Anti-VEGF Agents for the Treatment of Pigment Epithelial Detachments Associated with Neovascular Age-related Macular Degeneration: An Evidence-based Approach

Pegaptanib (Eyetech Pharmaceuticals and Pfizer), which was approved by the FDA at the end of 2004, was the first anti-VEGF therapy for neovascular AMD (3). After approval of bevacizumab (Genentech/ Roche) for cancer therapy and in view of the suspected role of VEGF in wet AMD, systemic intravenous and, later, intravitreal bevacizumab began to be administered off-label to treat neovascular AMD (4). Ranibizumab (Genentech/ Novartis), a humanized monoclonal anti-Fab antibody, engineered to bind with high affinity to VEGF-A and inhibit all of its biologically active isoforms, was found to be an effective therapeutic agent for neovascular AMD. This was proven in two pivotal trials: the Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AgeRelated Macular Degeneration (MARINA) and the AntiVEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in Age-Related Macular Degeneration (ANCHOR) (5). Based on this evidence, ranibizumab was approved by the FDA in 2006 as therapy for the treatment of wet AMD (6).