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Intravitreal Ranibizumab and Bevacizumab: A Review of Risk 

Authors: Rima M. Dafer a;  Michael Schneck a;  Thomas R. Friberg b; Walter M. Jay c
Affiliations:   a Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
b University of Pittsburgh School of Medicine, UPMC Eye Center, Pittsburgh, PA, USA
c Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
DOI: 10.1080/08820530701543024
Publication Frequency: 6 issues per year
Published in: journal Seminars in Ophthalmology, Volume 22, Issue 3 July 2007 , pages 201 - 204
Subject: Ophthalmology;
Formats available: HTML (English) : PDF (English)
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Abstract

Ranibizumab (Lucentis®), a recombinant monoclonal antibody, blocks all active forms of vascular endothelial growth factor A and was the first treatment for age-related macular degeneration shown to improve visual acuity in a substantial percentage of patients rather than slowing visual loss. Bevacizumab (Avastin®) has a similar action, is related to the ranibizumab compound with respect to its structure, but has not been approved by the FDA for intravitreal use and therefore must be utilized only in an off-label setting. While ranibizumab was approved by the FDA at a dose of 0.5 mg per intravitreal injection, the manufacturer recently issued a letter to physicians warning of the increased risk of stroke at the FDA-approved dose as compared to a lower studied dose of 0.3 mg. An interim analysis of the ongoing SAILOR study revealed a 1.2% risk of stroke in the 0.5 mg arm versus 0.3% in the 0.3 mg arm (p = 0.02). It is unclear whether the trend toward a higher risk of stroke in patients receiving 0.5 mg dose of ranibizumab would persist in the final analysis, but details such as causality, topography, and severity of stroke in the SAILOR study should also be delineated. The risks of intraocular use of bevacizumab remain largely unknown at this time.
Keywords: ranibizumab; vascular endothelial growth factor; stroke; macular degeneration
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