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Vakharia P, Eichenbaum D. Geographic atrophy: current and future therapeutic agents and practical considerations for retinal specialists. Curr Opin Ophthalmol 2024; 35:165-169. [PMID: 38421937 DOI: 10.1097/icu.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW Geographic atrophy (GA) from age-related macular degeneration (AMD) remains a leading cause of vision loss. The purpose of this review is to summarize currently available intravitreal therapeutics, and discuss pipeline therapeutics that are currently in clinical trials. RECENT FINDINGS The FDA approval of pegcetacoplan and avacincaptad pegol, both approved in 2023, represent the first therapeutics to treat GA. These are delivered via intravitreal injections, and have been shown to slow progression of GA. Both drugs have a risk of new onset neovascular age-related macular degeneration (nAMD). Initial indications seem to be that pegcetacoplan therapy has higher risks of inflammation, vasculitis, and nonarteritic ischemic optic neuropathy (NAION) as compared to avacincaptad pegol, but more real-world data will help to clarify this further. Pipeline therapeutics that we discuss include intravitreal gene therapy, oral anticomplement therapy, and intravitreal injections of a novel glycoprotein. SUMMARY Both pegcetacoplan and avacincaptad pegol are FDA approved to treat GA. The decision to treat patients is still complex and nuanced, but the approval of two treatments for GA is a tremendous advance in our field. Future therapeutics may further refine our ability to treat patients more effectively and safely.
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Affiliation(s)
| | - David Eichenbaum
- Retina Vitreous Associates of Florida, St. Petersburg
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Lanzetta P, Korobelnik JF, Heier JS, Leal S, Holz FG, Clark WL, Eichenbaum D, Iida T, Xiaodong S, Berliner AJ, Schulze A, Schmelter T, Schmidt-Ott U, Zhang X, Vitti R, Chu KW, Reed K, Rao R, Bhore R, Cheng Y, Sun W, Hirshberg B, Yancopoulos GD, Wong TY. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet 2024; 403:1141-1152. [PMID: 38461841 DOI: 10.1016/s0140-6736(24)00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Intravitreal aflibercept 8 mg could improve treatment outcomes and provide sustained disease control in patients with neovascular age-related macular degeneration (nAMD), with extended dosing compared with aflibercept 2 mg. METHODS PULSAR is a phase 3, randomised, three-group, double-masked, non-inferiority, 96-week trial conducted across 223 sites worldwide. Adults with nAMD were randomised 1:1:1 to aflibercept 8 mg every 12 weeks (8q12), aflibercept 8 mg every 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following three initial monthly doses in all groups. From week 16, patients in the aflibercept 8 mg groups had their dosing interval shortened if pre-specified dose regimen modification criteria denoting disease activity were met. The primary endpoint was change from baseline in best-corrected visual acuity (BCVA) at week 48. All patients with at least one dose of study treatment were included in the efficacy and safety analyses. This trial is registered with ClinicalTrials.gov (NCT04423718) and is ongoing. FINDINGS Of 1011 patients randomised to aflibercept 8q12 (n=336), 8q16 (n=338), or 2q8 (n=337) between Aug 11, 2020, and July 30, 2021, 1009 patients received study treatment (aflibercept 8q12 n=335; aflibercept 8q16 n=338; and aflibercept 2q8 n=336). Aflibercept 8q12 and 8q16 showed non-inferior BCVA gains versus aflibercept 2q8 (mean BCVA change from baseline +6·7 [SD 12·6] and +6·2 [11·7] vs +7·6 [12·2] letters). The least squares mean differences between aflibercept 8q12 versus 2q8 and 8q16 versus 2q8, respectively, were -0·97 (95% CI -2·87 to 0·92) and -1·14 (-2·97 to 0·69) letters (non-inferiority margin at 4 letters). The incidence of ocular adverse events in the study eye was similar across groups (aflibercept 8q12 n=129 [39%]; aflibercept 8q16 n=127 [38%]; and aflibercept 2q8 n=130 [39%]). INTERPRETATION Aflibercept 8 mg showed efficacy and safety with extended dosing intervals, which has the potential to improve the management of patients with nAMD. FUNDING Bayer AG and Regeneron Pharmaceuticals.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy; Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
| | - Jean-François Korobelnik
- Service d'Ophtalmologie, CHU Bordeaux, Bordeaux, France; Bordeaux Population Health Research Center, INSERM, UMR1219, F-33000, University of Bordeaux, Bordeaux, France
| | | | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Tomohiro Iida
- Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | | | | | | | | | - Xin Zhang
- Bayer Consumer Care AG, Basel, Switzerland
| | | | - Karen W Chu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Rohini Rao
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Rafia Bhore
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Wei Sun
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
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Eichenbaum D, Gonzalez VH, Roth D, Fortun J, Radcliffe NM, Cutino A, Kasper J, Coughlin BA, Arevalo JF. Ocular, Visual, and Anatomical Outcomes in Eyes Requiring Incisional Intraocular Pressure-Lowering Surgery Following the 0.19-mg Fluocinolone Acetonide Intravitreal Implant. Ophthalmic Surg Lasers Imaging Retina 2024; 55:22-23. [PMID: 38189802 DOI: 10.3928/23258160-20231109-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE To assess ocular, visual, and anatomical outcomes following the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN®) and incisional intraocular pressure (IOP)-lowering surgery in diabetic macular edema. PATIENTS AND METHODS From a 36-month, phase 4, open-label, observational study (N = 202 eyes, 159 patients), 8 eyes (7 patients) required IOP-lowering surgery post-FAc; eyes were segregated by FAc-induced (n = 5, 2.47%) versus neovascular glaucoma (NVG)-related (n = 3, 1.49%) IOP elevations and assessed for IOP, best corrected visual acuity (BCVA), central subfield thickness (CST), and cup-to-disc ratio (c/d). RESULTS Changes at 36 months were +5.4 letters BCVA (P > 0.05) and +0.09 c/d (P = 0.0217); IOP and CST were unchanged. FAc-induced-group eyes required fewer IOP-lowering medications than NVG-group eyes (2.0 versus 4.0; P < 0.01) but for longer duration (15.2 versus 2.6 months; P < 0.001). CONCLUSIONS Post-FAc IOP-lowering surgery, regardless of cause, largely did not affect the outcomes measured; these procedures, then, may not meaningfully threaten positive outcomes. [Ophthalmic Surg Lasers Imaging Retina 2024;55:22-29.].
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Roth DB, Eichenbaum D, Malik D, Radcliffe NM, Cutino A, Small KW. The 0.19-mg Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema: Intraocular Pressure-Related Effects over 36 Months. Ophthalmol Retina 2024; 8:49-54. [PMID: 37586482 DOI: 10.1016/j.oret.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/27/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate effects of the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN) on intraocular pressure (IOP) in patients with diabetic macular edema (DME). DESIGN Secondary analysis of a 36-month, phase IV, nonrandomized, open-label, observational study. PARTICIPANTS The study included 202 eyes from 159 patients who received the 0.19-mg FAc implant after a successful prior steroid challenge per the United States label indication. METHODS Study eyes were assessed for IOP values, incidence of IOP elevations, and best-corrected visual acuity (BCVA) for up to 36 months post-FAc implant. RESULTS Mean IOP was stable over 36 months post-FAc; IOP change from baseline peaked at 2.12 mmHg at 9 months, then declined to baseline levels. At 36 months, eyes had a 32.5% cumulative probability of an IOP event > 25 mmHg and a 15.6% probability of an IOP event > 30 mmHg (Kaplan-Meier). The probability of requiring IOP-lowering medication at any time by month 36 was 38.3%. A total of 78% of eyes did not have IOP elevations > 25 mmHg if similar values were seen with the previous steroid challenge. Although 7.4% of eyes had an IOP > 30 mmHg during a scheduled study visit, most exceeded this threshold only once (60%). Regardless of IOP status, mean BCVA remained stable. CONCLUSIONS Over 36 months, the 0.19-mg FAc implant was associated with relatively stable IOPs in patients with DME, and there was no significant impact of IOP elevations identified regarding their effects on long-term visual outcomes. The probability that a prior corticosteroid challenge will not predict an IOP elevation > 25 mmHg over 36 months post-FAc is 22%; therefore, routine IOP monitoring should be scheduled. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel B Roth
- Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | | | - Deepika Malik
- Ophthalmic Consultants of Long Island, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Kent W Small
- Macula and Retina Institute, Glendale, California and Molecular Insight Research Foundation, Los Angeles and Glendale, California
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Patel SS, Lally DR, Hsu J, Wykoff CC, Eichenbaum D, Heier JS, Jaffe GJ, Westby K, Desai D, Zhu L, Khanani AM. Correction: Avacincaptad pegol for geographic atrophy secondary to age-related macular degeneration: 18-month findings from the GATHER1 trial. Eye (Lond) 2023; 37:3705. [PMID: 37237234 PMCID: PMC10686405 DOI: 10.1038/s41433-023-02548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
| | - David R Lally
- New England Retina Consultants, Springfield, MA, USA
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA
| | | | - David Eichenbaum
- Retina Vitreous Associates of Florida, St. Petersburg, FL, USA
- Morsani College of Medicine at The University of South Florida, Tampa, FL, USA
| | | | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | | | | | | | - Arshad M Khanani
- Sierra Eye Associates and The University of Nevada, Reno School of Medicine, Reno, NV, USA.
