[Monotherapy of exudative age-related macular degeneration with ranibizumab in patients at cardiovascular risk. Advantages of ranibizumab compared to a combination with pegaptanib]

Abstract

Background: Intravitreal ranibizumab (Lucentis®) and pegaptanib (Macugen®) are effective treatment options for exudative age-related macular degeneration (AMD). There might be some differences regarding effectiveness (higher with ranibizumab) and safety issues (presumed to be higher with pegaptanib), which led to the question whether these advantages might be combined. To clarify this question the current study was performed.

Methods: All patients treated for exudative AMD between February 2007 and May 2010 were evaluated for a potential cardiovascular risk profile. Patients with a positive history of coronary heart disease, proven by medical treatment, history of myocardial infarction, stent implantation or bypass operation or a history of stroke were classified as risk patients, while others without such a history were classified as non-risk patients. Risk patients were treated with a combination therapy (first injection: ranibizumab, second and third injections pegaptanib--combination group) when presenting between February 2008 and September 2009 or standard care (first, second and third injections ranibizumab--standard group) during upload. All patients were evaluated for best-corrected visual acuity on the day of diagnosis, injections during the upload phase and first follow-up visit after upload.

Results: Both groups did no differ regarding age, gender, subtype of choroidal neovascularization or waiting time between first visit and first injection. Visual acuity changes showed no differences up to the third injection and control visit. Visual acuity continued to improve within the standard group but rapidly declined in the combination group.

Conclusions: Even patients at risk for cardiovascular accidents should not be treated with a combination therapy of ranibizumab and pegaptanib as this combination results in a decline of visual acuity during upload.