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Case Reports
. 2008 Feb;83(2):231-4.
doi: 10.1111/j.1600-0420.2007.01014.x.

Ranibizumab combined with low-dose sorafenib for exudative age-related macular degeneration

Teresa Diago  1 , Jose S Pulido, Julian R Molina, Lucienne C Collett, Thomas P Link, Edwin H Ryan Jr
Affiliations
Case Reports

Ranibizumab combined with low-dose sorafenib for exudative age-related macular degeneration

Teresa Diago et al. Mayo Clin Proc. 2008 Feb.

Abstract

Angiogenesis is a common factor in the pathogenesis of cancer and in exudative age-related macular degeneration (AMD). Therefore, angiogenesis inhibition has been developed as a therapeutic strategy. We report 2 cases of recurrent exudative AMD in which oral sorafenib, a tyrosine kinase inhibitor approved for cancer, was added to intravitreal ranibizumab, an antibody to vascular endothelial growth factor. These 2 patients were followed up by determination of visual acuity, fluorescein angiography, fundoscopy, and optical coherence tomography. The visual acuity of 1 patient improved from 20/70 to 20/60 while he was receiving sorafenib therapy; that of the other did not. Marked improvement was noted in both patients on optical coherence tomography. Additionally, both patients appeared to receive some benefit when low-dose oral sorafenib was used as monotherapy after its initial addition to ranibizumab therapy. Randomized trials of adding sorafenib to standard therapy for patients with neovascular AMD should be considered.

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Figures

FIGURE 1
FIGURE 1
Case 1. A, Timeline of treatment with ranibizumab and/or sorafenib from September 2005 to September 2007. B, Initial fluorescein angiogram reveals leakage consistent with a neovascular membrane. C, Optical coherence tomogram confirms the presence of intraretinal fluid (arrow) before combined therapy was given. D, Optical coherence tomogram shows no intraretinal fluid 1 month after combined therapy. E, Recurrence of intraretinal fluid (arrow) 2 months after discontinuation of sorafenib. F, Optical coherence tomogram shows no intraretinal fluid 1 month after reinstitution of sorafenib.
FIGURE 2
FIGURE 2
Case 2. Timeline of treatment with ranibizumab and/or sorafenib from September 2005 to September 2007. B, Initial fluorescein angiogram shows leakage consistent with a neovascular membrane. C, Optical coherence tomogram confirms presence of intraretinal fluid (arrow) 2 months after ranibizumab injection. D, Optical coherence tomogram shows intraretinal fluid (arrow) 1 month after ranibizumab injection. E, Optical coherence tomogram shows no intraretinal fluid 1 month after administration of sorafenib.
See this image and copyright information in PMC

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