Anti–Vascular Endothelial Growth Factor Pharmacotherapy for Age-Related Macular Degeneration: A Report by the American Academy of Ophthalmology

Received 11 July 2008; accepted 5 August 2008.

Objective

To examine the evidence about the safety and efficacy of anti–vascular endothelial growth factor (VEGF) pharmacotherapies for the treatment of neovascular age-related macular degeneration (AMD).

Design

Literature searches were conducted in May and October 2007 in PubMed with no date restrictions, limited to articles published in English, and in the Cochrane Central Register of Controlled Trials without a language limitation and yielded 310 citations. The first author reviewed the abstracts of these articles and selected 73 articles of possible clinical relevance for review by the panel. The panel deemed 64 of these articles sufficiently clinically relevant to review in full text and assigned ratings of level of evidence to each of the selected articles with the guidance of the panel methodologists.

Results

Eleven studies provided level I evidence for intravitreal pegaptanib and ranibizumab for neovascular AMD; there were no studies rated level I for bevacizumab for neovascular AMD. Five studies were rated as level II, which included studies of ranibizumab and bevacizumab, and the remaining 38 articles retrieved were rated as level III. The studies do not provide information about long-term results or the value (comparative effectiveness) and cost-effectiveness of combined therapies.

Conclusions

Review of the available literature to date suggests that anti-VEGF pharmacotherapy, delivered by intravitreal injection, is a safe and effective treatment for neovascular AMD for up to 2 years. There is level I evidence to support this conclusion for pegaptanib and ranibizumab, but none for bevacizumab at this time.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Manuscript no. 2008-832.

Funded without commercial support by the American Academy of Ophthalmology.

Prepared by the Ophthalmic Technology Assessment Committee Retina/Vitreous Panel and approved by the American Academy of Ophthalmology's Board of Trustees June 20, 2008.

Financial Disclosure(s): The author(s) have made the following disclosure(s):

Michael S. Ip - Consultant/Advisor - Bausch & Lomb, Inc.; Genentech, Inc.; OSI; Pfizer Ophthalmics; QLT Phototherapeutics, Inc.; Sirion.

Lecture Fees - Eli Lilly & Co.

Grant Support - Allergan, Inc.

Ingrid U. Scott - Consultant/Advisor, Lecture Fees - Eyetech (OSI); Genentech, Inc.; Pfizer Ophthalmics.

Gary C. Brown - Consultant/Advisor - NeoVista.

Consultant, Grant Support - Allergan, Inc.; Genentech, Inc.

Equity Owner - Center for Value Based Medicine.

Melissa M. Brown - Consultant/Advisor - Allergan, Inc.; Genentech, Inc.; NeoVista.

Equity Owner - Center for Value Based Medicine.

Allen C. Ho - Consultant/Advisor, Grant Support - Alcon Laboratories, Inc.; Eyetech Ltd.; Genentech, Inc.; Novartis; Occulogix; QLT Phototherapeutics, Inc.; Regeneron.

Lecture Fees - Alcon Laboratories, Inc.; Eyetech Ltd.; Genentech, Inc.

Suber S. Huang - Consultant/Advisor - Bausch & Lomb, Inc.; Digital Healthcare, Inc.; Genentech, Inc.; i2i Innovative Ideas, Inc.; Second Sight; SurModics, Inc.; WMR Biomedical, Inc.

Lecture Fees - Allergen, Inc.; American Academy of Family Physicians; Novartis; Synergetics, Inc.

Equity Owner - i2i Innovative Ideas, Inc.; SurModics, Inc.; WMR Biomedical, Inc.

Franco M. Recchia - Consultant/Advisor - Alcon Laboratories, Inc.; Genentech, Inc.

Correspondence: Nancy Collins, American Academy of Ophthalmology, Box 7424, San Francisco, CA 94120. E-mail: ncollins@aao.org.

PII: S0161-6420(08)00763-X

doi:10.1016/j.ophtha.2008.08.012

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