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Patel SS, Lally DR, Hsu J, Wykoff CC, Eichenbaum D, Heier JS, Jaffe GJ, Westby K, Desai D, Zhu L, Khanani AM. Avacincaptad pegol for geographic atrophy secondary to age-related macular degeneration: 18-month findings from the GATHER1 trial. Eye (Lond) 2023; 37:3551-3557. [PMID: 36964259 PMCID: PMC10686386 DOI: 10.1038/s41433-023-02497-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND/OBJECTIVES To assess the safety and efficacy of avacincaptad pegol (ACP), a C5 inhibitor, for geographic atrophy (GA) secondary to age-related macular degeneration (AMD) over an 18-month treatment course. SUBJECTS/METHODS This study was an international, prospective, randomized, double-masked, sham-controlled, phase 2/3 clinical trial that consisted of 2 parts. In part 1, 77 participants were randomized 1:1:1 to receive monthly intravitreal injections of ACP 1 mg, ACP 2 mg, or sham. In part 2, 209 participants were randomized 1:2:2 to receive monthly ACP 2 mg, ACP 4 mg, or sham. The mean rate of change of GA over 18 months was measured by fundus autofluorescence. RESULTS Compared with their respective sham cohorts, monthly ACP treatment reduced the mean GA growth (square root transformation) over 18 months by 28.1% (0.168 mm, 95% CI [0.066, 0.271]) for the 2 mg cohort and 30.0% (0.167 mm, 95% CI [0.062, 0.273]) for the 4 mg cohort. ACP treatment was generally well tolerated over 18 months, with most ocular adverse events (AEs) related to the injection procedure. Macular neovascularization (MNV) was more frequent in both 2 mg (11.9%) and 4 mg (15.7%) cohorts than their respective sham control groups (2.7% and 2.4%). CONCLUSIONS Over this 18-month study, ACP 2 mg and 4 mg showed continued reductions in the progression of GA growth compared to sham and continued to be generally well tolerated. A pivotal phase 3 GATHER2 trial is currently underway to support the efficacy and safety of ACP as a potential treatment for GA.
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Affiliation(s)
| | - David R Lally
- New England Retina Consultants, Springfield, MA, USA
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA
| | | | - David Eichenbaum
- Retina Vitreous Associates of Florida, St. Petersburg, FL, USA
- Morsani College of Medicine at The University of South Florida, Tampa, FL, USA
| | | | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | | | | | | | - Arshad M Khanani
- Sierra Eye Associates and The University of Nevada, Reno School of Medicine, Reno, NV, USA.
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Sharma A, Holz FG, Regillo CD, Freund KB, Sarraf D, Khanani AM, Baumal C, Holekamp N, Tadayoni R, Kumar N, Parachuri N, Kuppermann BD, Bandello F, Querques G, Loewenstein A, Özdek Ş, Rezai K, Laurent K, Bilgic A, Lanzetta P, Zur D, Yannuzzi N, Corradetti G, Kaiser P, Hilely A, Boyer D, Rachitskaya A, Chakravarthy U, Wintergerst M, Sarao V, Parolini B, Mruthyunjaya P, Nguyen QD, Do D, Keane PA, Hassan T, Sridhar J, Eichenbaum D, Grewal D, Splitzer M. Biosimilars for retinal diseases: United States-Europe awareness survey (Bio-USER - survey). Expert Opin Biol Ther 2023; 23:851-859. [PMID: 36726203 DOI: 10.1080/14712598.2023.2176218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess the awareness of biosimilar intravitreal anti-VEGF agents among retina specialists practicing in the United States (US) and Europe. METHODS A 16-question online survey was created in English and distributed between Dec 01, 2021 and Jan 31, 2022. A total of 112 respondents (retinal physicians) from the US and Europe participated. RESULTS The majority of the physicians (56.3%) were familiar with anti-VEGF biosimilars. A significant number of physicians needed more information (18.75%) and real world data (25%) before switching to a biosimilar. About one half of the physicians were concerned about biosimilar safety (50%), efficacy (58.9 %), immunogenicity (50%), and their efficacy with extrapolated indications (67.8 %). Retinal physicians from the US were less inclined to shift from off-label bevacizumab to biosimilar ranibizumab or on-label bevacizumab (if approved) compared to physicians from Europe (p=0.0001). Furthermore, physicians from the US were more concerned about biosimilar safety (p=0.0371) and efficacy compared to Europe (p= 0.0078). CONCLUSIONS The Bio-USER survey revealed that while the majority of retinal physicians need additional information regarding the safety, efficacy and immunogenicity when making clinical decisions regarding their use. Retinal physicians from US are more comfortable in continuing to use off-label bevacizumab compared to physicians from Europe.
