Ranibizumab for myopic choroidal neovascularization

ABSTRACT

Introduction

Myopic choroidal neovascularization (CNV) is one of the most vision-threatening complications in patients with pathologic myopia. Over the last decade, anti-angiogenesis therapy with anti-vascular endothelial growth factor (anti-VEGF) agents has become the standard-of-care treatment for myopic CNV and ranibizumab has been approved for treating myopic CNV.

Areas covered

Review of preclinical studies and clinical trials data supporting the use of ranibizumab for myopic CNV. Discussion on the mechanisms, efficacy, safety, regulatory affairs, and future directions of ranibizumab for myopic CNV are highlighted.

Expert opinion

Ranibizumab has demonstrated good efficacy and safety profile in multiple clinical trials and long-term studies for treating myopic CNV. Cost-effective analysis has shown that ranibizumab therapy is a cost-effective treatment for myopic CNV. Among the currently available anti-VEGF agents, ranibizumab is the only drug that is approved for the treatment of myopic CNV by the US Food and Drug Administration. In the coming few years, biosimilars of ranibizumab may become available and will have the potential to lower the cost of ranibizumab. Long-term visual gain after ranibizumab treatment for myopic CNV is limited by chorioretinal atrophy associated with pathologic myopia and further research is required to tackle the development of chorioretinal atrophy.

KEYWORDS:

• Ranibizumab
• choroidal neovascularization
• anti-VEGF
• myopia

Article highlights

• Myopic choroidal neovascularization (CNV) is a major cause of visual impairment in eyes with pathologic myopia.

• Ranibizumab is an anti-vascular endothelial growth factor drug which has been approved by various regulatory authorities including the US Food and Drug Administration and European Medicines Agency for the treatment of myopic CNV.

• Phase III clinical trials including RADIANCE and BRILLIANCE studies have shown that intravitreal ranibizumab resulted in significantly better visual acuity outcomes compared with verteporfin photodynamic therapy.

• Long-term post-RADIANCE follow-up study showed that the initial visual improvements of ranibizumab for myopic CNV could be maintained for over 4 years with a low number of retreatment.

• The phase IV LUMINOUS post-marketing study also demonstrated that intravitreal ranibizumab is effective in the real-world setting with a low treatment burden.

This box summarizes the key points contained in the article.

Declaration of interest

Dr T Lai is a consultant for Bayer, Boehringer Ingelheim, Genentech, Novartis, and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One of the reviewers on this manuscript has received speaker fees and consultation honoraria from Allergan, Alimera, Bayer, and Novartis. Two additional peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.