Pegaptanib: new drug. In macular degeneration: too many risks for too little benefit

(1) Age-related macular degeneration with vascular proliferation can markedly hamper vision. In patients with subfoveolar involvement, verteporfin photodynamic therapy slows the loss of visual acuity on the EDTRS scale in about 15% of patients after 2 years of follow-up. (2) Pegaptanib, a vascular endothelial growth factor (VEGF) inhibitor, has been approved for the treatment of the neovascular form of age-related macular degeneration. (3) Two double-blind placebo-controlled trials involved a total of 1208 patients. When pegaptanib was injected into the eye every 6 weeks, at a dose of 0.3 mg, visual loss measured one year after beginning treatment was slowed in about 15% more patients on pegaptanib than on placebo. Efficacy during the second year is uncertain. Pegaptanib has not been compared with other treatments, nor has it been assessed in combination with verteporfin. (4) A variety of ocular adverse events were reported during clinical trials, three of which were serious and each affected about 1% of patients: endophthalmia, retinal detachment, and cataracts. Transient ocular hypertension occurred in about 15% of patients. A few cases of retinal arterial and venous thrombosis have been described. No long-term adverse effects were reported after clinical trials, but hypersensitivity reactions were reported post-approval. (5) Treatment with pegaptanib involves an intraocular injection every 6 weeks under local anaesthesia and under conditions of surgical asepsis. (6) In practice, an indirect comparison suggests that intraocular pegaptanib is no more effective than verteporfin photodynamic therapy. In contrast, adverse events are more numerous and treatment is less convenient.