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Affiliation(s)
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - David Sarraf
- Stein Eye Institute, UCLA, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA and The University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Caroline Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts
| | | | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, St Louis and Fondation Adolphe de Rothschild hospitals, Paris, France
| | | | | | - Baruch D Kuppermann
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA
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Freeman WR, Bandello F, Souied E, Guymer RH, Garg SJ, Chen FK, Rich R, Holz FG, Patel SS, Kim K, López FJ, Guymer R, Korobelnik JF, Souied E, Holz F, Ziemssen F, Bandello F, Campos E, Grignolo/Eandi C, Midena E, Peiretti E, Staurenghi G, Viola F, Bailey C, Esposti SD, Jackson T, Menon G, Pagliarini S, Quhill F, Antoszyk A, Brooks L, Callanan D, Csaky K, Edwards A, Eichenbaum D, Freeman W, Garg S, Ghuman AT, Gonzalez V, Gupta S, Hamilton R, Khurana R, Kunimoto D, Kuppermann B, Lauer A, Lee SY, Maturi R, Patel S, Reddy R, Rich R, Rivellese M, Rose S, Segal Z, Wong R. Randomized Phase 2b Study of Brimonidine Drug Delivery System Generation 2 for Geographic Atrophy in Age-related Macular Degeneration. Ophthalmol Retina 2023:S2468-6530(23)00097-0. [PMID: 36906177 DOI: 10.1016/j.oret.2023.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of repeat injections of Brimonidine Drug Delivery System (Brimo DDS) Generation 2 (Gen 2) containing 400 μg brimonidine in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). DESIGN Phase 2b, randomized, multicenter, double-masked, sham-controlled, 30-month study (BEACON). PARTICIPANTS Patients diagnosed with GA secondary to AMD and multifocal lesions with total area >1.25 mm2 and ≤18 mm2 in the study eye. METHODS Enrolled patients were randomized to treatment with intravitreal injections of 400-μg Brimo DDS (n=154) or sham procedure (n=156) in the study eye every 3 months from day 1 through month 21. MAIN OUTCOME MEASURES The primary efficacy endpoint was change from baseline in the GA lesion area in the study eye, assessed with fundus autofluorescence imaging, at month 24. Safety measures included treatment-emergent adverse events (AEs). RESULTS The study was terminated early, at the time of the planned interim analysis, because of a slow GA progression rate (∼1.6 mm2/year) in the enrolled population. Least-squares mean (standard error) GA area change from baseline at month 24 (primary endpoint) was 3.24 (0.13) mm2 with Brimo DDS (n=84) versus 3.48 (0.13) mm2 with sham (n=91); the reduction in GA area change from baseline in the Brimo DDS group compared with the sham group was 0.25 mm2 (7%) (P = 0.150). At month 30, the GA area change from baseline was 4.09 (0.15) mm2 with Brimo DDS (n=49) versus 4.52 (0.15) mm2 with sham (n=46), a reduction of 0.43 mm2 (10%) with Brimo DDS compared with sham (P=0.033). Exploratory analysis showed numerically smaller loss over time in retinal sensitivity assessed with scotopic microperimetry with Brimo DDS compared with sham (P=0.053 at month 24). Treatment-related AEs were usually related to the injection procedure. No implant accumulation was observed. CONCLUSIONS Multiple intravitreal administrations of Brimo DDS (Gen 2) were well tolerated. The primary efficacy endpoint at 24 months was not met, but there was a numerical trend for reduction in GA progression at 24 months compared with sham treatment. The study was terminated early because of the lower-than-expected GA progression rate in the sham/control group.
