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http://www.revoptom.com/content/c/20600/
VOLUME 4, NUMBER 28
November 14, 2014

THERE ARE FOUR PRIMARY PHARMACOLOGICAL TREATMENT OPTIONS FOR PATIENTS WITH WET AGE-RELATED MACULAR DEGENERATION (AMD)—MACUGEN (PEGAPTANIB, VALEANT PHARMACEUTICALS), LUCENTIS (RANIBIZUMAB, GENENTECH/ROCHE), AVASTIN (BEVACIZUMAB, GENENTECH/ROCHE) AND EYLEA (AFLIBERCEPT, REGENERON). WHILE ALL FOUR AGENTS INHIBIT VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) BINDING AND ACTIVATION, UNDERSTANDING THEIR SUBTLE DIFFERENCES WILL ALLOW YOU TO MORE EFFECTIVELY EDUCATE YOUR PATIENTS AND WILL HELP YOU DETERMINE WHEN A REFERRAL IS WARRANTED.

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In 2004, Macugen became the first anti-VEGF agent to receive FDA approval for the treatment of neovascular AMD. The drug is delivered via intravitreal injection, and is specifically indicated for dosing every six weeks. While Macugen is not currently FDA approved for the treatment of diabetic macular edema, researchers have documented significant visual improvement in affected patients following treatment.¹

Lucentis is FDA approved for the treatment of neovascular AMD, macular edema associated with central retinal vein occlusion and diabetic macular edema. This drug is indicated for monthly dosing. However, treatment data recently obtained from the Comparison of AMD Treatments Trial (CATT) suggested that Lucentis is most effective when administered PRN.² Specifically, patients who received monthly injections were 43% more likely to develop geographic atrophy following two years of treatment than those who received PRN injections.²

Avastin is actually FDA approved for the treatment of angiogenesis associated with colon cancer, small cell lung cancer and glioblastoma. However, because Avastin costs profoundly less than Lucentis, the drug frequently is compounded and used off-label to treat wet AMD.

Eylea is the most recently approved anti-VEGF agent for neovascular AMD. Additionally, the drug secured approval for the treatment of macular edema associated with central retinal vein occlusion and diabetic macular edema within the last two years. It is important to note that the VIEW study showed that bimonthly Eylea injections were clinically equivalent to monthly injections of Lucentis.³ Further, Eylea has a longer duration of effect than Lucentis and Avastin, and also may be more effective for the treatment of diabetic macular edema.

1. Sultan MB, Zhou D, Loftus J, et al. A phase 2/3, multicenter, randomized, double-masked, 2-year trial of pegaptanib sodium for the treatment of diabetic macular edema. Ophthalmology. 2011 Jun;118(6):1107-18.
2. Grunwald JE, Daniel E, Huang J, et al. CATT Research Group. Risk of geographic atrophy in the age-related macular degeneration treatment trials. Ophthalmology. 2014 Jan;121(1):150-61.
3. Heier JS. Intravitreal aflibercept (VEGF Trap-Eye) in wet age-related macular degeneration. Ophthalmology. 2012 Dec;119(12):2537-48.
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