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D. N. Sang, M. S. Hughes, C. Chin; Induction/Maintenance Therapy With Ranibizumab (Lucentis) Followed by Pegaptanib (Macugen) Intravitreal Injections in the Treatment of Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1795.
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An extensive body of research has established that vascular endothelial growth factor (VEGF) promotes ocular neovascularization and vascular permeability, and is thus an attractive therapeutic target. Lucentis (an antibody to all isoforms of VEGF-A) and Macugen (an RNA aptamer against the VEGF165 isoform) have proved clinically effective as treatments for all forms of neovascular age-related macular degeneration. As the pharmacotherapy of AMD evolves, it is likely that, as seen in oncology, different therapeutic regimens will be employed in combination. We therefore evaluated a regimen of Lucentis induction followed by Macugen maintenance therapy for treatment of AMD.
Twenty patients with a cross section of angiographic subtypes of NV AMD were included in this prospective, non-comparative, interventional case series. The patients included a broad range of baseline visions seen in an office based practice. Treatment protocol included Lucentis induction (3 monthly injections) followed by 2 Macugen maintenance injections given 6 weeks apart. Subjects were monitored for visual acuity, slit lamp biomicroscopy, dilated funduscopy, FFA, and OCT. Time to retreatment with Lucentis for recurrences was assessed.
Patients treated with Lucentis induction followed by Macugen maintenance achieved clinically meaningful responses as determined by a combined assessment of visual acuity, OCT and FFA ancillary testing. Rates of recurrence of CNV and times to retreatment are presented. No adverse events were observed.
A regimen of induction therapy with Lucentis followed by Macugen may offer a balance of clinically meaningful outcomes and reduced risk in the treatment of AMD. Total number of treatment sessions was reduced compared to what would be anticipated with Lucentis monotherapy. Further trials employing combinations of selective and non-selective VEGF blockade appear warranted.
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