Aflibercept, Lucentis and Eylea are three commonly prescribed injectable medications used to treat wet age-related macular degeneration (wet AMD). You will require injections every four weeks; at each visit your pupil will be dilated and an eye scan completed.

Studies suggest that eating foods rich in lutein and zeaxanthin may help slow macular degeneration progression. Your physician can advise on which dietary choices would be most effective.

Bevacizumab

Bevacizumab (Avastin) is an intravenous anti-vascular endothelial growth factor receptor monoclonal antibody designed to block interactions between VEGF and its ligands. VEGF is a protein that fosters cancer cell proliferation by driving angiogenesis – a process in which new blood vessels form to supply nutrients and oxygen directly to tumor cells. Bevacizumab increases cancer cells’ sensitivity to anticancer treatments by blocking their VEGF receptor, as well as inhibiting microvessel formation in tumor tissue. Combinations of antineoplastic agents are prescribed in combination to treat metastatic colorectal cancer, recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer and nonsquamous non-small cell lung cancer; additionally they can also be combined with platinum-based chemotherapy regimens to treat metastatic breast cancer patients.

Numerous phase III trials have demonstrated that adding bevacizumab to standard first-line therapy improves progression-free survival and overall survival in advanced ovarian cancer, yet it is important to weigh its benefits, risks and costs carefully before undertaking treatment. Accordingly, the PBAC recommends making this medication available under special arrangements in Section 100 Efficient Funding of Chemotherapy Program for use against advanced ovarian cancer.

GOG-0218 trial pitted bevacizumab against standard of care consisting of six cycles of paclitaxel and carboplatin chemotherapy treatment. As this was an open-label study, its results may have been affected. Furthermore, 27.7% of participants in comparator arm switched over to bevacizumab after disease progression while 15.1% continued receiving this drug beyond its progression; these factors may have altered its results towards bevacizumab’s favour.

ICON-7 trial explored molecular subtyping of ovarian cancer. Proliferative and mesenchymal subtypes showed the greatest advantage from bevacizumab therapy, with significant prolongations of PFS and OS. Conversely, patients with poor intrinsic chemosensitivity (defined by unfavorable KELIM scores) did not show an advantage from bevacizumab added to standard therapy.

Bevacizumab may cause adverse events, including gastrointestinal reactions (grade 2-4 diarrhoea and grade 4-5 bowel perforation with fistula formation), serious hypertension reactions, pulmonary embolism risks and CNS involvement; therefore it is vitally important to monitor patients closely for signs of CNS involvement which could indicate severe reactions that require immediate discontinuation of bevacizumab therapy.

Ranibizumab

Ranibizumab can slow the progression of wet age-related macular degeneration (wet AMD), improving vision by blocking new blood vessel growth that causes fluid leakage into the back of the eye. It should be administered every four to six weeks and is the only treatment that has proven its efficacy with advanced forms of wet AMD; its brand name is Lucentis.

Clinical trial data demonstrated that monthly intraocular injections of ranibizumab (Lucentis) significantly enhanced visual acuity for patients suffering macular edema due to branch retinal vein occlusion (BRVO). The phase III MINERVA study included 397 participants randomized either 6 monthly injections of ranibizumab or placebo; additionally the latter group received laser therapy treatments as part of their care plan. Results of this trial were shared at ARVO 2016, while HORIZON provided a meta-analysis of ROCC and CRUISE trials combined into one submission.

These drugs work by inhibiting vascular endothelial growth factor (VEGF), a protein responsible for stimulating abnormal blood vessel formation. When administered intravitreally, they prevent new vessels from sprouting within the eye that leak and damage retina.

This medication is prescribed to treat neovascular age-related macular edema, macular edema after retinal vein occlusion, diabetic macular edema, and myopic choroidal neovascularization (mCNV). As part of its class of anti-VEGF agents it may also be combined with other treatments to achieve maximum effectiveness.

This medication should never be given to children, as it may lead to serious side effects, including bleeding in the brain or blood vessels in the head and neck which could result in death. You should immediately notify your physician if any such side effects arise, including mental impairment such as difficulty thinking clearly or concentrating; driving or operating machinery while taking this medication.

Ranibizumab’s Medicare Benefits Schedule items should soon be finalised, with MSAC considering these items on their safety, efficacy and cost-effectiveness in light of current evidence. The Medicare Benefits Schedule is Australia’s system for subsidising medicines; its purpose is to help decide whether a particular medicine should be listed under Pharmaceutical Benefits Scheme or not. If a company disagrees with MSAC’s decision they can either resubmit their submission or seek an independent review of it.

