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Management of Neovascular Age-Related Macular Degeneration in Clinical Practice: Initiation, Maintenance, and Discontinuation of Therapy

By Pearse A. Keane, Adnan Tufail and Praveen J. Patel

Abstract

Neovascular age-related macular degeneration (AMD) is a leading cause of irreversible visual loss in elderly populations. In recent years, pharmacological inhibition of vascular endothelial growth factor (VEGF), via intravitreal injection of ranibizumab (Lucentis) or bevacizumab (Avastin), has offered the first opportunity to improve visual outcomes in patients diagnosed with this disorder. In this paper, we provide recommendations on how bevacizumab and ranibizumab may be best applied in current clinical practice, with an emphasis on their underlying pharmacology and efficacy. In addition, we review current guidelines for the initiation, maintenance, and discontinuation of anti-VEGF therapies, as well as emerging treatment strategies and future directions in the field

Topics: Review Article
Publisher: Hindawi Publishing Corporation
OAI identifier: oai:pubmedcentral.nih.gov:3228281
Provided by: PubMed Central

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Citations

  1. a c u ,E .S t i f t e r ,P .V .V ´ ecsei-Marlovits et al., “Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration,”
  2. (2008). a g e r ,W .F .M i el e r ,a n dJ .W .M i ll e r ,“ A g e - r el a t edm ac u l a r degeneration,” The New England
  3. (2010). A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration: clinical and economic impact,”
  4. A v e r y ,D .J .P i e r a m i c i ,M .D .R a b e n a ,A .A .C a s t e l l a r i n
  5. (2009). A variabledosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration:
  6. (2010). A.Tufail,P.J.Patel,C.Eganetal.,“Bevacizumabforneovascular age related macular degeneration (ABC Trial): multicentre randomised double masked study,”
  7. Accuracy, precision and repeatability in preparing the intravitreal dose with a 1.0-cc syringe,” Acta Ophthalmologica.
  8. (2008). Age-related macular degeneration and mortality from cardiovascular disease or stroke,”
  9. (2007). An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular agerelated macular degeneration,”
  10. (2007). Anti-VEGF agents in the treatment of neovascular age-related macular degeneration: applying clinical trial results to the treatment of everyday patients,”
  11. (2009). Antiangiogenic approaches to age-related macular degeneration in the future,”
  12. (2009). Antiangiogenic approaches to age-related macular degeneration today,”
  13. (1991). Argon laser photocoagulation for neovascular maculopathy. Five-year results from randomized clinical trials.
  14. (2006). B r o w n ,P .K .K a i s e r ,M .M i c h e l se ta l . ,“ R a n i b i z u m a b versus verteporfin for neovascular age-related macular degeneration,” NewEnglandJournalofMedicine,vol.
  15. (2010). C h a n g ,D .V .D o ,S .B .B r e s s l e r ,S .D .C a s s a r d
  16. (2010). Characteristics of patients losing vision after 2 years of monthly dosing in the phase III ranibizumab clinical trials,”
  17. (2004). Choroidal neovascularization,”
  18. (2010). Combination therapy with verteporfin and antiVEGF agents in neovascular age-related macular degeneration: Where do we stand?”
  19. (2008). Combined treatment of acute subretinal haemorrhages with intravitreal recombined tissue plasminogen activator, expansile gas and bevacizumab: a retrospective pilot study,”
  20. (2008). Comparison of visual acuity in macular degeneration patients measured with snellen and early treatment diabetic retinopathy study charts,”
  21. (2009). Delay in treating age-related macular degeneration in Spain is associated with progressive vision loss,”
  22. (2006). Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration,”
  23. (2011). Effect of needle type and injection technique on pain level
  24. (2009). Effect of ranibizumab retreatment frequency on neurosensory retinal volume in neovascular
  25. (2011). Efficacy and safety of monthly versus quarterly ranibizumab treatment in neovascular age-related macular degeneration.
  26. (2011). G u t h o ff,T .M e i g e n ,a n dW .G o e b e l ,“ I n t r a v i t -reous injection of bevacizumab, tissue plasminogen activator, and gas in the treatment of submacular hemorrhage in agerelated macular degeneration,”
  27. (2006). h a h a r ,R .L .A v e r y ,G .H e i l w e i le ta l . ,“ E l e c t r o p h y s i o l o g i c and retinal penetration studies following intravitreal injection of bevacizumab
  28. (2010). H o l z ,J .F .K o r o b e l n i k ,P .L a n z e t t ae ta l . ,“ T h ee ffects of a flexible visual acuity-driven ranibizumab treatment regimen in age-related macular degeneration: outcomes of a drug and disease model,”
  29. (2011). H.Oubraham,S.Y.Cohen,S.Samimietal.,“Injectandextend dosing versus dosing as needed: a comparative retrospective study of ranibizumab in exudative age-related macular degeneration,”
