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Anti-VEGF and Other Novel Therapies for Neovascular Age-Related Macular Degeneration: An Update

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Abstract

Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness in older adults. The prognosis for the neovascular type of advanced AMD improved with the introduction of biological drugs with antiangiogenic properties, beginning with off-label bevacizumab, which was first used intravitreally in 2006. These drugs target newly formed vessels that grow beneath the center of the retina, causing loss of central vision, and they can help to maintain or improve vision. Repeated intravitreal injections are needed to achieve prolonged inhibition of proangiogenic cytokines, primarily vascular endothelial growth factor (VEGF). Major regulatory agencies have approved several molecules for AMD treatment, including ranibizumab, aflibercept, and brolucizumab. The development of further drugs was mainly targeted at prolonging anti-VEGF inhibition—thus reducing the frequency of injections—and expanding the biological targets of proangiogenic cytokine inhibition. Finally, biosimilars are already being marketed in some countries, allowing the containment of costs of AMD treatment, which are growing steadily in many settings because of the need for long-term treatment. This review summarizes the properties and clinical profiles of anti-VEGF biological drugs that are approved to treat neovascular AMD as well as ongoing research on molecules that may be marketed in the near future.

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Authors and Affiliations

  1. IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198, Rome, Italy

    Mariacristina Parravano & Eliana Costanzo

  2. Unit of Clinical Pharmacology, A.O.U. “G. Martino”, Messina, Italy

    Giulia Scondotto

  3. Department of Diagnostics and Public Health, University of Verona, Verona, Italy

    Gianluca Trifirò

  4. Scientific Responsible of Academic Spin-off “INSPIRE-Innovative Solutions for Medical Prediction and Big Data Integration in Real World Setting”, Azienda Ospedaliera Universitaria “G. Martino”, Messina, Italy

    Gianluca Trifirò

  5. Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze and AOU Careggi, Florence, Italy

    Gianni Virgili

  6. Centre for Public Health, Queen’s University of Belfast, Belfast, Northern Ireland, UK

    Gianni Virgili

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  1. Mariacristina Parravano
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  2. Eliana Costanzo
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Correspondence to Mariacristina Parravano.

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The research for this paper was in part financially supported by the Italian Ministry of Health and Fondazione Roma. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

Mariacristina Parravano served on advisory boards for Allergan, Bayer, Novartis, lecture fees from Zeiss and Omikron, honoraria from Alfaintes.

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MP: concept and review design; drafting, revision, and final approval of manuscript. EC: review design; drafting and revision of manuscript. GS: review design; revision of manuscript; preparation of tables. GT: review design; revision of manuscript. GV: concept and review design; supervision; drafting, revision, and final approval of manuscript.

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Parravano, M., Costanzo, E., Scondotto, G. et al. Anti-VEGF and Other Novel Therapies for Neovascular Age-Related Macular Degeneration: An Update. BioDrugs 35, 673–692 (2021). https://doi.org/10.1007/s40259-021-00499-2

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