Anti-VEGF therapies for age-related macular degeneration: a powerful tactical gear or a blunt weapon? The choice is ours

Abstract

Purpose Blindness and vision loss are still frequent disabilities associated with a relevant impact on health care and quality of life, and a high economic burden. Supranational programs established by the World Health Organization (WHO), International Agency for the Prevention of Blindness (IAPB), and World Health Assembly (WHA) aim at reducing avoidable visual impairment. Age-related macular degeneration (AMD), diabetic retinopathy (DR), and other retinal diseases are well known causes of visual disability. Since more than a decade, intravitreal agents are available for the treatment of these diseases. The aim of this study is to review whether pharmacotherapy with anti-vascular endothelial growth factor (VEGF) drugs has led to a decrease in the prevalence of blindness with emphasis on AMD and different countries. A brief analysis of other factors correlated to changes in the rate of blindness is also presented. Methods PubMed and Scopus web platforms were used to identify relevant studies on epidemiology of blindness and vision impairment, the influence of intravitreal therapies, and the existence of different vision care models. Additional data and material was searched in web internet accessed by the web browser Firefox. Results Age-standardized prevalence of blindness secondary to AMD has started to decline as testified by a number of studies in different countries. This is due to the adoption of anti-VEGF therapy and its adequate management. The frequency of treatment and regimens applied are indirect signs of successful treatment. Local rules and regulations may represent an obstacle. Conclusions This review shows that by implementing existing health care systems and dispensing adequate therapies in the field of retinal diseases, the prevalence of blindness due to these conditions can decline.

Anti-VEGF Drugs Dynamics: Relevance for Clinical Practice

“…Pharmacologic inhibition of intraocular VEGF is effective in the treatment of neovascular AMD, and its introduction in clinical practice has revolutionized the visual prognosis of this condition [1,2]. Optimal results were initially observed using a fixed monthly dose of 0.5 mg of ranibizumab.…”

“…The development and widespread use of intravitreal endothelial growth factor (VEGF) inhibitors has transformed the management of neovascular age-related macular degeneration (AMD), reducing the number of cases of legal blindness by 50% over the last decade [1,2]. Nowadays, in clinical practice, four VEGF-neutralizing molecules, such as ranibizumab (Lucentis ® , Genentech, South San Francisco, CA, USA and Novartis Pharma AG, Basel, Switzerland) aflibercept (Eylea ® , Regeneron Pharmaceuticals, Tarrytown, NY, USA and Bayer HealthCare, Berlin, Germany), brolucizumab (Beovu ® , Genentech, South San Francisco, CA, USA and Novartis Pharma AG, Basel, Switzerland), and bevacizumab (Avastin ® , Genentech, S. San Francisco, CA, USA/Roche, Basel, Switzerland) have been effectively used to treat neovascular AMD, although only the first three have received United States Food and Drug Administration and European Medicines Agency approval for intravitreal use [3,4].…”

An Update on Strategies to Deliver Protein and Peptide Drugs to the Eye

“…Generally, the standard treatment of retinal neovascularization involves laserassisted thermal photocoagulation or ablation of CNV so that the retina becomes anoxic. Currently, the standard treatment has been replaced by intravitreal injections of US Food and Drug Administration (FDA) approved anti-VEGF agents 2 such as ranibizumab (Lucentis), pegaptanib (Macugen), conbercept (Lumitin), brolucizumab (Beovu), 2,11 and aflibercept (Eylea) that act as "VEGF trap". Bevacizumab (Avastin) is a humanized monoclonal IgG1 antibody (molecular weight 149 kDa) used off-label in the treatment of chorioretinal vascular disease.…”

GSK3 Is a Central Player in Retinal Degenerative Diseases but a Challenging Therapeutic Target

“…This phenotype is correlated with the increased expression of Vascular Endothelial Growth Factor (VEGF), a target gene of Wnt signaling [ 163 , 164 ]. A commonly used treatment strategy for wet-AMD and DR relies on reducing angiogenesis via anti-VEGF agents [ 165 , 166 , 167 , 168 , 169 , 170 , 171 ].…”