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Ranibizumab

Class
VEGF inhibitors
Subclass
Anti-VEGF-A monoclonal antibodies
Substance name
Ranibizumab, ranibizumab-eqrn, ranibizumab-nuna
Brand names
Lucentis®, Susvimo®, Cimerli®, Byooviz®
Common formulations
Solution for injection, Solution for intravitreal injection
Dosage and administration
Adults patients
Age-related macular degeneration • Neovascular
•
0.5 mg intravitreal q1 month
Alternative
•
0.5 mg intravitreal q3 months
Alternative
•
Start at: 0.5 mg intravitreal q1 month for 4 doses
•
Maintenance: 0.5 mg intravitreal q3 months
Diabetic macular edema
•
0.3 mg intravitreal q1 month
Diabetic retinopathy
•
0.3 mg intravitreal q1 month
Macular edema in patients with retinal vein occlusion
•
0.5 mg intravitreal q1 month
Myopic choroidal neovascularization
•
0.5 mg intravitreal q1 month for up to 3 months
Indications for use
Labeled indications
Adults
•
Treatment of age-related macular degeneration (neovascular)
•
Treatment of age-related macular degeneration (neovascular, previously responded to at least two intravitreal injections of a VEGF inhibitor)
•
Treatment of diabetic macular edema
•
Treatment of diabetic retinopathy
•
Treatment of macular edema in patients with retinal vein occlusion
•
Treatment of myopic choroidal neovascularization
Safety risks
Contraindications
Hypersensitivity to ranibizumab or any of its components
Ocular or periocular infections
Warnings and precautions
Endophthalmitis, retinal detachment, retinal vasculitis
•
Maintain a high level of suspicion, as ranibizumab has been associated with an icnreased risk of endophthalmitis and retinal detachment and, rarely, retinal vasculitis with or without occlusion.
Increased intraocular pressure
•
Maintain a high level of suspicion, as ranibizumb has been associated with an increased risk of transient and sustained elevations of intraocular pressure.
Macular edema, diabetic retinopathy
•
Use caution in patients with advanced diabetic complications.
Thromboembolic complications
•
Maintain a high level of suspicion, as there is a potential risk of arterial thromboembolic events including nonfatal stroke, nonfatal myocardial infarction, or vascular death after intravitreal administration of ranibizumab.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Use only if clearly needed. Evidence of fetal harm in animals.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Blepharitis, cataract, conjunctival chemosis, dry eye disease, eye floaters, hypertension, ↑ intraocular pressure, iritis, nasopharyngitis, ⊕ rapid antibody test, posterior vitreous detachment, eye irritation, eye pain, foreign body sensation in the eyes, red eyes, visual disturbances, subconjunctival hemorrhage
Common 1-10%
•
Arterial thromboembolism, cerebrovascular accident, corneal abrasion, corneal edema, diabetic macular edema, diabetic retinopathy, endophthalmitis, cough, headache, metallic taste, retinal pathology, vitreous hemorrhage
Rare < 0.1%
•
Retinal detachment
Unknown frequency
•
↓ visual acuity, retinal pigment epithelium detachment, retinal vasculitis
Interactions
Drug(s)
Check Interactions
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