A comprehensive review of the scientific literature by the American Academy of Ophthalmology (AAO) finds that anti-VEGF therapy is a safe and effective treatment for neovascular AMD. There is high quality evidence to support this conclusion for Macugen (pegaptanib) and Lucentis (ranibizumab), but none for Avastin (bevacizumab) at this time.
The literature review suggests that anti-VEGF pharmacotherapy, delivered by intravitreal injection, is a safe and effective treatment for neovascular AMD, for up to 2 years of follow-up for Macugen and for up to 1 year of follow-up for Lucentis. There is level I evidence to support this conclusion for Macugen and Lucentis.
Level I research is well-designed and well-conducted randomized clinical trials. Level II research includes well-designed case-control and cohort studies and poor-quality randomized studies. Level III research includes case series, case reports, and poor-quality cohort and case-control studies.
The data suggest that vision outcomes with Lucentis are superior to those with Macugen, and there is no definitive evidence to suggest a difference in safety between the drugs. As a result, Macugen is not a commonly used therapy for neovascular AMD.
There is level II and level III evidence that suggests Avastin, delivered by intravitreal injection, may be a safe and effective treatment for neovascular AMD, but the possibility that vision outcomes and safety may be inferior to those for Lucentis has not been ruled out.
WHAT IT MEANS TO YOU: This endorsement by the AAO establishes anti-VEGF therapy with Lucentis and Macugen as the "Gold Standard" for the treatment of neovascular AMD. By acknowledging that the vision outcomes for Macugen are inferior to those for Lucentis, and that there is no clear safety advantage for Macugen, the AAO has clearly given the nod to Lucentis as the current standard of care for this disease. This however, may change as new studies emerge, such as the much anticipated head-to-head comparison between Avastin and Lucentis in the Comparison of AMD Treatments Trials (CATT).
Source:http://www.ncbi.nlm.nih.gov/pubmed/18929163