Prescrire international
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Prescrire international · Sep 2015
Aflibercept (Eylea) and diabetic macular oedema. A first-choice VEGF inhibitor in case of marked visual loss.
Overall, VEGF inhibitors administered by intravitreal injection have a similar harm-benefit balance. However, a publicly funded trial has shown that aflibercept is more effective than ranibizumab and bevacizumab in patients with marked loss of visual acuity.
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Prescrire international · Sep 2015
ReviewBevacizumab (AVASTIN) and age-related macular degeneration. Lower cost does not justify taking risks.
Intravitreal injection of ranibizumab, a VEGF inhibitor, is an option for patients with neovascular age-related macular degeneration (AMD). Because of its lower price, bevacizumab, a VEGF inhibitor closely related to ranibizumab and marketed for the treatment of various malignancies, is sometimes used off label for intravitreal injection in AMD. In 2011, the harm-benefit balance of bevacizumab in patients with AMD was uncertain. ⋯ In early 2015, there are no bevacizumab products suitable for intravitreal injection. In 2011, cases of sight-threatening infectious endophthalmitis were reported in the United States, following contamination during syringe preparation for intravitreal administration. In practice, when treatment with a VEGF inhibitor is considered for AMD, it is more prudent to choose ranibizumab, despite its currently unacceptable price.