Macular degeneration can be divided into ‘Dry’ and ‘Wet’ forms. Wet AMD is distinguished by the development of abnormal blood vessels underneath the retina in the macula; treatments like Lucentis may reduce these abnormal vessels to improve vision in patients suffering from Wet AMD.

These medications, administered via eye injections, can be extremely effective at improving or retarding vision loss. Also referred to as anti-VEGF medicines.

Aflibercept

Aflibercept is an anti-vascular endothelial growth factor (VEGF) injection prescribed to treat wet age-related macular degeneration, commonly referred to as wet AMD. Wet AMD occurs when abnormally high levels of VEGF and platelet-derived growth factor (PlGF) promote new blood vessel formation that leads to vision loss; Aflibercept blocks the action of these growth factors by decreasing retinal blood vessel formation thereby decreasing leakage of retinal blood vessels; this results in improved vision for ushers who use prefilled syringes when treating diabetic macular oedema caused by diabetic retinopathy oedema due to diabetic retinopathy. Eylea is available throughout North America with prefilled syringe delivery systems available throughout its state markets.

Clinical trials have demonstrated that intravitreal aflibercept can significantly improve best-corrected visual acuity for those living with wet AMD, with its benefits diminishing over time; especially among patients who received more than seven injections during their first year. One study compared ranibizumab and aflibercept injections equally; however, improvements with the former were greater at week 24 than with ranibizumab due to reduced frequency monitoring needs requiring less monitoring with aflibercept leading to faster improvements with faster improvement being attributed to lower frequency monitoring requirements that came into play for faster improvement overall.

VIEW 1 and 2 trials compared ranibizumab 0.5 mg given monthly with three forms of Aflibercept (2 mg monthly, 0.5 mg every other month or 8-weekly following three initial monthly injections), all administered subcutaneously. Aflibercept was found non-inferior to ranibizumab in terms of maintaining vision at week 52; thus the PBAC concluded that 2 mg Aflibercept equivalent is reasonable in maintaining functional vision.

Brolucizumab

Macular degeneration treatment in the UK involves monoclonal antibodies which target vascular endothelial growth factor (VEGF) to decrease fluid accumulation in the retina and treat wet AMD (neovascular age-related macular degeneration). They can be found both as injections and tablets; furthermore they are often prescribed to treat diabetic macular oedema and retinal vein occlusion as well.

Beovu (Brolucizumab), approved by the FDA late 2019, provides longer-acting anti-VEGF therapy than previous medications and requires less frequent injections, enabling patients to go three months between injections without visiting their eye care professional for injections – giving patients clear vision with reduced medication costs and time commitment.

The KITE study, which compared brolucizumab with aflibercept in treating neovascular wet AMD, demonstrated that brolucizumab was comparable to aflibercept for change from baseline in BCVA scores. Brolucizumab also showed more effective resolution of early residual fluid and CST reduction compared with aflibercept, leading to better best-corrected visual acuity improvements through week 96 compared with both drugs, which demonstrated its safety and effectiveness for wet AMD patients. These findings demonstrate its safe and efficacious treatment approach for wet AMD patients. However, as this medication may interact with other medicines prescribed to you and interfere with treatment plans, it’s essential that you discuss this option with your physician first before beginning therapy with this drug. Utilize RxList drug interaction checker to identify potential interactions and adverse reactions between medications you’re taking and those prescribed to you by your doctor. Furthermore, keep track of everything you take and share that list with them – be it allergies, pregnancy status or breastfeeding status and any health concerns.

Faricimab

Faricimab is an intravitreal therapy that targets VEGF-A and angiopoietin 2, to treat both neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). As the first bispecific retinal treatment targeting both angiogenic pathways simultaneously, clinical trials and real world evidence has demonstrated its efficacy; tolerability has also been reported with minimal incidences of treatable intraocular inflammation; it also lasts longer than its competitors without needing frequent follow ups.

Roche’s bispecific antibody faricimab, targeting both VEGF-A and angiopoietin-2, has received a priority review by the Food and Drug Administration (FDA), for two major causes of blindness. Eylea from Bayer may pose competition here as faricimab could potentially treat both neovascular AMD and diabetic macular oedema, two conditions which cause significant vision loss.

Recent network meta-analyses of clinical trial data demonstrated that faricimab was associated with better visual acuity outcomes and faster retinal fluid clearance compared with other anti-VEGF agents. Furthermore, results also show that faricimab has longer duration of action than its competitors and was safe; moreover patients receiving faricimab needed less injections annually.

Though these results are encouraging, it should be remembered that CADTH’s reimbursement review is advisory in nature and cannot bind governments. However, its recommendations could sway their decisions regarding drug usage in their countries.

Current treatments of wet age-related macular degeneration and DME approved by the FDA, MHRA and EMA include Aflibercept and Ranibizumab; both can reduce ocular bleeding while increasing retinal thickness for people living with DME; however they cannot stop its progression or cure it – therefore more effective therapies must be developed in order to enhance quality of life for those suffering macular degeneration.

Ranibizumab

Ranibizumab (Lucentis, Novartis Pharmaceuticals UK Ltd) is an anti-angiogenic agent which inhibits vascular endothelial growth factor A (VEGF-A). By blocking interactions between VEGF-A and its receptors, retinal neovascularisation and macular oedema are reduced significantly; making this medication effective against age-related macular degeneration as well as retinal vein occlusion macular oedema or diabetic macular oedema; these conditions require monthly intravitreal injections to remain effective against.

Macular degeneration is the leading cause of severe vision loss among those aged 60 or above in the UK and other countries, and its symptoms include progressive central vision deterioration that makes reading, recognising faces, driving and taking part in everyday tasks more challenging. Rapid decline can increase risks of falls as well as require assistance with daily tasks – all having significant negative repercussions for quality of life and life expectancy.

Current wet AMD treatments involve monthly injections of the vascular endothelial growth factor inhibitors ranibizumab and aflibercept, creating a substantial resource burden at wet AMD centers, along with regular long-term monitoring of patients. To assess cost effectiveness, this study evaluated an individualised T&E protocol of ranibizumab treatment versus monitoring protocol in comparison to an Aflibercept T&E model in UK setting.

AWTTC’s model compares the cost-effectiveness of ranibizumab with best supportive care (BSC) in adults suffering from choroidal neovascularisation associated with age-related macular degeneration or pathologic myopia. It follows the MINERVA trial for 12 months before best corrected visual acuity is assumed to change with natural history. Recurrence rates of disease are assumed at an annual rate of 6% while mortality data provided by Office for National Statistics survival data with an added modifier factor dependent upon degree of visual impairment.

Verteporfin

Verteporfin (brand name Visudyne) is a photosensitizing agent used in combination with laser light therapy to treat macular degeneration by stopping leaky blood vessels in the eye caused by macular degeneration. It works by traveling through the bloodstream and being absorbed into abnormal vessels in retina where it accumulates; when exposed to nonthermal red light it releases short-lived singlet oxygen that damages endothelium layers in vessels, blocking their permeability, as well as producing reactive oxygen species that cause cell death resulting in macular degeneration treatment.

TAP and VIP trials showed that verteporfin PDT reduced risk of vision loss significantly and maintained this result after 2 years – becoming the first treatment to significantly prevent visual acuity loss in neovascular age-related macular degeneration patients. There were however limitations associated with these results due to limited subject numbers and quality research conducted.

Side effects may include itching, swelling and pain at the injection site; serious heart conditions including fast or irregular heartbeats, chest fluttering or shortness of breath may occur as well as itchy rashes around injection sites. Anyone taking this medication should avoid direct sunlight as well as high-powered indoor lights (such as those found in operating rooms or dental clinics) for five days following their infusion.

Vereporfin should be administered intravenously and is best administered on alternate days; first treating one eye, then the second. To minimize extravasation risks, all tubing should be covered with opaque covering; an in-line filter and syringe pump may help further by blocking light from reaching these devices. It is crucial that correct diluents be used and no medications or diluents be mixed together with this drug; additionally it is wise to check the product Certificate of Analysis which details how much free verteporfin each dose contains.