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AAO report: Published clinical studies support use of anti-VEGF in AMD
Ophthalmology. 2008;115(10):1837-1846.
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Available evidence in the published literature supports the use of intravitreal pegaptanib sodium and ranibizumab for neovascular age-related macular degeneration, although data is lacking on long-term use and the value of or cost-effectiveness of combined therapies.
A literature review by a panel found 64 published studies on the use of anti-VEGF therapy. Of these, the panel found that 11 offered level 1 evidence for Macugen (pegaptanib sodium, OSI Eyetech/Pfizer) and Lucentis (ranibizumab, Genentech). No studies supplied level 1 evidence for Avastin (bevacizumab, Genentech). Five studies supplied level 2 evidence, including studies on ranibizumab and bevacizumab, and the remaining 38 were rated as level 3.
“Review of the available literature to date suggests that anti-VEGF pharmacotherapy, delivered by intravitreal injection, is a safe and effective treatment for neovascular AMD, for up to 2 years of follow-up for pegaptanib and for up to 1 year of follow-up for ranibizumab,” the report said.
This article confirms what we already know at this point – while pegaptanib and ranibizumab have level 1 evidence of efficacy and safety and are approved by FDA for intraocular use, bevacizumab does not. However, the important point is that, despite the extensive literature review, the authors state that “there are no data currently available to support that ranibizumab may be superior to bevacizumab or vice versa.” This will be the single most important question to answer in the future given the large difference in cost between the two drugs, despite perceived similarities in safety and efficacy. Until the CATT trial answers the question of which drug is better or until a new drug with more potency, longer duration of action, or safer route of delivery can be found, physicians will continue to use both ranibizumab and bevacizumab.
– Judy E. Kim, MD
OSN Retina/Vitreous Board Member
As this report states, there is currently insufficient clinical trial data on bevacizumab that we can use to compare to published literature on either ranibizumab or pegaptanib for the treatment of wet AMD. Therefore, the informed consent process is important so that patients understand the present lack of knowledge available for the use of bevacizumab for this indication. Clearly, there is a need for future research in this area, and bevacizumab should only be used if found comparable to pegaptanib and ranibizumab in randomized controlled trials.
– José G. Cunha-Vaz, MD, PhD
OSN Europe/Asia-Pacific Editorial Board Member