Advances Treatment in the Age-

Related Macular Degeneration (AMD) by Ranibizumab Injection

Presented bySugata Som

3RD Year B.Pharm Sec- BRoll: 19301913088

Bengal School of Technology

What is Age-Related Macula Degeneration? Age related macula degeneration (AMD) is defined as the loss of macular function from the degenerative changes of aging. The macula is the most important part of the retina that responsible for sharp, central vision.AMD is divided specifically two distinct types:A) DRY (less severe)B) WET (more severe) Basically Ranibizumab injection work on WET type AMD. The root causes of this AMD are still unknown.

Difference between normal retina and affected retina

What are the risk factors for AMD?

How is AMD Diagnosed? As the many other medical conditions , the approach to diagnosing AMD requires the integration of both the patient history and the physical exam. Commonly test Lipid Profile, Sugar fasting & PP and check the Oxygen level in the body and monitoring the BP. Fundus fluorescein angiography examination detect the dry AMD only display changes in retinal pigment epithelium along with DRUSEN (yellow deposits). Scan of both eye is need for detect the Wet AMD display the GREEN & RED spot in retina.

Scan report of affected & normal eye.

Wet Macular Degeneration??????? Abnormal blood vessels grow up from the choroid behind the retina. Aggressive and faster Progression of vascular endothelial.Blindness, Low vision found. VASCULAR ENDOTHELIAL GROWTH FACTOR (VEFG) is mainly responsible for WET AMD.Photoreceptors (Rods and Cones) are damaged. New capillaries break through Bruch’s membrane into the base of RPE.  

What is the VEGF ???? Vascular Endothelial Growth Factor (VEGF),originally known as vascular permeability factor (VPF), is a signal protein produced by cells that stimulates vasculogenesis and angiogenesis. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate.

Why VEGF is responsible in Wet-AMD?? VEGF’s normal function is create new blood vessels during embryonic development, new blood vessels after injury, muscle following exercise, and new vessels to bypass blocked vessels.

When VEGF is over expressed, it can contribute to disease. Over expression of VEGF can cause vascular disease in the retina of the eye. Drugs such a Avastin, Bevacizumab, RANIBIZUMAB can inhabit VEGF and control or slow Wet AMD. 

Why Ranibizumab Injection ???

 Ranibizumab (trade name Lucentis among others) is a MONOCLONAL ANTIBODY FRAGMENT (FAB) .

It is an anti-angiogenic that has been approved to treat the WET type age-related macular degeneration (AMD), a common form of Vision loss. Its rates of side effect shorter than Bevacizumab. Ranibizumab was developed by Genetech and is marketed by Genetech and Novartis, under brand name Lucentis. 

Dosage & administration of Ranibuzimab??

The recommended dose of Lucentis is 0.5 mg (0.05 ml) or 0.3 mg (0.03 ml) given as a single intravitreal injection. 

How Ranibizumab work (MODE of ACTION) 

Ranibizumab binds to receptor binding site active forms of VEGF-A. The binding of ranibizumab to VEGF-A prevents the interaction of VEGF-A with receptor on the endothelial cells, reducing endothelial cell proliferation, vascular leakage and new blood vessel formation. 

Adverse effect of Ranibizumab InjectionRanibizumab Injection is a monoclonal antibody that works by slowing the growth of abnormal new blood vessels in the eye and decreasing leakage from of wet AMD. 1. Increased tears in affected eye (s). 2. Itchy or watery eyes 3. Dry eyes 4. Swelling of eyelids 5. Blurred vision 6. Eye redness 7. Joint pain 8. vomiting 9. Nausea 10. Eye painThis injection administered as an injection into the eye, with local aesthetic.

 

Any Precautions Should follow before administration????? 1. To infrom doctor or Pharmacist if allergic to ranibizumab, any other medications, or any of the ingredients in ranibizumab injection2.  To infrom doctor and pharmacist what other prescription and non prescription medicine, vitamins, herbal products.3.  Tell doctor if patient is pregnant, plan to become pregnant, or are breast feeding. If become pregnant while receiving ranibizumab.4.  Any infection is found in eye inform doctor.  

Barrier of AMD treatment The Ranibuzimab injection is very much costly. The cost of per injection is RS.25000 in India (Price source from Disha Eye Hospital in WB).So, its treatment is not affordable to person. Those have Medical Insurance they are take chance easy.This is treatment is 1 year long term procedure.  Any other same category drug??? Ranibizumab like some drugs found in market. Bevacizumab (Avastin), Pegaptanib Sodium is works as an anti VEGF drug.  

References:1.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. 2.  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).3.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: CD005139. 4. Lucentis Prescribing Information. Genentech. June 2010. 5. 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 .6. 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. 

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