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Cenegermin is a medication belonging to the recombinant human nerve growth factor (rhNGF) class of drugs. This drug is utilized for the management of neurotrophic keratitis and is the first-ever topical biologic approved in the field of ophthalmology. In 2018, the U.S. Food and Drug Administration (FDA) approved the 0.002% ophthalmic solution of cenegermin. As a topical rhNGF, the drug demonstrates remarkable specificity for the anterior segment of the eye, playing a crucial role in supporting corneal innervation and maintaining its integrity. This activity thoroughly outlines the FDA-approved indications, action, and contraindications of cenegermin, positioning it as a valuable treatment for neurotrophic keratitis. Furthermore, this activity will highlight the mechanism of action, adverse event profile, and other essential factors of cenegermin, including dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions, which are crucial for the interprofessional team to manage neurotrophic keratitis in patients effectively. In addition, the activity provides clinicians with information on effectively managing toxicity in the event of an overdose during cenegermin administration. Objectives: Identify appropriate candidates with neurotrophic keratitis for cenegermin therapy based on the indications and contraindications provided in the product labeling. Screen patients with neurotrophic keratitis for potential risk factors or medical conditions that may impact cenegermin therapy. Apply evidence-based practices in managing adverse drug reactions or unexpected hypersensitivity reactions to cenegermin to achieve optimal therapeutic outcomes. Collaborate with other interprofessional healthcare team members to ensure seamless coordination of cenegermin therapy and comprehensive patient care. Access free multiple choice questions on this topic.

Clinical trials and product labeling suggest that a topical overdose of cenegermin is unlikely to occur or be linked to toxicity. If a patient experiences a topical overdose of cenegermin in their eye(s), they can remove the excess by rinsing the affected area with lukewarm water. Notably, cenegermin is minimally absorbed into the systemic circulation, thereby posing no risk of systemic toxicity. Nonetheless, in cases of unexpected hypersensitivity reactions, clinicians should take measures to ensure a patent airway, proper breathing, and circulation. Although there is no data available on the use of cenegermin in pregnant women, animal studies indicate no evidence of direct or indirect harmful effects on reproductive toxicity. Similarly, there is no data on the impact of cenegermin therapy on human fertility. Despite administering the drug to male and female rats in a daily subcutaneous dosage equivalent to 1709 times the maximum recommended human ophthalmic dose (MRHOD), cenegermin did not impact their fertility parameters. According to the drug's label, administering the medication subcutaneously or ocularly to female rats resulted in ovarian issues such as follicular cysts, persistent estrus, changes in ovarian weight, and a decreased corpora lutea. These effects were observed when the dosage was equal to or greater than 119 times the MRHOD. A topical overdose of cenegermin is unlikely to cause toxicity. Although there is no specific antidote for cenegermin toxicity, any topical overdose can be flushed easily from a patient's eye(s) with tepid water. Moreover, ophthalmic cenegermin is not anticipated to cause toxic effects in breastfed infants.[19]

To ensure successful cenegermin therapy for patients, a team of healthcare professionals must work together collaboratively to manage the treatment effectively. This team includes a referring optometrist, primary care physician or advanced practice practitioner, ophthalmic technician, nursing staff, pharmacist, and ophthalmologist. At the primary care level, maintaining a high index of suspicion and referring patients promptly to an ophthalmologist are crucial steps for the early diagnosis of NK. Ophthalmologists play a pivotal role in monitoring care and assessing therapeutic effectiveness. Medical professionals, such as physicians and advanced practitioners, should be aware that patients typically do not report symptoms caused by a lack of corneal sensation. Instead, patients frequently report experiencing blurred vision as the main symptom and, occasionally, redness in the affected eye. Following diagnosis, clinicians should prioritize strict adherence to cenegermin therapy to achieve complete corneal healing. Ophthalmic technicians help educate patients about medication compliance and treatment schedules, reinforcing proper administration. On the other hand, pharmacists ensure accurate dosing and counsel patients about potential adverse drug reactions. Nurses specializing in ophthalmology are crucial in counseling patients about safety measures, possible adverse effects, and the significance of following the prescribed treatment. In addition, clinicians should refer patients to an ophthalmologist for potential surgical intervention if corneal healing is not achieved despite appropriate cenegermin therapy.[9][23]

Following diagnosis, clinicians should prioritize strict adherence to cenegermin therapy to achieve complete corneal healing. Ophthalmic technicians help educate patients about medication compliance and treatment schedules, reinforcing proper administration. On the other hand, pharmacists ensure accurate dosing and counsel patients about potential adverse drug reactions. Nurses specializing in ophthalmology are crucial in counseling patients about safety measures, possible adverse effects, and the significance of following the prescribed treatment. In addition, clinicians should refer patients to an ophthalmologist for potential surgical intervention if corneal healing is not achieved despite appropriate cenegermin therapy.[9][23] Proper management is crucial to mitigate the high morbidity risk associated with NK. Cenegermin provides a distinctive nonsurgical approach to managing NK and effectively restoring corneal integrity in patients. Therefore, each healthcare provider should comprehensively understand the indications, administration, and potential adverse effects of cenegermin therapy. Adopting an interprofessional team-based approach that involves clinicians, specialists, ophthalmic technicians, pharmacists, and patients is instrumental in achieving the desired therapeutic outcomes of cenegermin therapy. This collaborative effort helps minimize adverse drug reactions and reduces the likelihood of disease recurrence, resulting in an improved quality of life for patients.[24]