Abstract

FR.21.02

Intravitreal Ranibizumab (Lucentis®) is more effective than intravitreal Pegaptanib (Macugen®) in treating exsudative age-related macular degeneration for patients with history of cardiovascular accidents

Egbert Matthé, Dirk Sandner

Klinik mit Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus der TU Dresden

Background
There are two approved and effective ways of treating exsudative age-related macular degeneration: Pegaptanib (Macugen®) and Ranibizumab (Lucentis ®). Unspecific inhibition of all VEGF-types by Ranibizumab is discussed to be more dangerous because of suspected higher rates of severe cardiovascular accidents than selective inhibition by Pegaptanib.
Methods
Patients with exsudative age-related macular degeneration were during upload either treated with three times Ranibizumab (group II) when there were no history of cardivascular accident or with a first injection with Ranibizumab and twice Pegaptanib when there were positive history (group I). Best-corrected visual acuity (BCVA) was obtained and compared between the two groups.
Results
In group I 21 eyes, in group II 769 eyes were treated and retrospectively evaluated. Results and BCVA match the expectancies of MARINA-, ANCHOR- and PrONTO-study, but only up to the second injection, at which the groups‘ treatment differs. Group II patients continue to improve, but group I patients lose visual acuity continously until the first visit 4 weeks after the third injection, at which the difference between the groups becomes statistically significant. (group I loses 1.23 lines, group II gain 1.17 lines).
Conclusion
Treatment of patients with a history of cardiovascular accidents with Ranibizumab and Pegaptanib seems to be less effective than treatment with Ranibizumab alone. The presumed lower risk for cardiovascular accidents when treating patients this way seems to results in worse visual acuity during upload and has to be discussed individually with each patient.

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