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Affiliation(s)
- William R Freeman
- Jacobs Retina Center, University of California San Diego, La Jolla, California, USA.
| | - Francesco Bandello
- University Vita-Salute Scientific Institute, Hospital San Raffaele, Milan, Italy
| | - Eric Souied
- Centre Hospitalier Creteil, Service Universitaire d'Ophthalmologie, Creteil, France
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Sunir J Garg
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia; Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Ryan Rich
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Kimmie Kim
- Allergan, an AbbVie company, Irvine, California, USA
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Callanan D, Khurana RN, Maturi RK, Patel S, Wykoff CC, Eichenbaum D, Khanani AM, Hassan T, Badger H, Mehta S, Le G, Attar M, Seal J, Li XY. Impact of Modifying Abicipar Manufacturing Process in Patients with Neovascular Age-Related Macular Degeneration: MAPLE Study Results. Clin Ophthalmol 2023; 17:1367-1384. [PMID: 37197577 PMCID: PMC10184835 DOI: 10.2147/opth.s405994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/06/2023] [Indexed: 05/19/2023] Open
Abstract
Purpose To evaluate the impact of modifying the abicipar pegol (abicipar) manufacturing process on the safety and treatment effect of abicipar in patients with neovascular age-related macular degeneration (nAMD). Methods A new process for manufacturing abicipar was developed to reduce host cell impurities. In a prospective, Phase 2, multicenter, open-label, 28-week clinical trial, patients (n=123) with active nAMD received intravitreal injections of abicipar 2 mg at baseline (day 1) and weeks 4, 8, 16, and 24. Outcome measures included proportion of patients with stable vision (<15-letter loss from baseline; primary endpoint), change from baseline in best-corrected visual acuity (BCVA) and central retinal thickness (CRT), and adverse events. Results Overall, 8.9% (11/123) of patients experienced intraocular inflammation (IOI) and discontinued treatment. IOI cases were assessed as mild (2.4% [3/123]), moderate (4.9% [6/123]), or severe (1.6% [2/123]) and resolved with steroid treatment. Visual acuity in most patients with IOI (8 of 11) recovered to baseline BCVA or better by study end. No cases of endophthalmitis or retinal vasculitis were reported. Stable vision was maintained for ≥95.9% (≥118/123) of patients at all study visits. At week 28, treatment-naïve patients showed a greater mean improvement from baseline in BCVA compared with previously treated patients (4.4 vs 1.8 letters) and a larger mean CRT reduction from baseline (98.5 vs 45.5 μm). Conclusion Abicipar produced using a modified manufacturing process showed a moderately lower incidence and severity of IOI compared with Phase 3 abicipar studies. Beneficial effects of treatment were demonstrated.
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Affiliation(s)
- David Callanan
- Texas Retina Associates, Arlington, TX, USA
- Correspondence: David Callanan, Texas Retina Associates, 801 West Randol Mill Road, Suite 101, Arlington, TX, USA, 76012, Tel +1 817-261-9625, Fax +1 817-261-9586, Email
| | - Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, CA, USA
| | - Raj K Maturi
- Midwest Eye Institute, Indianapolis, IN, USA
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Charles C Wykoff
- Retina Consultants of Houston, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - David Eichenbaum
- Retina Vitreous Associates of Florida, St. Petersburg, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Tarek Hassan
- Associated Retinal Consultants, Royal Oak, MI, USA
| | - Hanh Badger
- Allergan plc, Irvine, CA, USA, at the time of this work
| | | | - Grace Le
- Allergan plc, Irvine, CA, USA, at the time of this work
| | | | | | - Xiao-Yan Li
- Allergan plc, Irvine, CA, USA, at the time of this work
- VivaVision Biotech, Inc, Shanghai, People’s Republic of China
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10
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Eichenbaum D, Brown DM, Ip M, Khanani AM, Figueroa MS, McAllister IL, Laude A, Guruprasad B, Tang S, Gmeiner B, Clemens A, Souied E. Impact of retinal fluid-free months on outcomes in nAMD: a treatment agnostic analysis of the HAWK and HARRIER studies. Retina 2022; 43:632-640. [PMID: 36705252 PMCID: PMC10035657 DOI: 10.1097/iae.0000000000003699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the effect of the total number of fluid-free months after loading on visual and anatomical outcomes in neovascular age-related macular degeneration (nAMD) patients receiving anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS This post-hoc analysis pooled patient-level data from the brolucizumab 6 mg (n=718) and aflibercept 2 mg (n=715) arms of the HAWK and HARRIER randomized clinical trials. Based on data from Weeks 12 to 96, patients were assigned to one of 5 categories based on fluid-free visits (FFV; the total number of monthly visits at which they were observed to be without retinal fluid). Three definitions of 'fluid-free' were explored based on the location of the fluid observed. RESULTS Patients allocated to categories 4 (15-21 FFV) and 5 (22 FFV, always dry) consistently had the best visual and anatomical outcomes at Week 96, while patients allocated to categories 1 (0 FFV, never dry) and 2 (1-7 FFV) consistently had the worst visual and anatomical outcomes. Variability in retinal thickness over time was lowest in categories 4 and 5. CONCLUSION Absence of retinal fluid at more visits after loading has a positive association with visual and anatomic outcomes in nAMD patients, regardless of fluid type.
