Study Shows AREDS Supplements May Accelerate Macular Degeneration

Arctic Medical Laboratories

Toronto — Nutritional supplements meant to slow the progression of age-related macular degeneration (AMD) may actually accelerate the disease in people with certain genotypes, according to research recently published¹ in the Journal of the American Academy of Ophthalmology¹. Carl Awh, M.D. (Nashville, TN) and colleagues evaluated DNA samples that had been collected from the Age-Related Eye Disease Study (AREDS), which demonstrated a modest overall benefit of nutritional supplements for patients with AMD and has served as the basis for most over-the-counter ocular nutritional supplements. 

In this published report, Dr. Awh and colleagues analyzed four groups of patients classified by their complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2) genetic risk. The analysis found that for patients with high CFH and low ARMS2 risk, a group that made up 13 percent of the study cohort, the risk of progression to advanced AMD within seven years was 43.2% for those treated with zinc, 40.2% for those treated with the AREDS supplement and 17% for those receiving placebo.

“Patients in this genotype group had worse outcomes when treated with zinc or the AREDS formulation than with placebo,” says Dr. Awh. “AMD patients with 2 high risk CFH alleles and no ARMS2 risk alleles—13.1% of patients in our study—should not take the AREDS formulation.”

Dr. Awh explained that for patients with low CFH and high ARMS2 risk, a group that made up 35 percent of the study cohort, the risk of progression to AMD within seven years was 37 percent lower for those treated with the AREDS supplement than with placebo.

“The AREDS supplements are quite helpful for patients in this group, which is the largest of the four genotype groups. We think that the beneficial response of this genotype group, balanced by the poor response of patients with high CFH and no ARMS2 risk, are the basis for the overall modest benefit demonstrated in AREDS. Our analysis supports the use of genetic testing for patients before recommending an AREDS-type supplement,” adds Dr. Awh.

“Based on these findings as well as an earlier study² by Dr. Awh, doctors with patients currently taking an AREDS supplement should consider withdrawing zinc-containing regimens in those with genotypes associated with increased progression,” says Brent Zanke, M.D., Ph.D., Chairman and Chief Medical Officer of Arctic Diagnostics. “Further research is needed, but until this is available it makes prudent sense to avoid zinc in those individuals with 2 risk alleles at the CFH locus and no ARMS2 risk alleles.”

Genetic testing is available for the CFH and ARMS2 alleles as documented in Dr. Awh’s studies by Arctic Medical Laboratories. Testing patients for high risk genetic profiles is a non-invasive cheek swab taken in the doctor’s office. There are 10 manufacturers that currently provide AREDS formulations with and without zinc as recommended in these studies.

Sources:

1. Awh, C, Hawkin, S, Zanke, B, Treatment Response to Antioxidants and Zinc Based on CFH and ARMS2 Genetic Risk Allele Number in the Age-Related Eye Disease Study, Ophthalmology, September 2014.
2. Awh, C, Kim, I, et al., CFH and ARMS2 Genetic Polymorphisms Predict Response to Antioxidants and Zinc in Patients with Age-related Macular Degeneration, Ophthalmology, August 2013.