Lucentis: Another Shot in the Eye, Effective TX for ARMD

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Lucentis: Another Shot in the Eye, Effective TX for ARMD

Lucentis is the second anti-VEGF drug FDA approved for the treatment of wet macular degeneration. It is an effective treatment for wet macular degeneration. The formulation differs from Macugen and Avastin as do the visual results.

Lucentis™ is the second intraocular, anti-VEGF injection FDA approved for the treatment of wet macular degeneration.  It was approved in 2006.  It fast became the mainstay of the treatment for wet macular degeneration.  It is still popular today among retina specialists for treatment of wet macular degeneration.

Facts About Lucentis

  • FDA approved for the treatment of Wet Macular Degeneration
  • Lucentis is a portion of an antibody directed against VEGF
  • Lucentis binds directly to VEGF
  • Lucentis is given as a series of intraocular injections
  • Directed against several forms of VEGF

Lucentis and Diabetic Retinopathy

  • It is not FDA approved for the treatment of diabetic retinopathy
  • May be suitable for diabetic macular edema
  • May be suitable for proliferative diabetic retinopathy

As with all the anti-VEGF intraocular injections, Lucentis is given as a series of injections.  The frequency varies, but it is safe to say that most retina specialists recommend injections every 4-6 weeks.  Originally, Lucentis was recommended for a complete year or more.

For our purposes, Lucentis is a portion of an antibody (specifically the Fab Fragment) directed against several forms of VEGF.  It does not block all isoforms (types) of VEGF.  Practically speaking, the antibody latches on, just as Macugen (an aptamer, but functions the same way as an antibody), to the VEGF molecule.  The binding to VEGF prevents VEGF from “plugging-in” to the receptor.  The receptor never gets activated.  VEGF effects are blocked.

Lucentis is manufactured by Genentech (Roche).  Genentech (Roche) also manufacturers Avastin™ (more tomorrow).  Compared to most drugs in ophthalmology, Lucentis is pretty pricey.  Though Medicare and other insurance companies do cover the cost of the drug, they do not cover the full price of the drug.  The difference is usually paid out of pocket by the patient if there is no “gap” insurance.

What Does This Mean? Lucentis rapidly became popular for the treatment of wet macular degeneration.  There were several reasons; effective marketing, “second generation” phenomenon (ergo, must be better) and the acceptance of intraocular injections overall.  By 2006, more and more doctors were now comfortable with the whole “package” or idea of giving intraocular injections and so, too, were patients.  The results were truly remarkable.  The injections, whether Macugen (approved 2004) or Lucentis………….patients were getting better!

As with all the anti-VEGF drugs, there may be true implications for their use in the treatment of diabetic retinopathy.  Remember that VEGF is implicated in vascular leakage, inflammation and neovascularization.  Vascular leakage and neovascularization can occur in diabetic retinopathy.  Inflammation is thought to be a key component as well.   In theory, anti-VEGF should be a “slam dunk” for the treatment of diabetic retinopathy. Many small studies have already indicated that anti-VEGF is an effective treatment for diabetic retinopathy.

“Randy”

Randall V. Wong, M.D.

Retina Specialist, Ophthalmologist
Fairfax Virginia

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