Ranibizumab (Lucentis) in neovascular age-related macular degeneration: evidence from clinical trials.
BACKGROUND
Neovascular age-related macular degeneration (AMD) has a poor prognosis if left untreated, frequently resulting in legal blindness. Ranibizumab is approved for treating neovascular AMD. However, further guidance is needed to assist ophthalmologists in clinical practice to optimise treatment outcomes.


METHODS
An international retina expert panel assessed evidence available from prospective, multicentre studies evaluating different ranibizumab treatment schedules (ANCHOR, MARINA, PIER, SAILOR, SUSTAIN and EXCITE) and a literature search to generate evidence-based and consensus recommendations for treatment indication and assessment, retreatment and monitoring.


RESULTS
Ranibizumab is indicated for choroidal neovascular lesions with active disease, the clinical parameters of which are outlined. Treatment initiation with three consecutive monthly injections, followed by continued monthly injections, has provided the best visual-acuity outcomes in pivotal clinical trials. If continued monthly injections are not feasible after initiation, a flexible strategy appears viable, with monthly monitoring of lesion activity recommended. Initiation regimens of fewer than three injections have not been assessed. Continuous careful monitoring with flexible retreatment may help avoid vision loss recurring. Standardised biomarkers need to be determined.


CONCLUSIONS
Evidence-based guidelines will help to optimise treatment outcomes with ranibizumab in neovascular AMD.
Mitchell
P
P
Eye Clinic (B4A), Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia. paul_mitchell@wmi.usyd.edu.au
Korobelnik
J-F
JF
Lanzetta
P
P
Holz
F G
FG
Prünte
C
C
Schmidt-Erfurth
U
U
Tano
Y
Y
Wolf
S
S
D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab; D016896:Treatment Outcome; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab