Asembia AXS25: Advancing nAMD and DME Treatments: Pharmacists' Role in Patient Care and Therapy Optimization

In an interview with Pharmacy Times®, Casey Koch, PharmD, MBA, BCACP, a clinical pharmacy coordinator at SelectHealth, discussed recent advancements in neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) treatments. He highlighted his presentation, "Advancing Care in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Optimizing Outcomes With Emerging Therapies," which he shared at Asembia's AXS25 Summit.

Koch highlighted the introduction of 2-3 new therapies and potential future developments like gene therapy. He emphasized the critical role pharmacists play in preventing and managing these conditions, particularly for patients with diabetes, by promoting lifestyle changes and ensuring medication adherence. Koch also focused on the importance of early detection, regular eye exams, and supporting patients in accessing treatments through case management and financial assistance programs.

Pharmacy Times: What are the most significant advancements in nAMD and DME treatment focused on reducing patient burden and improving outcomes?

Casey Koch, PharmD, MBA, BCACP: The biggest thing going on right now is that we have 2 or 3 new therapies on the market in the last 2 years. We're really adapting to that being a new treatment paradigm. In the future from there, we may have additional therapies with new targets. We might be looking at gene therapy in retinal disease, which is an interesting target as well. I think we're really at a spot where we're seeing a change in the treatment paradigm. From here, I think we're going to see adoption of new therapies. From the managed care perspective, we're going to see maybe some policies trying to direct towards certain therapies. It's becoming a little bit more crowded, so we have additional competition, which is always good. I'm really excited about where we're at right now.

Pharmacy Times: How can pharmacists support the adoption and optimal use of these newer nAMD/DME therapies to enhance patient adherence and visual results?

Koch: The first thing to realize is you are going to see patients that are on these drugs, whether you know it or not. They're very common, especially in the Medicare population. You're looking at a med rec; you're probably looking at the pharmacy side of drugs. These drugs are going to be on the medical side. You really need a total view of the patient's treatment to recognize that. Pharmacists can really be involved in, first of all, trying to prevent this disease. There are a lot of prevention measures, like smoking cessation and getting patients’ blood pressure under control if they have hypertension. Probably the single biggest target is patients with diabetes. Those patients, we really need to make sure their A1C is under control. Definitely be recommending that they're getting an annual eye exam. This condition is such that once patients have it, it's very treatable, and so from there, once a patient has been diagnosed, then it really becomes about adherence. Patients need to be receiving the drug regularly. If they miss doses, it subjects them to advancing disease and potentially permanent vision loss. If you're counseling a patient and they're talking about things like not being able to get to their appointments or not being able to afford their medications, those are really spots where pharmacists can intervene. You can help put patients in case management and get them rides to their appointments. You can also help with finding copay assistance and foundation assistance. Those programs are available, so that's really a spot where a pharmacist can help patients in this area.

Pharmacy Times: When evaluating new nAMD/DME treatments, what are the critical clinical and real-world data points pharmacists should consider for patient care and formulary decisions?

Koch: In the clinical trials, often the primary end point is something around visual acuity, so change from baseline. It is possible to see improvement in patients, so if they're diagnosed with some vision loss initially, these VEGF inhibitors can have some reversal of that. That's really the real-world evidence that we're really particularly looking at: increasing vision or at least delaying vision loss. We're also looking at things like retinal thickness and other secondary measures that can be important for these patients. But the primary symptom of the disease is the vision loss, and that's really where we want to focus. If you are counseling a patient and they talk about their vision getting worse while they're on therapy, it's definitely a spot where they should be getting in to see their provider, maybe changing medications or finding an alternative that can help their vision.