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Affiliation(s)
- David Eichenbaum
- Retina Vitreous Associates of Florida, St. Petersburg, FL, and the Morsani College of Medicine at the University of South Florida in Tampa, FL, USA
| | | | - Michael Ip
- Doheny Eye Institute, Los Angeles, CA, USA
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, and the University of Nevada, Reno School of Medicine, Reno, NV, USA
| | | | - Ian L McAllister
- University of Western Australia, Lions Eye Institute, WA, Australia
| | - Augustinus Laude
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - B Guruprasad
- Retina Vitreous Associates of Florida, St. Petersburg, FL, and the Morsani College of Medicine at the University of South Florida in Tampa, FL, USA
- Retina Consultants Houston, Houston, TX, USA
- Doheny Eye Institute, Los Angeles, CA, USA
- Sierra Eye Associates, Reno, NV, and the University of Nevada, Reno School of Medicine, Reno, NV, USA
- Clínica Baviera, Madrid, Spain
- University of Western Australia, Lions Eye Institute, WA, Australia
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
- Novartis Pharma GmbH, Germany
- Novartis Pharma AG, Basel, Switzerland
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, Créteil, France
| | - Shuhan Tang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Eric Souied
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, Créteil, France
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Wykoff CC, Hershberger V, Eichenbaum D, Henry E, Younis HS, Chandra P, Yuan N, Solloway M, DePaoli A. Inhibition of Complement Factor 3 in Geographic Atrophy with NGM621: Phase 1 Dose-Escalation Study Results. Am J Ophthalmol 2022; 235:131-142. [PMID: 34509438 DOI: 10.1016/j.ajo.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the safety and tolerability of single and multiple intravitreal injections of NGM621 in patients with geographic atrophy (GA) and to characterize the pharmacokinetics and immunogenic potential. DESIGN Multicenter, open-label, single- and multiple-dose phase 1 study. METHODS Fifteen patients enrolled at 4 sites in the United States. Participants had GA secondary to age-related macular degeneration, lesion size ≥2.5 mm2, best-corrected visual acuity of 4 to 54 letters (20/80 to 20/800 Snellen equivalent) in the study eye, and no history of choroidal neovascularization in either eye. Patients who met eligibility criteria were treated in a single ascending-dose phase (2 mg, 7.5 mg, and 15 mg) or received 2 doses of NGM621 (15 mg) 4 weeks apart in the multidose phase and were monitored for 12 weeks (85 days). Assessments included adverse events, best-corrected visual acuity, low-luminance visual acuity, vital signs, clinical laboratory evaluations, GA lesion area as measured by fundus autofluorescence, spectral domain optical coherence tomography, and pharmacokinetic, immunogenicity, and pharmacodynamic assessments. RESULTS All 15 participants completed the 12-week study. There were no serious adverse events, no drug-related adverse events, and no choroidal neovascularization developed in either eye. Mean visual acuity and GA lesion area appeared stable through week 12 for all cohorts. Pharmacokinetic analyses indicated that NGM621 serum exposures appeared to be dose proportional, and no antidrug antibodies were identified at any of the evaluated time points. CONCLUSIONS In this small, open-labeled, 12-week phase 1 study, NGM621 was safe and tolerable when administered intravitreally up to 15 mg.<END ABSTRACT>.
