Inhibitors of vascular endothelial growth factor (VEGF) in the management of neovascular age-related macular degeneration: a review of current practice.
We review the fundamental changes that are now occurring to the management of neovascular (wet) age-related macular degeneration (AMD). An improved understanding of the role of vascular endothelial growth factor (VEGF) in the genesis of choroidal neovascular membranes has led to the creation and use of intravitreous anti-VEGF antibodies (bevacizumab and ranubizumab) and an aptamer (pegaptanib) in the treatment of these lesions. These new intravitreous injections for AMD have supplanted previous treatments in both efficacy and safety and are now the standard of care for neovascular AMD. We discuss the biochemistry of the anti-VEGF pathway. While there is substantial evidence for the use of ranubizumab and pegaptanib, the intravitreous administration of bevacizumab has not been tested in randomised controlled clinical trials. We review the evidence base for all three agents and the patho-physiological basis for adverse reactions to intravitreous VEGF blockade.
van Wijngaarden
Peter
P
The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Qureshi
Salmaan H
SH
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000009:adverse effects / Q000627:therapeutic use; D000068258:Bevacizumab; D020256:Choroidal Neovascularization; D002986:Clinical Trials as Topic; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000209:etiology; D010778:Photochemotherapy; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors* / Q000502:physiology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab