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2014 ; 78
(4
): 699-706
Nephropedia Template TP
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Anti-vascular endothelial growth factor therapies in ophthalmology: current use,
controversies and the future
#MMPMID24602183
Kwong TQ
; Mohamed M
Br J Clin Pharmacol
2014[Oct]; 78
(4
): 699-706
PMID24602183
show ga
Use of anti-vascular endothelial growth factor (VEGF) therapies was introduced
for the treatment of ocular disorders in 2005. In the UK, the current licensed
and NICE approved indications are for the treatment of neovascular age-related
macular degeneration (nAMD), diabetic macular oedema (DMO), macular oedema
secondary to a retinal vein occlusion (RVO) and choroidal neovascularization in
pathological myopia. These diagnoses alone account for two-thirds of the main
causes of legally registrable visual impairment and blindness. Ranibizumab
(Lucentis®; Genentech/Novartis), a drug specifically designed for intraocular
use, is the primary licensed medication. Controversially however, clinicians have
been using an unlicensed cheaper drug, bevacizumab (Avastin®; Genentech/Roche),
originally designed for systemic administration, with a similar mode of action
and shown to have a similar efficacy. However, there are fears of greater side
effects with bevacizumab though studies have not been sufficiently powered to
show statistical difference. In the current global economic climate, anti-VEGF
treatment places huge financial and logistical pressure on already strained
health care systems. Bevacizumab is considerably more cost effective than
ranibizumab, and thus using bevacizumab would widen access to treatment
particularly in developing countries. This licensing issue also places clinicians
in a difficult medico-legal position especially in Europe, where doctors are duty
bound to use a licensed drug for a particular indication if this is available. As
the indications of anti-VEGF therapies expand and the cost of health care
provision becomes more expensive, the controversies surrounding their use will
inevitably become more important.
|Antibodies, Monoclonal, Humanized/adverse effects/therapeutic use
[MESH]
|Bevacizumab
[MESH]
|Eye Diseases/*drug therapy
[MESH]
|Humans
[MESH]
|Licensure
[MESH]
|Ranibizumab
[MESH]
|Receptors, Vascular Endothelial Growth Factor/adverse effects/therapeutic use
[MESH]
|Recombinant Fusion Proteins/adverse effects/therapeutic use
[MESH]
free
free
free