Pegaptanib

Pegaptanib is a prescription drug designed to slow abnormal blood vessel growth and leakage associated with wet age-related macular degeneration in one or both eyes. Administered via injection directly into the eye by healthcare providers, typically every six weeks – it belongs to a group of medications called Vascular Endothelial Growth Factor Antagonists.

This medication is an aptamer, a pegylated modified oligonucleotide with high selectivity and affinity that binds directly to its target molecule with great selectivity and affinity. Specifically, this one targets the VEGF receptor to inhibit its binding site for VEGF, thus blocking its action on eye tissue and thus treating wet AMD more effectively than traditional treatments. Studies have proven its efficacy.

Recent clinical trial data for 0.3 mg pegaptanib sodium (Macugen) revealed it to be more effective than either sham injections or PDT in maintaining and improving visual acuity for those suffering from neovascular age-related macular degeneration, according to a report in the New England Journal of Medicine published December 30th 2018. Pegaptanib is the first selective inhibitor of VEGF that targets its isoform 165 with high affinity, inhibiting its activity in vivo unlike non selective inhibitors such as ranibizumab which only target non VEGF inhibitors such as ranibizumab which only target other isoforms such as ranibizumab which are non selective inhibitors such as ranibizumab or ranibizumab.

Preclinical studies conducted using retinal pigment epithelium from diabetic mice have demonstrated that pegaptanib, administered intravitreally, can effectively prevent diabetic macular edema by effectively blocking its breakdown. This is significant, as macular edema is one of the primary causes of vision loss in neovascular AMD as well as one component of wet age-related macular degeneration.

Drug treatment’s positive effect on vision continues after stopping, providing further proof of its disease-modifying abilities. Estimations show it takes between one and two years of regular treatments to achieve these benefits; thus making this an attractive solution for many wet AMD sufferers.

Direct costs associated with an injection of 0.3 mg pegaptanib are expected to outweigh their direct costs, estimated at PS1.2 million in 2006. Furthermore, projected indirect savings include NHS and Personal Social Service expenditure on blind registration, low vision aids, rehabilitation, community care services and residential care facilities.

Aflibercept

Aflibercept is the latest anti-VEGF medication approved for use by the FDA, intended for treatment of macular degeneration and diabetic macular edema. The medicine works by blocking vascular endothelial growth factor receptors responsible for retinal neovascularization and leakage of fluid into retinal vessels. Aflibercept should be administered via eye injection monthly. In addition, topical solutions are also available as treatments to manage ocular surface inflammation.

Recent findings by the PANORAMA study demonstrate that Aflibercept is effective at preventing progression to proliferative DR and DME in people living with diabetes. Lloyd Clark MD of Palmetto Retina Center in New York City presented his ASRS poster highlighting this study at this year’s conference; featuring both anatomical and visual results from both PULSAR and PHOTON clinical trials that show greater anatomical and visual benefits with 8 mg dose than 2mg dosage of Aflibercept.

The XTEND trial gathered real-world, intravitreal aflibercept regimen data during the COVID-19 pandemic at 127 medical centers worldwide during treatment-naive patients with nAMD who were non-responders to prior treatment and found that proactive intravitreal aflibercept significantly increased best corrected visual acuity compared to sham injections; furthermore, its benefits remained stable over two years.

Viatris and Momenta Pharmaceuticals’ biosimilar MYL-1701P was recently found to demonstrate therapeutic equivalence with Aflibercept in DME in an INSIGHT study, published this week at AAO 2022 Annual Meeting Chicago and consistent with earlier data from GALILEO and COPERNICUS studies.

Aflibercept is the gold standard treatment for wet age-related macular degeneration. It works by blocking VEGF-A and VEGF-B proteins which promote angiogenesis and leakage, acting as a decoy for their receptors to prevent signaling pathways from activating. Aflibercept is one of few agents with demonstrated efficacy against subfoveal choroidal neovascularization due to central retinal vein occlusion (CRVO).

The PBAC found that, as well as being effective against neovascular AMD, Aflibercept could also help treat diabetic retinopathy-related macular oedema and inflammatory choroidal neovascularisation; however, MSAC guidelines did not list it due to cost considerations; ranibizumab or bevacizumab would likely provide more cost-effective options in treating these indications.