رانيبيزوماب

رانيبيزوماب
الأجسام المضادة وحيدة النسيلة
النوعFab fragment
المصدرHumanized (from mouse)
الهدفVEGF-A
البيانات السريرية
الأسماء التجاريةLucentis
AHFS/Drugs.comMonograph
MedlinePlusa607044
License data
مسارات
الدواء		Intravitreal injection
رمز ATC
الحالة القانونية
الحالة القانونية
بيانات الحركية الدوائية
Elimination half-lifeApprox. 9 days[1]
المعرفات
رقم CAS
DrugBank
ChemSpider
  • none
UNII
KEGG
ChEMBL
Chemical and physical data
التركيبC2158H3282N562O681S12
الكتلة المولية48,350 g/mol
 ☒NYesY (what is this?)  (verify)

رانيبيزوماب (اسمه التجاري لوسنتيس Lucentis)، هو is a monoclonal antibody fragment (Fab) created from the same parent mouse antibody as bevacizumab. It is an anti-angiogenic that has been approved to treat the "wet" type of age-related macular degeneration (AMD, also ARMD), a common form of age-related vision loss.

Its effectiveness is similar to that of bevacizumab.[2][3] Its rates of side effects also appear similar.[4] However, ranibizumab typically costs $2,000 a dose, while the equivalent dose of bevacizumab typically costs $50.[5][6][7][8]

Ranibizumab was developed by Genentech and marketed by them in the United States, and elsewhere by Novartis,[9] under the brand name Lucentis.

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علم الأدوية

Ranibizumab is a monoclonal antibody that inhibits angiogenesis by inhibiting vascular endothelial growth factor A, a mechanism similar to Bevacizumab.[10]


الاستخدامات الطبية

It is often used for age-related wet macular degeneration. Its effectiveness is similar to that of bevacizumab[2][11] and aflibercept.[12] A 2017 systematic review update found that while ranibizumab and bevacizumab provide similar functional outcomes in diabetic macular edema, there is low-certainty evidence suggesting that ranibizumab is more effective in reducing central retinal thickness than bevacizumab.[13][needs update]

الآثار الجانبية

A 2014 Cochrane review did not find a difference between bevacizumab and ranibizumab in deaths or total severe side effects when used for macular degeneration.[4] There, however, was not a lot of evidence, and thus this conclusion is not that certain.[4]

Ranibizumab does appear to result in a lower risk of stomach and intestinal problems.[4] It is also associated with a low rate of eye related side effects.[14]

The most common side effects in clinical trials were conjunctival haemorrhage, eye pain, vitreous floaters, increased intraocular pressure, and intraocular inflammation.

Although there is a theoretical risk for arterial thromboembolic events in people receiving VEGF-inhibitors by intravitreal injection, the observed incidence rate was low (< 4%) and similar to that seen with placebo.

Serious adverse events related to the injection procedure occurred with an incidence rate of less than 1% and included endophthalmitis, retinal detachment, and traumatic cataracts. Other serious ocular adverse events observed among ranibizumab-treated patients (incidence rate < 1%) included intraocular inflammation and blindness.[15]

التداخلات الدوائية

No significant interactions are known.[16]

الادارة

The drug is injected intravitreally (into the vitreous humour of the eye) once a month. If monthly injections are not feasible, the regimen may be reduced to 1 injection every 3 months after the first 4 months.[1]

Dosing every 3 months is linked to a loss of approximately 5 letters (1 line) in visual acuity for the following 9 months as compared with dosing on a monthly basis. Large phase 3 clinical trials (MARINA and ANCHOR) which randomized patients with wet macular degeneration showed that 95% of ranibizumab-treated patients maintained visual acuity compared with 62% of those administered placebo (P < .01) at 1 year; moreover, up to 40% demonstrated an improvement in vision of at least 3 lines. Vision maintenance and loss were defined as a loss of less than 15 letters and a gain of 15 or more letters in visual acuity, respectively, as measured using the Early Treatment of Diabetic Retinopathy eye chart.[17]

Similar results were found in a randomized controlled trial of patients suffering from macular edema caused by central retinal vein occlusion. Participants injected once a month for 6 months showed a gain of approximately 13 to 15 letters in visual acuity, measured using the Early Treatment of Diabetic Retinopathy eye chart.[18][19]

