Authors
Shibkova P.R.1, Ivanova A.A.2, Markina V.V.2, Karibova S.V.3, Dekkusheva L.R.2
1 N.N. Burdenko Voronezh State Medical University, Voronezh
2 N.I. Pirogov Russian National Research Medical University, Moscow
3 Stavropol State Medical University, Stavropol
Abstract
Rationale: The article examines modern aspects of anti-VEGF therapy as the primary treatment method for the neovascular form of age-related macular degeneration (AMD). The pathophysiological mechanisms of disease development, including the role of vascular endothelial growth factor in pathological neovascularization, are described.
Objective: To conduct a comparative analysis of the efficacy and safety of anti-VEGF drugs used in the treatment of neovascular AMD, considering their pharmacological characteristics, administration regimens, and potential adverse effects.
Methods: A review of scientific literature was conducted, analyzing studies indexed in international bibliographic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, from 2019 to the present. The selection included original clinical studies (randomized controlled trials, cohort studies, systematic reviews, and meta-analyses) that assess the efficacy and safety of anti-VEGF drugs in patients with neovascular AMD.
Results: A comparative analysis of anti-VEGF drugs, including Ranibizumab, Aflibercept, Bevacizumab, Faricimab, and Brolucizumab, was performed. Differences in mechanisms of action, duration of therapeutic effects, injection frequency, and safety profiles were noted. Various dosing regimens optimizing injection frequency were reviewed. Potential risks of anti-VEGF therapy, including intraocular inflammation, retinal vasculitis (most commonly associated with Brolucizumab), and systemic adverse effects, were identified.
Conclusion: Anti-VEGF therapy remains the primary treatment method for neovascular AMD, ensuring disease stabilization and preservation of visual function. Modern drugs demonstrate high efficacy but differ in pharmacokinetic properties and safety profiles, necessitating an individualized approach to therapy.
Keywords: anti-VEGF therapy, age-related macular degeneration, vascular endothelial growth factor, Ranibizumab, Aflibercept, Bevacizumab, Faricimab, Brolucizumab.
References
1. Ivakhnenko OI, Neroev VV, Zaitseva OV. Age-related macular degeneration and diabetic eye disease. Socio-economic aspects of morbidity. Bulletin of Ophthalmology. 2021; 137(1): 123-129. (In Russ.)
2. Blindness and visual impairment. World Health Organization. Available at: https://www.who.int/ru/news-room/fact-sheets/detail/blindness-and-visual-impairment. Accessed 07.03.2025. (In Russ.)
3. Yakupova E.M. Improving the organization of medical care for people with age-associated retinal disease at the level of a constituent entity of the Russian Federation. [dissertation]. 2023. (In Russ.)
4. Yanchenko SV, Malyshev AV, Sakhnov SN, et al. Our Experience of Nutraceutical Effects in Age-Related Macular Degeneration. Ophthalmology in Russia. 2020; 17(4): 804-810. (In Russ.) doi: 10.18008/1816-5095-2020-4-804-810.
5. Fayzrakhmanov RR. Anti-VEGF therapy of neovascular age-related macular degeneration: from randomized trials to routine clinical practice. Russian Ophthalmological Journal. 2019; 12(2): 97-105. (In Russ.) doi: 10.21516/2072-0076-2019-12-2-97-105.
6. Pugazhendhi A, Hubbell M, Jairam P, Ambati B. Neovascular Macular Degeneration: A Review of Etiology, Risk Factors, and Recent Advances in Research and Therapy. Int J Mol Sci. 2021; 22(3): 1170. doi: 10.3390/ ijms22031170.
7. Ricci F, Bandello F, Navarra P, et al. Neovascular Age-Related Macular Degeneration: Therapeutic Management and New-Upcoming Approaches. Int J Mol Sci. 2020; 21(21): 8242. doi: 10.3390/ijms21218242.
8. Cheng S, Zhang S, Huang M, et al. Treatment of neovascular age-related macular degeneration with anti-vascular endothelial growth factor drugs: progress from mechanisms to clinical applications. Frontiers in Medicine. 2024; 11. doi: 10.3389/fmed.2024.1411278.
9. Chaikitmongkol V, Sagong M, Lai TYY, et al. Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society. Asia Pac J Ophthalmol (Phila). 2021; 10(6): 507-518. doi: 10.1097/APO.0000000000000445.
10. Kanadani T, Rabelo N, Takahashi D, et al. Comparison of antiangiogenic agents (ranibizumab, aflibercept, bevacizumab and ziv-aflibercept) in the therapeutic response to the exudative form of age-related macular degeneration according to the treat-and-extend protocol: true head-to-head study. International Journal of Retina and Vitreous. 2024; 10(13).
11. Khanani AM, Patel SS, Ferrone PJ, et al. Efficacy of every four monthly and quarterly dosing of faricimab vs ranibizumab in neovascular age-related macular degeneration: The Stairway Phase 2 randomized clinical trial. JAMA Ophthalmology. 2020; 138(9): 964-972.
12. Heier JS, Khanani AM, Quezada Ruiz C, et al. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. The Lancet. 2022; 399(10326): 729-740.
13. Galimova AB, Galimova VU. Long-term results of anti-VEGF therapy in macular edema caused by central retinal vein occlusion. Russian Ophthalmological Journal. 2023; 16(4): 11-17. (In Russ.) doi: 10.21516/2072-0076-2023-16-4-11-17.
14. Lee A, Garg PG, Lyon AT, et al. Long-term Outcomes of Treat and Extend Regimen of Anti-vascular Endothelial Growth Factor in Neovascular Age-related Macular Degeneration. J Ophthalmic Vis Res. 2020; 15(3): 331-340. doi: 10.18502/jovr.v15i3.7452.
15. Bhandari S, Nguyen V, Arnold J, et al. Treatment Outcomes of Ranibizumab versus Aflibercept for Neovascular Age-Related Macular Degeneration: Data from the Fight Retinal Blindness! Registry. Ophthalmology. 2020; 3: 369-376.
16. Ng DSC, Ho M, Iu LPL, Lai TYY. Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization. Expert Opin Drug Saf. 2022; 21(1): 43-54. doi: 10.1080/14740338.2021.1952979.
17. Motevasseli T, Mohammadi S, Abdi F, Freeman WR. Side Effects of Brolucizumab. J Ophthalmic Vis Res. 2021; 16(4): 670-675. doi: 10.18502/ jovr.v16i4.9757.