Ranibizumab in the treatment of age-related macular degeneration

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Age-related macular degeneration is one of the most common irreversible causes of visual loss. It has been well established from both animal and human studies that vascular endothelial growth factor plays an important role in the pathogenesis of this process. Ranibizumab is a monoclonal antibody fragment directed towards human vascular endothelial growth factor that was developed to halt the progression of wet age-related macular degeneration. The antibody fragment has a molecular weight of 48 kDa and is produced by an Escherichia coli expression system. Ranibizumab received approval in the USA in July 2006 and the European Union in January 2007. It is introduced into the eye by injection into the vitreous cavity. Conjunctival hemorrhage, vitreous floaters, intraocular inflammation, increased intraocular pressure and eye pain were the most common ocular complaints of patients receiving ranibizumab injections over sham treatments. The rates of retinal detachment, cataract and endophthalmitis do not exceed that of other intravitreal injections and patients should be treated under strict aseptic conditions to reduce this risk. No unanticipated systemic adverse events were found during any phase of the studies of ranibizumab thus far and the risk of thromboembolic events was less than 4% and not different to sham. Combined data from the Minimally classic/occult trial of the Anti-vascular endothelial growth factor antibody Ranibizumab In the treatment of Neovascular Age-related macular degeneration (MARINA), ANti-vascular endothelial growth factor antibody for the treatment of predominantly classic CHORoidal neovascularization in age-related macular degeneration (ANCHOR), and Phase IIIb, multicenter, randomized, double-masked, sham Injection-controlled study of the Efficacy and safety of Ranibizumab in subjects with subfoveal choroidal neovasularization with or without classic choroidal neovascularization secondary to age-related macular degeneration (PIER) studies have validated the safety and efficacy of ranibizumab amongst a large population compared with sham and standard treatment (photodynamic therapy). Intravitreal administration is recommended monthly for patients. However, an alternative dosing of every 3 months is better than no treatment but probably less effective than sham treatment.

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