Ranibizumab

Ranibizumab
Monoclonal antibody
TypeFab fragment
SourceHumanized (from mouse)
TargetVEGF-A
Names
Trade namesLucentis, Byooviz
Other namesranibizumab-nuna
Clinical data
Drug classVascular endothelial growth factor A (VEGF-A) inhibitor[1]
Main usesAge-related macular degeneration (AMD), diabetic retinopathy, macular edema due to retinal vein occlusion, retinopathy of prematurity[1]
Side effectsConjunctival bleeding, eye pain, floaters, increased intraocular pressure[2]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
    Routes of
    use    		Intravitreal injection
    External links
    AHFS/Drugs.comMonograph
    MedlinePlusa607044
    Legal
    License data
    Legal status
    Pharmacokinetics
    Elimination half-lifeApprox. 9 days[4]
    Chemical and physical data
    FormulaC2158H3282N562O681S12
    Molar mass48379.97 g·mol−1

    Ranibizumab, sold under the brand name Lucentis among others, is a medication used to treat "wet" type of age-related macular degeneration (AMD), diabetic retinopathy, macular edema due to retinal vein occlusion, and retinopathy of prematurity.[1] It is given by injection into the eye.[1]

    Common side effects include conjunctival bleeding, eye pain, floaters, and increased intraocular pressure.[2] Other side effects may include endophthalmitis and retinal detachment.[2] It is a small piece of monoclonal antibody that attaches to and blocked vascular endothelial growth factor A (VEGF-A).[1]

    Ranibizumab was approved for medical use in the United States in 2006 and Europe in 2007.[2][1] In the United Kingdom it costs the NHS about £550 per dose as of 2021.[7] In the United States it is about 2000 USD per dose.[8]

    Medical uses

    Ranibizumab is indicated for the treatment of macular degeneration (AMD), choroidal neovascularisation (CNV), diabetic macular oedema (DME), and retinal vein occlusion (branch RVO or central RVO) in adults.[5][6][9]

    It is used for age-related wet macular degeneration.[10] Its effectiveness is similar to that of bevacizumab[11][12] and aflibercept.[13] A 2017 review found that while ranibizumab and bevacizumab provide similar functional outcomes in diabetic macular edema, there is low-certainty evidence suggesting that ranibizumab is more effective in reducing central retinal thickness than bevacizumab.[14]

    Dosage

    It is generally given as a 0.5 mg injection into the eye.[1]

    Side effects

    A 2014 Cochrane review did not find a difference between bevacizumab and ranibizumab in deaths or total severe side effects when used for macular degeneration.[15] There, however, was not a lot of evidence, and thus this conclusion is not that certain.[15]

    Ranibizumab does appear to result in a lower risk of stomach and intestinal problems.[15] It is also associated with a low rate of eye related side effects.[16]

    The most common side effects in clinical trials were conjunctival haemorrhage, eye pain, vitreous floaters, increased intraocular pressure, and intraocular inflammation.

    Although there is a theoretical risk for arterial thromboembolic events in people receiving VEGF-inhibitors by intravitreal injection, the observed incidence rate was low (< 4%) and similar to that seen with placebo.

    Serious adverse events related to the injection procedure occurred with an incidence rate of less than 1% and included endophthalmitis, retinal detachment, and traumatic cataracts. Other serious ocular adverse events observed among ranibizumab-treated patients (incidence rate < 1%) included intraocular inflammation and blindness.[17]

    Interactions

    No significant interactions are known.[18]

    Pharmacology

    Ranibizumab is a monoclonal antibody that inhibits angiogenesis by inhibiting vascular endothelial growth factor A, a mechanism similar to that of Bevacizumab.[19]

    Society & culture

    Economics

    Its effectiveness is similar to that of bevacizumab.[11][20] Its rates of side effects also appear similar.[15] However, ranibizumab typically costs $2,000 a dose, while the equivalent dose of bevacizumab typically costs $50.[21][22][23][24]

    On November 3, 2010, The New York Times reported that Genentech began offering secret rebates to about 300 ophthalmologists in an apparent inducement to get them to use more ranibizumab rather than their less expensive bevacizumab. This may have been in anticipation of the results of the CATT clinical trial,[22] which was sponsored by the National Eye Institute, and compared the relative safety and efficacy of ranibizumab and bevacizumab in treating AMD. In 2008, bevacizumab cost Medicare only $20 million for about 480,000 injections, while ranibizumab cost Medicare $537 million for only 337,000 injections.[25] A small study showed no superior effect of ranibizumab versus bevacizumab in direct comparison.[26] The initial results of the larger Comparison of Age-related Macular Degeneration Treatments Trials (CATT) trial were published in the New England Journal of Medicine in May 2011.[22] The trial showed that the two drugs "had equivalent effects on visual acuity when administered according to the same schedule;" however, serious adverse events were more common in the bevacizumab arm of the trial.

