NEJM – The discovery of Vascular Endothelia Growth Factor (VEGF) opened the door for the production of many novel pharmaceuticals. The newest drugs to inhibit this factor are not targeted at malignancy, but rather at the destructive angiogenesis that occurs in wet macular degeneration. Now maker Genentech has to do is figure out the price point that people will pay to save their eyesight.

One RCT by Rosenfeld et al. and another by Brown. et al appear in the NEJM, demonstrating the efficacy of Ranibizumab for age related wet macular degeneration.

The Rosenfeld et al. study compared monthly intravitreal injections of the compound agains sham injections for 2 years. They were able to do this because they tested subjects with occult lesions, or predominantly non-classic lesions – which currently have no approved therapy. They found a significant increase in mean visual acutity in the treatment group, while the placebo group had a decrease.

The Brown et al. study tested the drug against verteporfin and laser therapy – the only other approved therapy for predominantly classic lesions. In this head to head trial, more than 90% of subjects in the Ranibizumab group showed delayed progression of the disease, while only 64% in the usual treatment group did so. Again the mean visual acuity increased in the new treatment, while the usual treatment group experienced a decrease.

The next question to answer is whether older anti-VEGF drugs such as Avastin, originally targeted at cancer, will provide a cheaper alternative to produce the same or better effect.