39.
The Use of Anti-VEGF Inhibitors in Wet AMD:
Balancing the Risks
Ralf Blank (Rüsselsheim)
Two drugs that inhibit vascular endothelial growth factor have been improved for use in the
treatment of choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
Pegabtanib sodium (Macugen, OSI /Eytech and Pfizer New York) selectively inhibits the most
biologically active isoform of VEGF, VEGF 165. Ranibizumab (Lucentis, Gentech, San
Francisco) nonselectively targets all known isoforms of VEGF-A. Another VEGF-blocking drug,
Bevacizumab (Avastin, Gentech) has also recently been used for treatment of CNV in AMD,
although it was not developed for ocular use and has not been approved for that indication.
Although VEGF inhibition is the goal of all these drugs as well as several other compounds in
development for the treatment and prevention of CNV, it should not be forgotten that VEGF is
an important compound for the normal function of the human body.
Several epidemiologic studies have shown an increased risk of cardiovascular disease, hypertension, and cardiovascular
events including stroke and myocardial infarction, in people with AMD. Given that systemic nonselective VEGF inhibition may
be associated with an increased risk of thrombembolic events, and that repeated intravitreal delivery of VEGF inhibitors
inevitably involves systemic exposure of these VEGF-blocking agents, it is important to consider the systemic safety of these
ocular treatments in AMD patient population, especially over the long term.