  30. (2010). Imaging chorioretinal vascular disease,”
  31. (2011). Intraocular pharmacokinetics after a single intravitreal injection of 1.5Mg versus 3.0Mg of bevacizumab in humans,”
  32. (2010). Intravitreal bevacizumab for age-related macular degeneration with good visual acuity,”
  33. (2006). Intravitreal bevacizumab treatment of choroidal neovascularization secondary toage-relatedmaculardegeneration,”Retina,v ol.26,no .4,pp .
  34. (2011). Investigation of the role of neutralizing antibodies against bevacizumab as mediators of tachyphylaxis,”
  35. (2008). Is there tachyphylaxis to intravitreal anti-vascular endothelial growth factor pharmacotherapy in age-related macular degeneration?”
  36. (2002). Management of submacular hemorrhage,”
  37. (2005). Managing patients treated with bevacizumab combination therapy,”
  38. (2009). o r o o g h i a n ,C .C u k r a s
  39. (2008). Ongchin et al., “Quantitative subanalysis of optical coherence tomography after treatment with ranibizumab for neovascular age-related macular degeneration,”
  40. (2005). Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular
  41. (2010). Pathway-based therapies for age-related macular degeneration: an integrated survey of emerging treatment alternatives,” Retina,v o l .3 0 ,n o .9 ,p p .
  42. (2007). Pharmacokinetics and retinal distribution of ranibizumab, a humanized antibody fragment directed against VEGF-A, following intravitreal administration in rabbits,”
  43. (2008). Polypoidal choroidal vasculopathy and treatments,”
  44. (2010). Polypoidal choroidal vasculopathy masquerading as neovascular age-related macular degeneration refractory to ranibizumab,”
  45. (2011). Preclinical aspects of antiVEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab,”
  46. (2005). Preclinical pharmacokinetics of ranibizumab (rhuFabV2) after a single intravitreal administration,”
  47. (2011). Prevalence of age-related macular degeneration intheUSpopulation,”ArchivesofOphthalmology,vol.129,pp. 75–80,
  48. (2011). Primary endpoint results of a phase II study of vascular endothelial growth factor trap-eye in wet age-related macular degeneration,”
  49. (2008). Primary intravitreal bevacizumab for subfoveal choroidal neovascularization in age-related macular degeneration: results of the pan-american collaborative retina study group at 12 months follow-up,”
  50. (2005). Progression of visual loss and time between initial assessment and treatment of wet age-related macular degeneration,”
  51. R o s e n f e l d ,D .M .B r o w n ,J .S .H e i e re ta l . ,“ R a n i b i z u m a b for neovascular age-related macular degeneration,”
  52. (2006). R.F.Spaide,“Perspectives:rationaleforcombinationtherapies for choroidal neovascularization,”
  53. (2008). Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration:
  54. (2010). Randomized, doublemasked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 2,”
  55. (2010). Ranibizumab (Lucentis) in neovascular age-related macular degeneration: evidencefromclinicaltrials,”BritishJournalofOphthalmology,
  56. (2011). Ranibizumab and bevacizumab for neovascular age-related macular degeneration,” The New England
  57. (2007). Ranibizumab for predominantly classic neovascular age-related macular degeneration: subgroup analysis of first-year ANCHOR results,”
  58. (2009). Refractory neovascular age-related macular degeneration secondary to polypoidal choroidal vasculopathy,”
  59. (2011). Results of flexible ranibizumab treatment in age-related macular degeneration and search for parameters with impact on outcome,”
  60. (2010). Risks of mortality, myocardial infarction, bleeding, and stroke associated with therapies for age-related macular degeneration,”
  61. (2011). Silicone oil microdroplets and protein aggregates in repackaged bevacizumab and ranibizumab: effects of long-term storage and product mishandling,”
  62. Tachyphylaxis during treatment of exudative age-related macular degeneration with ranibizumab,” The British Journal of Ophthalmology.
  63. (2010). Takahashi,andT.Nishimura,“Plasmalevelsofvascularendothelial growth factor and pigment epithelium-derived factor before andafterintravitrealinjectionofbevacizumab,”BritishJournal of Ophthalmology,
  64. (2007). Tears of the retinal pigment epithelium: an old problem in a new era,”
  65. (2011). The 1-year results of CLEAR-IT 2, a phase 2 study of vascular endothelial growth factor trap-eye dosed as-needed after 12-week fixed dosing,”
  66. (2006). The international intravitreal bevacizumab safety survey: using the internet to assess drug safety worldwide,”
  67. (2002). The role of apoptosis in age-related macular degeneration,”
  68. The royal college of ophthalmologists interim recommendations for the management of patients with agerelatedmaculardegeneration,”Eye,vol.22,pp.864–868,2008.
  69. (2009). Treat and extend” dosing of intravitreal antivascular endothelial growth factor therapy for type 3 neovascularization/retinal angiomatous proliferation,”

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