قضايا التسويق

On November 3, 2010, The New York Times reported that Genentech began offering secret rebates to about 300 ophthalmologists in an apparent inducement to get them to use more ranibizumab rather than their less expensive bevacizumab. This may have been in anticipation of the results of the CATT clinical trial,[6] which was sponsored by the National Eye Institute, and compared the relative safety and efficacy of ranibizumab and bevacizumab in treating AMD. In 2008, bevacizumab cost Medicare only $20 million for about 480,000 injections, while ranibizumab cost Medicare $537 million for only 337,000 injections.[20] A small study showed no superior effect of ranibizumab versus bevacizumab in direct comparison.[21] The initial results of the larger Comparison of Age-related Macular Degeneration Treatments Trials (CATT) trial were published in the New England Journal of Medicine in May 2011.[6] The trial showed that the two drugs "had equivalent effects on visual acuity when administered according to the same schedule;" however, serious adverse events were more common in the bevacizumab arm of the trial.

The results of several subsequent head-to-head trials of the two anti-VEGF treatments were later published, and the overall results reinforced CATT's findings. The two therapies performed equally at restoring visual acuity according to a 2012 meta-analysis,[22] and also in the IVAN trial, alone and in the investigators' meta-analysis pooling its own results with CATT's.[23] A 2012 meta-analysis focused specifically on safety issues concluded that the rates of several adverse events were higher with bevacizumab, although the absolute rates of ocular serious adverse events were low with both therapies: ocular adverse events were about 2.8 times as frequent with bevacizumab than with ranibizumab, and "The proportion of patients with serious infections and gastrointestinal disorders was also higher." The authors concluded that " clinicians and patients should continue to carefully weigh-up the benefits and harms when choosing between the two treatment options. We also emphasize the need for studies that are powered not just for efficacy, but for defined safety outcomes based on the signals detected in this systematic review".[3]

