Age-related macular degeneration (AMD) affects the area of the retina called the macula and leads to the gradual reduction of vision and colour perception. “Wet” AMD causes a gradual, sometime rapid decline in visual acuity, and even a loss of central vision.

Ranibizumab (Lucentis°) administered through intravitreal injection is the reference or
second-line treatment depending on the type of AMD. Because of its lower cost, bevacizumab (Avastin°), which is similar to ranibizumab, is sometimes used off-label, even though its presentation is not appropriate for intravitreal injection.

According to independent clinical trials, the efficacy of bevacizumab after one or two years' treatment is similar to that of ranibizumab in slowing the loss of visual acuity. There are no available data for the longer term. No fewer injections are required with bevacizumab compared with ranibizumab.

The adverse effects of bevacizumab are similar to those of ranibizumab, both ocular and extra-ocular, including cardiovascular disorders. However, bevacizumab appears to expose patients to slightly more severe  adverse gastrointestinal effects. It also exposes them to a sometimes severe risk of infections due to the manipulations necessary for its preparation (since it is not sold in a form that is injectable in the eye), whereas ranibizumab has the advantage of being in the form of a pre-filled syringe designed for injecting into the eye.

The question  of ranibizumab's excessive price needs to be resolved  by the public authorities.

©Prescrire 1 September 2015

"Bevacizumab (Avastin°) and age-related macular degeneration" Prescrire Int 2015; 24 (163): 201-205. (Pdf, subscribers only).