Statins May Aid in Dry Macular Degeneration Signs of AMD regressed in small trial
Monday, June 5, 2017
by Will Boggs MD, Reuters Health
June 01, 2017
NEW YORK (Reuters Health) -- High-risk signs of dry age-related macular degeneration (AMD) regress with intensive statin treatment, according to results from a pilot interventional study.
"AMD is a heterogeneous disease and targeting the lipid pathway in the appropriate manner and to the appropriate populations we may have the potential not only to slow down or arrest the disease but also to reverse it," Demetrios G. Vavvas, MD, PhD, from Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, told Reuters Health by email.
AMD shares many features with atherosclerosis, but studies of statin treatment for AMD have yielded conflicting results.
Vavvas' team investigated the effects of the hydrophobic atorvastatin (80 mg daily) in a prospective pilot study of 26 patients with AMD and the presence of many large, soft drusenoid deposits and pigmentary alterations but without evidence of neovascularization (wet AMD).
Of the 23 patients who completed the study, 10 responded to treatment with significant regression of drusen deposits. Eight of these 10 patients showed near complete regression, the researchers report in EBioMedicine, online Feb. 4.
The average time to response was 11.7 months (range, 3-22 months). Responders gained an average of three letters of visual acuity, whereas nonresponders lost an average of 2.3 letters.
None of the patients converted to neovascular AMD.
Atorvastatin had no noticeable effect on progression of pigmentary changes in fundus photographs or on intraretinal hyper-reflective foci.
"There were no easy reasons to explain what made some people to respond and some not," Vavvas said. "Cholesterol reduction was drastic in responders and non-responders, and the responders were actually somewhat older (by 6 years)."
"We would like to initiate a pharma-sponsored or a NIH U10-sponsored prospective controlled clinical trial with a large number of patients that will include assessments of multiple variables of visual function (contrast, dark adaptation microperimetry) and genetic analysis as well as metabolic analysis," Vavvas said.
Shusheng Wang, PhD, from Tulane University in New Orleans, Louisiana, who recently reviewed current therapeutic developments in AMD, told Reuters Health by email, "This is a very promising report. As mentioned in the paper, definitely a lot more needs to be done to generalize the results. Examples of experiments to be done include: large-scale study, long-term efficacy, long-term safety, difference between responders and non-responders, preventive effect on drusen deposit in general."
"Based on the established safety profile of high-dose statins, this might be a promising approach to treat early or intermediate stage dry AMD," said Wang, who was not involved in the study.