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Singer M, Singh RP, Gibson A, Moini H, Reed K, Vitti R, Du W, Eichenbaum D. Association of Early Anatomic Response with Visual Function in Neovascular Age-Related Macular Degeneration. Ophthalmology 2021; 128:1657-1660. [PMID: 34019956 DOI: 10.1016/j.ophtha.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Michael Singer
- Medical Center Ophthalmology Associates, San Antonio, Texas
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland, Ohio
| | | | - Hadi Moini
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | - Robert Vitti
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | - Weiming Du
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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Yu HJ, Kiernan DF, Eichenbaum D, Sheth VS, Wykoff CC. Home Monitoring of Age-Related Macular Degeneration: Utility of the ForeseeHome Device for Detection of Neovascularization. Ophthalmol Retina 2021; 5:348-356. [PMID: 32810682 PMCID: PMC7428765 DOI: 10.1016/j.oret.2020.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 04/14/2023]
Abstract
PURPOSE To evaluate the real-world utility of the ForeseeHome monitoring device (Notal Vision, Ltd., Tel Aviv, Israel) for the detection of conversion from intermediate age-related macular degeneration (iAMD) to neovascular AMD (nAMD) and to compare with results published by the Home Monitoring of the Eye (HOME) study. DESIGN Retrospective analysis of electronic health records. PARTICIPANTS Eyes prescribed use of the ForeseeHome device across 4 retinal practices in the United States. METHODS Usage information was collected from the online ForeseeHome portal for all eyes prescribed the device. For a predetermined subset of eyes, additional clinical information was collected through chart review and analyzed for clinical utility. MAIN OUTCOME MEASURES Frequency and length of use, number of eyes that used the device, number of eyes that established a baseline measurement, number of eyes that converted to nAMD, and number of alerts. RESULTS Seven hundred seventy-five eyes of 448 patients were prescribed use of the ForeseeHome device. Six hundred forty-nine eyes (83.7%) used the device at least once; among this population, 478 (73.7%) established a baseline measurement. Patients who established a baseline measurement were significantly younger than those who did not (P < 0.001). Among eyes that established a baseline measurement, 126 (26.4%) had an overall inadequate frequency of use (≥2 tests per week), and 250 (52.3%) did not use the device as frequently as instructed by the manufacturer (≥3 tests per week); 24.7% of eyes discontinued use within 1 year. Of the 136 eyes that established a baseline measurement among 211 eyes prescribed the device at 1 clinical site, 52 alerts were recorded; 3 (6.8%) correctly identified conversion to nAMD and 47 (93.2%) represented false-positive alerts. CONCLUSIONS Compared with the prospective HOME study, the utility of the ForeseeHome device in the current analysis of clinical practice application was limited. A meaningful proportion of eyes never used the device or could not establish a baseline measurement. Overall frequency of use was low, and continuous use of the device decreased over time. A need exists for improvement in home monitoring technology for eyes with iAMD at risk of conversion to nAMD.
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Key Words
- amd, age-related macular degeneration
- areds, age-related eye disease study
- cnv, choroidal neovascularization
- copd, chronic pulmonary obstructive disease
- fa, fluorescein angiography
- home, home monitoring of the eye
- iamd, intermediate dry age-related macular degeneration
- namd, neovascular age-related macular degeneration
- sd oct, spectral-domain optical coherence tomography
- va, visual acuity
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Affiliation(s)
- Hannah J Yu
- Retina Consultants of Houston, Houston, Texas
| | - Daniel F Kiernan
- Division of Retina and Vitreous, Ophthalmic Consultants of Long Island, Rockville Centre, New York
| | | | - Veeral S Sheth
- University Retina and Macula Associates, Chicago, Illinois
| | - Charles C Wykoff
- Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Methodist Hospital, Houston, Texas.
