Lasting controversy on ranibizumab and bevacizumab

Abstract

Vascular endothelial growth factor (VEGF), an important angiogenic factor that is able to stimulate the proliferation and migration of endothelial cells, is the best-studied hallmark of angiogenesis. Neovascularization is a major cause of age-related macular degeneration (AMD) which is a leading cause of blindness in the elderly population. Specific molecular inhibitors of VEGF have been proved to be useful in the treatment of AMD. Ranibizumab and Bevacizumab are structurally similar to anti-VEGF drugs in the treatment of AMD. Many studies have indicated that Ranibizumab and Bevacizumab are of roughly equal short-term efficacy and safety, Bevacizumab is an attractive alternative to Ranibizumab due to its lower cost. However, only Ranibizumab has received Food and Drug Administration (FDA) approval for the treatment of macular degeneration. More multicenter clinical trials are required to compare the relative efficacy and safety of these two drugs and some progress has been achieved. This review discusses the clinical effectiveness, safety, cost and other practical implications of Ranibizumab and Bevacizumab.

Keywords: Bevacizumab; Ranibizumab; age-related macular degeneration; angiogenesis.; vascular endothelial growth factor (VEGF).

Figure 1

Schematic of vascular endothelial growth factor (VEGF) pathway. VEGFR2 is the main signal transducing VEGF receptor for angiogenesis and mitogenesis of endothelial cells. In endothelial cells, the VEGF signal system can adjust the vascular permeability through eNOS. However, the developing vasculature also requires other signaling pathways, including the FGF and the ICAMs/VCAMs/MMPs, and so on.