Anecortave acetate: possible new treatment for glaucoma?

Anecortave acetate (Retaane, Alcon Laboratories) is a potential new therapy for glaucoma that seems to be highly effective, with a mean 25% decrease in IOP 6 months after one juxtascleral injection.

Alan Robin, MD, of the department of ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, reported the results of a nonrandomized, open-label trial of anecortave acetate in six patients.

"Anecortave acetate is a steroid that lowers IOP," Dr. Robin said.

While anecortave acetate is similar to tetrahydrocortisol, modifications - such as the removal of the 11-hydroxyl OH group, introduction of the C9-11 double bond, and addition of a 21-acetate group - result in the absence of the anti-inflammatory and immunosuppressive properties of glucocorticoids, he explained.

Patients (mean age, 59 years) received one injection of anecortave acetate (0.8 ml of the 3% solution). The injections were given over 1 minute. The patients were followed at 1 hour and 1 week, and then weekly for 1 month and monthly for 6 months. The patients all had an IOP level that exceeded 23 mm Hg (range, 23 to 56) despite topical anti-glaucoma medications. The mean IOP before treatment was almost 31 ± 11.3 mm Hg. Four patients had primary open-angle glaucoma (n = 4), pseudoexfoliation syndrome (n = 1), and pigmentary dispersion syndrome (n = 1).

"Five of the six patients had an IOP decrease of 25% or greater 3 months after the injection," Dr. Robin said. "The mean IOP after treatment was 16.4 ± 6 mm Hg."

IOP decreased from 25 to 12 mm Hg in one patient 2 months after treatment and decreased from 25 to 15 mm Hg in another patient 4 months after treatment. In both cases, the prostaglandin they were taking was stopped. The patient with pigmentary dispersion syndrome did not respond to anecortave acetate.

In addition to the sustained decrease in IOP, Dr. Robin pointed out the delivery system may be an answer to administration of eye drops, which can be problematic in some patients.

Studies are under way to determine the mechanism of action of anecortave acetate in the lowering of IOP.