المصادر

  1. ^ أ ب Lucentis Prescribing Information. Genentech. June 2010.
  2. ^ أ ب Formoso, G; Marata, AM; Magrini, N; Bero, L (Sep 15, 2014). "A clearer view of evidence in treating macular degeneration: off-label policies and independent research". The Cochrane Database of Systematic Reviews. 9 (9): ED000090. doi:10.1002/14651858.ED000090. PMID 25228121.
  3. ^ أ ب Schmucker C, Ehlken C, Agostini HT, et al. (2012). "A safety review and meta-analyses of bevacizumab and ranibizumab: off-label versus goldstandard". PLoS ONE. 7 (8): e42701. doi:10.1371/journal.pone.0042701. PMC 3411814. PMID 22880086.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  4. ^ أ ب ت ث Moja, L; Lucenteforte, E; Kwag, KH; Bertele, V; Campomori, A; Chakravarthy, U; D'Amico, R; Dickersin, K; Kodjikian, L; Lindsley, K; Loke, Y; Maguire, M; Martin, DF; Mugelli, A; Mühlbauer, B; Püntmann, I; Reeves, B; Rogers, C; Schmucker, C; Subramanian, ML; Virgili, G (Sep 15, 2014). "Systemic safety of bevacizumab versus ranibizumab for neovascular age-related macular degeneration". The Cochrane Database of Systematic Reviews. 9 (9): CD011230. doi:10.1002/14651858.CD011230.pub2. PMC 4262120. PMID 25220133.
  5. ^ Peter Whoriskey; Dan Keating (December 7, 2013). "An effective eye drug is available for $50. But many doctors choose a $2,000 alternative". The Washington Post. {{cite news}}: Unknown parameter |lastauthoramp= ignored (|name-list-style= suggested) (help)
  6. ^ أ ب ت Catt Research, Group; Martin, DF; Maguire, MG; Ying, GS; Grunwald, JE; Fine, SL; Jaffe, GJ (2011). "Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration". New England Journal of Medicine. 364 (20): 1897–1908. doi:10.1056/NEJMoa1102673. PMC 3157322. PMID 21526923.
  7. ^ Switch From Lucentis to Avastin Could Save Medicare $18B, Diedtra Henderson, Medscape, June 17, 2014
  8. ^ David Hutton; Paula Anne Newman-Casey; Mrinalini Tavag; et al. (June 2014). "Switching To Less Expensive Blindness Drug Could Save Medicare Part B $18 Billion Over A Ten-Year Period". Health Aff. 33 (6): 931–939. doi:10.1377/hlthaff.2013.0832. PMC 4137040. PMID 24889941.
  9. ^ Lucentis Fact Sheet. Genentech.
  10. ^ "ranibizumab". medscape. Retrieved 24 March 2015.
  11. ^ Solomon, SD; Lindsley, K; Vedula, SS; Krzystolik, MG; Hawkins, BS (Aug 29, 2014). "Anti-vascular endothelial growth factor for neovascular age-related macular degeneration". The Cochrane Database of Systematic Reviews. 8 (8): CD005139. doi:10.1002/14651858.CD005139.pub3. PMC 4270425. PMID 25170575.
  12. ^ Sarwar S, Clearfield E, Soliman MK, Sadiq MA, Baldwin AJ, Hanout M, Agarwal A, Sepah YJ, Do DV, Nguyen QD (2016). "Aflibercept for neovascular age-related macular degeneration". Cochrane Database Syst Rev. 2: CD011346. doi:10.1002/14651858.CD011346.pub2. PMC 5030844. PMID 26857947.
  13. ^ "Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis" (PDF). Cochrane Database Syst Rev. 6: CD007419. 2017. doi:10.1002/14651858.CD007419.pub5. PMC 6481463. PMID 28639415. {{cite journal}}: Cite uses deprecated parameter |authors= (help)
  14. ^ Schmucker, C; Ehlken, C; Agostini, HT; Antes, G; Ruecker, G; Lelgemann, M; Loke, YK (2012). "A safety review and meta-analyses of bevacizumab and ranibizumab: off-label versus goldstandard". PLOS ONE. 7 (8): e42701. doi:10.1371/journal.pone.0042701. PMC 3411814. PMID 22880086.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ Haberfeld, H, ed. (2009). Austria-Codex (in German) (2009/2010 ed.). Vienna: Österreichischer Apothekerverlag. ISBN 978-3-85200-196-8.{{cite book}}: CS1 maint: unrecognized language (link)[صفحة مطلوبة]
  16. ^ Ranibizumab, Lexi-Drugs. Ranibizumab. Lexi-Comp, Inc.; 2007.
  17. ^ Lai, T. Y. Y.; Lai, T. Y. (2013). "Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema". Clinical Interventions in Aging. 8: 467–483. doi:10.2147/CIA.S36811. PMC 3677930. PMID 23766636.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  18. ^ Brown DM; Campochiaro PA; Singh RP; Li Z; Gray S; Saroj N; Rundle AC; Rubio RG; Murahashi WY; CRUISE Investigators (2010). "Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study". Ophthalmology. 117 (6): 1124–1133. doi:10.1016/j.ophtha.2010.02.022. PMID 20381871.
  19. ^ Braithwaite T, Nanji AA, Lindsley K, Greenberg PB (2014). "Anti-vascular endothelial growth factor for macular edema secondary to central retinal vein occlusion". Cochrane Database Syst Rev. 10 (5): CD007325. doi:10.1002/14651858.CD007325.pub3. PMC 4292843. PMID 24788977.
  20. ^ Andrew Pollack (November 3, 2010). "Genentech Offers Secret Rebates for Eye Drug". The New York Times.
  21. ^ Subramanian, M L; Abedi, G; Ness, S; Ahmed, E; Fenberg, M; Daly, M K; Houranieh, A; Feinberg, E B (2010). "Bevacizumab vs ranibizumab for age-related macular degeneration: 1-year outcomes of a prospective, double-masked randomised clinical trial". Eye. 24 (11): 1708–1715. doi:10.1038/eye.2010.147. PMID 20885427.
  22. ^ Jiang S; Park C; Barner JC (Jun 2014). "Ranibizumab for age-related macular degeneration: a meta-analysis of dose effects and comparison with no anti-VEGF treatment and bevacizumab". J Clin Pharm Ther. 39 (3): 234–9. doi:10.1111/jcpt.12146. PMID 24635444.
  23. ^ Chakravarthy U; Harding SP; Rogers CA; Downes SM; Lotery AJ; Culliford LA; Reeves BC; IVAN study investigators (Oct 12, 2013). "Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial". Lancet. 382 (9900): 1258–67. doi:10.1016/S0140-6736(13)61501-9. PMID 23870813.

وصلات خارجية

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