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Magdalena G. Krzystolik, M.D. - Paul B. Greenberg, M.D.

Expert retinal care for Rhode Island and Southern Massachusetts

Anti-VEGF Drug Treatments for patients with AMD - Southern New England Retina Associates

Anti-VEGF Drugs

Exudative or “wet” age-related macular degeneration (AMD) occurs in approximately 10% patients who have AMD and may lead to a devastating vision loss as abnormal blood vessels grow under the central part of the retina (macula) and leak fluid, blood, or yellowish fatty deposits (exudates) and eventually form a scar.

Over the last decade, the researchers have developed new drugs for the wet AMD.  These drugs target a chemical in the body called vascular endothelial growth factor or VEGF that stimulates the growth of the abnormal blood vessels in wet AMD; the drugs block VEGF leading to regression of the abnormal  blood vessels.

There are three primary anti-VEGF drugs that are injected directly into the eye with a needle to slow down the growth of the leaking blood vessels: ranibizumab (Lucentis), bevacizumab (Avastin), and aflibercept (Eylea).  Pegabtanib (Macugen), the first anti-VEGF drug for wet AMD, and photodynamic therapy (PDT) are treatments that are considered less effective than the drugs above but still may be used under special circumstances.

Ranibizumab was approved by the FDA to treat the exudative AMD in 2006.  In very rigorous studies, ranibizumab was shown to benefit patients by maintaining their vision or improving it.  For example, in one 2 year clinical study, nine out of ten patients receiving Lucentis every month lost fewer than 15 letters on the eye chart and three out of ten patients increased their vision.  Lucentis was the first drug for exudative AMD that has offered a realistic hope for vision improvement.

Bevacizumab has not been approved by the FDA to treat wet AMD. Nevertheless, it has been widely used as an off-label drug for this condition.  The clinicians began to use the drug because of its anti-VEGF properties as well as its substantially lower cost and ready availability.  Bevacizumab have been shown to be equivalent to those of ranibizumab in terms of visual outcomes; however, the safety with bevacizumab has not been studied as extensively as ranibizumab.  Moreover, bevacizumab needs to be compounded in a pharmacy which as an extra step in drug preparation and, if not done properly, may put a patient at risk for a serious infection.  Despite its limitations, bevacizumab is now more widely used than ranibizumab in the US for the management of wet AMD .

Aflibercept became available for treatment of wet AMD after the FDA approval in 2011. It is also a VEGF blocker.  Aflibercept has been shown to be as effective as ranibizumab in comparative studies with fewer injections. For the patient, fewer injections means less inconvenience, lower risk of complications, and cost savings.

Ranibizumab, bevacizumab, and aflibercept have been very successful in treating patients with AMD, however, they do not cure this disease.  Most patients require multiple injections indefinitely. As with any type of surgical procedure and administration of medication, there are potential risks that include a serious infection (endophthalmitis), retinal detachment (separation of the retinal tissue from the back of the eye ), clouding of the lens (cataract), and elevated eye pressure (glaucoma).  There is also a potential risk of blood clots leading to a heart attack or a stroke. Patients should call their doctor immediately if they experience decline in vision, flashes of lights or floaters, or new eye redness or pain after the injection. Despite the limitations of anti-VEGF drugs, they offer hope to preserve vision and to allow many AMD patients to enjoy an improved quality of life.