    The results of several subsequent head-to-head trials of the two anti-VEGF treatments were later published, and the overall results reinforced CATT's findings. The two therapies performed equally at restoring visual acuity according to a 2012 meta-analysis,[27] and also in the IVAN trial, alone and in the investigators' meta-analysis pooling its own results with CATT's.[28] A 2012 meta-analysis focused specifically on safety issues concluded that the rates of several adverse events were higher with bevacizumab, although the absolute rates of ocular serious adverse events were low with both therapies: ocular adverse events were about 2.8 times as frequent with bevacizumab than with ranibizumab, and "The proportion of patients with serious infections and gastrointestinal disorders was also higher." The authors concluded that " clinicians and patients should continue to carefully weigh-up the benefits and harms when choosing between the two treatment options. We also emphasize the need for studies that are powered not just for efficacy, but for defined safety outcomes based on the signals detected in this systematic review".[20]

    Ranibizumab was developed by Genentech and marketed by them in the United States, and elsewhere by Novartis.[29]

    Biosimilars

    See also: Biosimilars

    Byooviz was approved for medical use in the European Union in August 2021.[6]

    Byooviz was approved for medical use in the United States in September 2021.[9]

    References

    1. 1 2 3 4 5 6 7 "Lucentis". Archived from the original on 10 September 2021. Retrieved 15 October 2021.
    2. 1 2 3 4 "DailyMed - LUCENTIS- ranibizumab injection, solution". dailymed.nlm.nih.gov. Archived from the original on 21 September 2021. Retrieved 15 October 2021.
    3. 1 2 "AusPAR: Ranibizumab". Therapeutic Goods Administration (TGA). 9 December 2014. Archived from the original on 21 September 2021. Retrieved 20 September 2021.
    4. 1 2 "Lucentis- ranibizumab injection, solution". DailyMed. Archived from the original on 21 September 2021. Retrieved 20 September 2021.
    5. 1 2 "Lucentis EPAR". European Medicines Agency. Archived from the original on 10 September 2021. Retrieved 9 September 2021.
    6. 1 2 3 "Byooviz EPAR". European Medicines Agency. 23 June 2021. Archived from the original on 10 September 2021. Retrieved 9 September 2021.
    7. ↑ BNF (80 ed.). BMJ Group and the Pharmaceutical Press. September 2020 – March 2021. p. 1255. ISBN 978-0-85711-369-6.{{cite book}}: CS1 maint: date format (link)
    8. ↑ "Lucentis Prices, Coupons & Patient Assistance Programs". Drugs.com. Archived from the original on 29 December 2018. Retrieved 15 October 2021.
    9. 1 2 "FDA Approves First Biosimilar to Treat Macular Degeneration Disease and Other Eye Conditions". U.S. Food and Drug Administration (Press release). 20 September 2021. Archived from the original on 20 September 2021. Retrieved 20 September 2021. Public Domain This article incorporates text from this source, which is in the public domain.
    10. ↑ Ramin, Shahrokh; Soheilian, Masoud; Habibi, Gholamreza; Ghazavi, Roghayeh; Gharebaghi, Reza; Heidary, Fatemeh (2015). "Age-Related Macular Degeneration: A Scientometric Analysis". Medical Hypothesis, Discovery & Innovation Ophthalmology Journal. 4 (2): 39–49. ISSN 2322-4436. PMC 4458325. PMID 26060829.
    11. 1 2 Formoso, G; Marata, AM; Magrini, N; Bero, L (Sep 15, 2014). "A clearer view of evidence in treating macular degeneration: off-label policies and independent research". The Cochrane Database of Systematic Reviews. 9 (9): ED000090. doi:10.1002/14651858.ED000090. PMID 25228121.
    12. ↑ Solomon, SD; Lindsley, K; Vedula, SS; Krzystolik, MG; Hawkins, BS (Aug 29, 2014). "Anti-vascular endothelial growth factor for neovascular age-related macular degeneration". The Cochrane Database of Systematic Reviews. 8 (8): CD005139. doi:10.1002/14651858.CD005139.pub3. PMC 4270425. PMID 25170575.
    13. ↑ Sarwar S, Clearfield E, Soliman MK, Sadiq MA, Baldwin AJ, Hanout M, Agarwal A, Sepah YJ, Do DV, Nguyen QD (2016). "Aflibercept for neovascular age-related macular degeneration". Cochrane Database Syst Rev. 2: CD011346. doi:10.1002/14651858.CD011346.pub2. PMC 5030844. PMID 26857947.
