Perimacular Atrophy Following Voretigene Neparvovec-Rzyl Treatment in the Setting of Previous Contralateral Eye Treatment With a Different Viral Vector.
Ku Cristy A, Igelman Austin D, Huang Samuel J, Bailey Steven T, Lauer Andreas K, Duncan Jacque L, Weleber Richard G, Yang Paul, Pennesi Mark E
AI Summary
Voretigene neparvovec-rzyl caused perimacular atrophy in eyes previously treated with a different viral vector, despite visual gains. This highlights potential risks when using different gene therapy vectors in each eye.
Abstract
Purpose
To report on cases of unilateral perimacular atrophy after treatment with voretigene neparvovec-rzyl, in the setting of previous contralateral eye treatment with a different viral vector.
Design
Single-center, retrospective chart review.
Methods
In this case series, four patients between the ages of six and 11 years old with RPE65-related retinopathy were treated unilaterally with rAAV2-CB-hRPE65 as part of a gene augmentation clinical trial (NCT00749957). Six to 10 years later the contralateral eyes were treated with the Food and Drug Administration-approved drug, voretigene neparvovec-rzyl. Best-corrected visual acuity (BCVA), fundus photos, ocular coherence tomography, two-color dark-adapted perimetry, full field stimulus threshold testing (FST), and location of subretinal bleb and chorioretinal atrophy were evaluated.
Results
Three out of four patients showed unilateral perimacular atrophy after treatment with voretigene, ranging from five to 22 months after treatment. Areas of robust visual field improvement were followed by areas of chorioretinal atrophy. Despite perimacular changes, BCVA, FST, and subjective improvements in vision and nyctalopia were maintained. Perimacular atrophy was not observed in the first eye treated with the previous viral vector.
Conclusions
We observed areas of robust visual field improvement followed by perimacular atrophy in voretigene treated eyes, as compared to the initially treated contralateral eyes.
Translational relevance: Caution is advised when using two different viral vectors between eyes in gene therapy. This may become an important issue in the future with increasing gene therapy clinical trials for inherited retinal dystrophies.
MeSH Terms
Shields Classification
Key Concepts5
Three out of four patients (75%) showed unilateral perimacular atrophy after treatment with voretigene neparvovec-rzyl, ranging from five to 22 months after treatment, in the setting of previous contralateral eye treatment with a different viral vector.
Areas of robust visual field improvement were followed by areas of chorioretinal atrophy in eyes treated with voretigene neparvovec-rzyl, in the setting of previous contralateral eye treatment with a different viral vector.
Despite perimacular changes, best-corrected visual acuity (BCVA), full field stimulus threshold testing (FST), and subjective improvements in vision and nyctalopia were maintained in eyes treated with voretigene neparvovec-rzyl, in the setting of previous contralateral eye treatment with a different viral vector.
Perimacular atrophy was not observed in the first eye treated with the previous viral vector (rAAV2-CB-hRPE65) as part of a gene augmentation clinical trial (NCT00749957) in patients with RPE65-related retinopathy.
Caution is advised when using two different viral vectors between eyes in gene therapy for inherited retinal dystrophies, due to observed perimacular atrophy in voretigene neparvovec-rzyl treated eyes compared to initially treated contralateral eyes with a different viral vector.
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