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Yu HJ, Kiernan DF, Eichenbaum D, Sheth VS, Wykoff CC. Reply. Ophthalmol Retina 2021; 5:e1-e2. [PMID: 33413801 DOI: 10.1016/j.oret.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Hannah J Yu
- Retina Consultants of Houston, Houston, Texas
| | - Daniel F Kiernan
- Division of Retina and Vitreous, Ophthalmic Consultants of Long Island, Rockville Centre, New York
| | | | - Veeral S Sheth
- University Retina and Macula Associates, Chicago, Illinois
| | - Charles C Wykoff
- Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
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Mansour SE, Kiernan DF, Roth DB, Eichenbaum D, Holekamp NM, Kaba S, Werts E. Two-year interim safety results of the 0.2 µg/day fluocinolone acetonide intravitreal implant for the treatment of diabetic macular oedema: the observational PALADIN study. Br J Ophthalmol 2020; 105:414-419. [PMID: 32461262 PMCID: PMC7907551 DOI: 10.1136/bjophthalmol-2020-315984] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 01/11/2023]
Abstract
Background The 0.2 µg/day fluocinolone acetonide (FAc) implant delivers continuous, low-dose, intravitreal corticosteroid for the treatment of diabetic macular oedema (DMO). This ongoing, 3-year, observational clinical trial provides long-term, ‘real-world’ safety results for the FAc implant in DMO. Methods This 24-month interim analysis of a prospective, observational study investigated patients with DMO receiving the commercially available intravitreal 0.2 µg/day FAc implant. The primary outcome was incidence of intraocular pressure (IOP)-lowering procedures. Other IOP-related signals and their relationship to previous corticosteroid exposure, best-corrected visual acuity, central subfield thickness (CST), ocular adverse events and frequency of other treatments were also measured. Results Data were collected from 95 previously steroid-challenged patients (115 study eyes) for up to 36 months pre-FAc and 24 months post-FAc implant. Mean IOP for the overall population remained stable post-FAc compared with pre-FAc implant. IOP-related procedures remained infrequent (two IOP-lowering surgeries pre-FAc; two trabeculoplasties and four IOP-lowering surgeries post-FAc). Mean visual acuity was stable post-FAc (mean improvement of 1–3 letters) and fewer DMO treatments were required per year following FAc implant. Mean CST was significantly reduced at 24 months post-FAc implant (p<0.001) and the percentage of patients with CST ≤300 µm was significantly increased (p=0.041). Conclusion Few IOP-related procedures were reported during the 24 months post-FAc implant. Positive efficacy outcomes were noted after treatment, with stabilisation of vision and reduction in inflammation, demonstrated by CST. The FAc implant has a favourable benefit–risk profile in the management of DMO, especially when administered after a prior steroid challenge. Trial registration number NCT02424019.
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Affiliation(s)
- Sam E Mansour
- Ophthalmology, George Washington University, Washington, District of Columbia, USA .,Virginia Retina Center, Warrenton, Virginia, USA
| | - Daniel F Kiernan
- Ophthalmic Consultants of Long Island, Rockville Center, New York, New York, USA
| | - Daniel B Roth
- Ophthalmology, Rutger Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - David Eichenbaum
- Retina Vitreous Associates of Florida, St Petersburg, Florida, USA.,Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | | | - Samer Kaba
- Alimera Sciences, Alpharetta, Georgia, USA
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Jaffrey C, Eichenbaum D, Denham DW, Norman J. A novel pancreatic model: the snip method of pancreatic isolation for in vitro study. Pancreas 1999; 19:377-81. [PMID: 10547198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We aimed to devise a method of preparing the pancreas for in vitro study that would provide tissue that is viable and functional for 24 h, with preservation of integral functional cell-membrane structures. Pancreata of NIH Swiss mice were excised, gently insufflated with media, and carefully snipped into portions of < 0.5 mm. Snips were incubated in cell culture for 0, 8, 24, and 48 h, with viability measured by 3-[4,5-dimethylthiazol-2-yl]-2,3-diphenyltetrazolium bromide (MTT) assay and amylase production quantified after stimulation with cerulein. Recombinant tumor necrosis factor-alpha (TNF-alpha) was added to cell culture, and apoptosis demonstrated by Hoechst staining at 0, 24, and 48 h. At 0, 8, and 24 h, pancreatic snips were determined to be viable by MTT assay. They also were functional with intact cell-membrane apparatuses at these same time points, as evidenced by amylase production in response to a cholecystokinin analogue. We were able to induce apoptosis with TNF-alpha ligand in these pancreatic snips in support of viability and overall cellular function. We conclude that the snip method provides an effective in vitro pancreatic model. Acinar cells are viable and functional for > or = 24 h, with evidence that their cell-surface receptors are preserved in their operational state.
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Affiliation(s)
- C Jaffrey
- Department of Surgery, University of South Florida, Tampa 33601, USA
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Abstract
We performed bimanual, bipolar intraocular diathermy by using a No. 22 disposable needle and a vitrectomy instrument. The technique required a smaller wound than unimanual bipolar cautery and was combined with membrane peeling techniques. The bipolar technique limited the extent of coagulation effects better than unipolar diathermy methods.
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Abstract
A chin-operated switch was developed to permit control of motorized operating microscope movement simultaneously along three axes. It permits use of both feet to operate surgical modalities, decreases microscope positioning time, and decreases needless hand movements.
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Abstract
A mechanical syringe drive permits one-handed, precise control of the suction force at the time of vitrectomy, is autoclavable, utilizes disposable syringes, and can be operated by surgeon or assistant.
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