    14. ↑ Virgili, Gianni; Parravano, Mariacristina; Evans, Jennifer R.; Gordon, Iris; Lucenteforte, Ersilia (16 October 2018). "Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis". The Cochrane Database of Systematic Reviews. 10: CD007419. doi:10.1002/14651858.CD007419.pub6. ISSN 1469-493X. PMC 6517135. PMID 30325017.
    15. 1 2 3 4 Moja, L; Lucenteforte, E; Kwag, KH; Bertele, V; Campomori, A; Chakravarthy, U; D'Amico, R; Dickersin, K; Kodjikian, L; Lindsley, K; Loke, Y; Maguire, M; Martin, DF; Mugelli, A; Mühlbauer, B; Püntmann, I; Reeves, B; Rogers, C; Schmucker, C; Subramanian, ML; Virgili, G (Sep 15, 2014). "Systemic safety of bevacizumab versus ranibizumab for neovascular age-related macular degeneration". The Cochrane Database of Systematic Reviews. 9 (9): CD011230. doi:10.1002/14651858.CD011230.pub2. PMC 4262120. PMID 25220133.
    16. ↑ Schmucker, C; Ehlken, C; Agostini, HT; Antes, G; Ruecker, G; Lelgemann, M; Loke, YK (2012). "A safety review and meta-analyses of bevacizumab and ranibizumab: off-label versus goldstandard". PLOS ONE. 7 (8): e42701. Bibcode:2012PLoSO...742701S. doi:10.1371/journal.pone.0042701. PMC 3411814. PMID 22880086.
    17. ↑ Haberfeld, H, ed. (2009). Austria-Codex (in Deutsch) (2009/2010 ed.). Vienna: Österreichischer Apothekerverlag. ISBN 978-3-85200-196-8.
    18. ↑ Ranibizumab Archived 2021-08-29 at the Wayback Machine, Lexi-Drugs. Ranibizumab. Lexi-Comp, Inc.; 2007.
    19. ↑ "ranibizumab". medscape. Archived from the original on 30 March 2015. Retrieved 24 March 2015.
    20. 1 2 Schmucker C, Ehlken C, Agostini HT, et al. (2012). "A safety review and meta-analyses of bevacizumab and ranibizumab: off-label versus goldstandard". PLOS ONE. 7 (8): e42701. Bibcode:2012PLoSO...742701S. doi:10.1371/journal.pone.0042701. PMC 3411814. PMID 22880086.
    21. ↑ Whoriskey, Peter; Keating, Dan (December 7, 2013). "An effective eye drug is available for $50. But many doctors choose a $2,000 alternative". The Washington Post. Archived from the original on January 26, 2021. Retrieved August 1, 2021.
    22. 1 2 3 Catt Research, Group; Martin, DF; Maguire, MG; Ying, GS; Grunwald, JE; Fine, SL; Jaffe, GJ (2011). "Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration". New England Journal of Medicine. 364 (20): 1897–1908. doi:10.1056/NEJMoa1102673. PMC 3157322. PMID 21526923.
    23. ↑ Switch From Lucentis to Avastin Could Save Medicare $18B Archived 2021-08-29 at the Wayback Machine, Diedtra Henderson, Medscape, June 17, 2014
    24. ↑ Hutton D, Newman-Casey PA, Tavag M, Zacks D, Stein J (June 2014). "Switching To Less Expensive Blindness Drug Could Save Medicare Part B $18 Billion Over A Ten-Year Period". Health Aff. 33 (6): 931–9. doi:10.1377/hlthaff.2013.0832. PMC 4137040. PMID 24889941.
    25. ↑ Pollack, Andrew (November 3, 2010). "Genentech Offers Secret Rebates for Eye Drug". The New York Times. Archived from the original on November 9, 2020. Retrieved August 1, 2021.
    26. ↑ Subramanian, M L; Abedi, G; Ness, S; Ahmed, E; Fenberg, M; Daly, M K; Houranieh, A; Feinberg, E B (2010). "Bevacizumab vs ranibizumab for age-related macular degeneration: 1-year outcomes of a prospective, double-masked randomised clinical trial". Eye. 24 (11): 1708–15. doi:10.1038/eye.2010.147. PMID 20885427.
    27. ↑ Jiang S, Park C, Barner JC (Jun 2014). "Ranibizumab for age-related macular degeneration: a meta-analysis of dose effects and comparison with no anti-VEGF treatment and bevacizumab". J Clin Pharm Ther. 39 (3): 234–9. doi:10.1111/jcpt.12146. PMID 24635444. S2CID 23979022.
    28. ↑ Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, et al. (IVAN study investigators) (Oct 12, 2013). "Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial". Lancet. 382 (9900): 1258–67. doi:10.1016/S0140-6736(13)61501-9. PMID 23870813.
    29. ↑ Lucentis Fact Sheet Archived 2012-10-28 at the Wayback Machine. Genentech.
    • "Ranibizumab". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2021-07-16. Retrieved 2021-08-01.
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