOI：10.1016/j.ophtha.2014.03.038

Objective: Eye drops of aganirsen, an antisense oligonucleotide preventing insulin receptor substrate-1 expression, inhibited corneal neovascularization in a previous dose-finding phase II study. We aimed to confirm these results in a phase III study and investigated a potential clinical benefit on visual acuity (VA), quality of life (QoL), and need for transplantation. %26lt;br%26gt;Design: Multicenter, double-masked, randomized, placebo-controlled phase III study. %26lt;br%26gt;Participants: Analysis of 69 patients with keratitis-related progressive corneal neovascularization randomized to aganirsen (34 patients) or placebo (35 patients). Patients applied aganirsen eye drops (86 mu g/day/eye) or placebo twice daily for 90 days and were followed up to day 180. %26lt;br%26gt;Main Outcome Measures: The primary end point was VA. Secondary end points included area of pathologic corneal neovascularization, need for transplantation, risk of graft rejection, and QoL. %26lt;br%26gt;Results: Although no significant differences in VAscores between groups were observed, aganirsen significantly reduced the relative corneal neovascularization area after 90 days by 26.20%(P = 0.014). This improvement persisted after 180 days (26.67%, P = 0.012). Aganirsen tended to lower the transplantation need in the intent-to-treat (ITT) population at day 180 (P = 0.087). In patients with viral keratitis and central neovascularization, a significant reduction in transplantation need was achieved (P = 0.048). No significant differences between groups were observed in the risk of graft rejection. However, aganirsen tended to decrease this risk in patients with traumatic/viral keratitis (P = 0.162) at day 90. The QoL analyses revealed a significant improvement with aganirsen in composite and near activity subscores (P = 0.039 and 0.026, respectively) at day 90 in the per protocol population. Ocular and treatment-related treatment-emergent adverse events (TEAEs) were reported in a lower percentage with aganirsen compared with placebo. Only 3 serious TEAEs (2 with aganirsen and 1 with placebo) were considered treatment-related. %26lt;br%26gt;Conclusions: This first phase III study on a topical inhibitor of corneal angiogenesis showed that aganirsen eye drops significantly inhibited corneal neovascularization in patients with keratitis. The need for transplantation was significantly reduced in patients with viral keratitis and central neovascularization. Topical application of aganirsen was safe and well tolerated.

• 出版日期2014-9