|Source||Humanized (from mouse)|
|Trade names||Lucentis, Byooviz|
|Drug class||Vascular endothelial growth factor A (VEGF-A) inhibitor|
|Main uses||Age-related macular degeneration (AMD), diabetic retinopathy, macular edema due to retinal vein occlusion, retinopathy of prematurity|
|Side effects||Conjunctival bleeding, eye pain, floaters, increased intraocular pressure|
|Elimination half-life||Approx. 9 days|
|Chemical and physical data|
|Molar mass||48379.97 g·mol−1|
|(what is this?)|
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. It is given by injection into the eye.
Common side effects include conjunctival bleeding, eye pain, floaters, and increased intraocular pressure. Other side effects may include endophthalmitis and retinal detachment. It is a small piece of monoclonal antibody that attaches to and blocked vascular endothelial growth factor A (VEGF-A).
Ranibizumab was approved for medical use in the United States in 2006 and Europe in 2007. In the United Kingdom it costs the NHS about £550 per dose as of 2021. In the United States it is about 2000 USD per dose.
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.
It is used for age-related wet macular degeneration. Its effectiveness is similar to that of bevacizumab and aflibercept. 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.
It is generally given as a 0.5 mg injection into the eye.
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. There, however, was not a lot of evidence, and thus this conclusion is not that certain.
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.
No significant interactions are known.
Society & culture
Its effectiveness is similar to that of bevacizumab. Its rates of side effects also appear similar. However, ranibizumab typically costs $2,000 a dose, while the equivalent dose of bevacizumab typically costs $50.
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, 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. A small study showed no superior effect of ranibizumab versus bevacizumab in direct comparison. 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. 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, and also in the IVAN trial, alone and in the investigators' meta-analysis pooling its own results with CATT's. 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".
Byooviz was approved for medical use in the European Union in August 2021.
Byooviz was approved for medical use in the United States in September 2021.
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