Peter Kaiser, MD

A panel of ophthalmologists discuss how retinal disease management has evolved in the past decade and continues to change.

Generational Trends and Innovations in Retinal Disease Care

1:00 Evolving trends
5:50 Key Advances
8:20 Targeting Ang/Tie pathway
13:12 Role of steroids
15:00 Biosimilars
18:44 Therapies in the pipeline

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A panel of ophthalmologists discuss how retinal disease management has evolved in the past decade and continues to change with advancements in diagnostics and therapies.

Generational Trends and Innovations in Retinal Disease Treatment

To watch the video series component of this episode, click here. 

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Recent advancements in oncology have focused on evolving trends, key advances, and novel therapeutic targets. The Ang/Tie pathway has emerged as a significant area of interest, offering potential for targeted therapies. The role of steroids in treatment regimens is being re-evaluated, with implications for patient management. Biosimilars are gaining traction, providing cost-effective alternatives to existing biologics. Additionally, several promising therapies are in the pipeline, indicating a dynamic future landscape in cancer treatment. These developments underscore the continuous evolution and innovation within the field of oncology.

When it comes to biosimilars, it’s important for an ophthalmologist to look very closely at the clinical studies to understand the approval process and to understand what a biosimilar is. Now, it goes without saying that the first biosimilar to be FDA approved came in at a list price considerably lower than reference ranibizumab, so this is a good thing for the health care system, and it remains to be seen what the pricing [will be] of the additional biosimilars that are currently in front of the FDA. In terms of concerns with using the biosimilar, the FDA does a good job testing the analytics of these medications and the clinical studies show us that the safety and efficacy, at least in a 1-year time point, is very similar. From my standpoint, I do not have any hesitation using a biosimilar. I will, of course, watch the patients closely and these companies are having postmarketing pharmacovigilance to look for anything that may not have come out in the clinical studies, but right now, I don’t have any overt concerns.

When we look at biosimilars, this is a new treatment that we need to put into our refrigerators. We have to decide which patients we may use a biosimilar on, which patients we may use a reference product on, and which patients we have to use a totally different anti-VEGF medication. These are all things that we are going to work out over time. Thankfully, we know the pricing of the first ranibizumab biosimilar to be FDA approved and it’s considerably lower than the reference product. But it’s important for anyone considering the use of biosimilars to look at the reimbursement, understand what this means for their particular situation and their particular practice, and understand some of the patients’ assistance programs, etc, that are being put into place by companies selling biosimilars. But you may need to make sure that your patients, their payer mix, and their insurance coverage is all answered before you use this, but suffice it to say, that just like reference ranibizumab, all of those programs that you were used to having are being put into place by the companies marketing and selling the biosimilars of ranibizumab.

When you talk to patients about the use of biosimilars, patients at this point in life have become used to the idea of biosimilars. The reason I say that is because they are so used to generics and although biosimilars are not a generic (I don’t want my audience to get confused by that), the fact of the matter is, that even when I go to a pharmacy, I am always asking for the generic version of the medication because I know that the FDA has shown the similarity and has FDA approved it, so I’d rather pay less. Patients are similarly going to accept biosimilars since they understand how expensive it is and they are always asking if there is any way to reduce pricing and this is really one way. It is up to us as ophthalmologists to explain to the patients about the approval process and to explain the safety and efficacy that was shown in clinical studies, but at the end of the day, patients will accept biosimilars. In fact, of all the cogs in the health care system, both the insurance companies and the patients are the ones who are most apt to accept it. It is up to the physicians to be the conduit of information for their patients.

Dr Peter Kaiser shares helpful hints for patient communication and for including biosimilars in clinical practice.

Helpful Hints for Use of Biosimilars in Ophthalmology Practices

When we discuss challenges to the use of biosimilars in ophthalmology, the biggest challenge is trust, so we have been using ranibizumab for many years and the reference ranibizumab and biosimilars are new. We need to trust the FDA and that their analytical studies are appropriate, and the safety is good, but overall, we need to trust that the outcomes will be the same and the clinical studies help us with that trust, but you only develop trust when you actually use something yourself. Over time, as we use this, we will develop the trust we need to use biosimilars.

Antidrug antibodies are something that we’re starting to learn a lot more about. Prior to brolucizumab and the intraocular inflammation that we saw with brolucizumab postlaunch, we didn’t pay attention to antidrug antibodies. Now, it seems that in the patients who are developing intraocular inflammation, a lot of them developed antidrug antibodies, which would explain the intraocular inflammation that they were seeing. What’s interesting is, that for all of our anti-VEGF agents in the clinical studies, antidrug antibodies were seen, both at baseline—so even before patients receive the drug, they could have antidrug antibodies—or even later in the clinical study, they may develop antidrug antibodies. It is important to watch for at baseline how many patients have it, as well as how many patients develop it over time. In all 3 of the clinical studies for biosimilars to date, the phase III studies that have been published, there was no increase in terms of ADA, or antidrug antibodies, in the biosimilar arms versus the ranibizumab reference arms. Even though in ophthalmology we do need to look at antidrug antibodies, at least with ranibizumab and biosimilars, the antidrug antibody production doesn’t seem to be leading to any differences in intraocular inflammation rates.

An ophthalmologist discusses challenges and concerns that physicians might face when using biosimilars for retinal diseases.

Peter Kaiser, MD

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