ranibizumab


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Related to ranibizumab: Bevacizumab, aflibercept, Pegaptanib, Lucentis

ranibizumab

(ran-i-bi-zoo-mab) ,

Lucentis

(trade name)

Classification

Therapeutic: ocular agents
Pharmacologic: monoclonal antibodies
Pregnancy Category: C

Indications

Neovascular (wet) age-related macular degeneration.Macular edema following retinal vein occlusion.Diabetic macular edema

Action

Binds to vascular endothelial growth factor A (VEGF-A) receptor sites, preventing the binding of endogenous VEGF-A, resulting in decreased endothelial proliferation, vascular leakage and new vessel formation.

Therapeutic effects

Decreased progression of visual loss.

Pharmacokinetics

Absorption: Intravitreal injection results in complete local bioavailability. Very low serum levels are achieved.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 9 days (intravitreal).

Time/action profile

ROUTEONSETPEAKDURATION
intravitrealunknownafter injection1 mo

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Ocular/periocular infections.
Use Cautiously in: Obstetric: Use only in pregnancy if clearly needed, use cautiously during lactation; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • conjunctival hemorrhage (most frequent)
  • eye pain (most frequent)
  • ↑ intraocular pressure (most frequent)
  • intraocular inflammation (most frequent)
  • vitreal floaters (most frequent)
  • endophthalmitis
  • retinal detachment

Cardiovascular

  • arterial thromboembolic events (life-threatening)

Interactions

Drug-Drug interaction

↑ risk of serious intraocular inflammation with verteporfin.

Route/Dosage

Macular Degeneration

Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly; after 4 mo, injections may be given every 1–3 mo.

Macular Edema Following Retinal Vein Occlusion

Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly.

Diabetic Macular Edema

Intravitreal (Adults) 0.3 mg (0.05 mL) once monthly.

Availability

Solution for intravitreal injection: 0.3 mg (0.05 mL)/vial, 0.5 mg (0.05 mL)/vial

Nursing implications

Nursing assessment

  • Assess eye for signs of infection frequently during week following injection.
  • Check perfusion of optic nerve head immediately after injection, use tonometry to measure intraocular pressure prior to and 60 min following the injection.

Potential Nursing Diagnoses

Disturbed sensory perception (Indications)

Implementation

  • Do not administer solutions that are discolored or contain particulate matter. Attach threaded plastic threader rod to the rubber stopper inside barrel of syringe. Do not pull back on plunger.
    • Adequate analgesia and a broad-spectrum antibiotic should be given prior to injection.
  • Intravitreal: For ophthalmic intravitreal injection only. Withdraw vial contents through a 5–micron gauge filter needle attached to a 1–cc tuberculin syringe. Discard filter needle after withdrawal. Replace filter needle with sterile 30–gauge x 1/2-inch needle for intravitreal injection. Expel contents until plunger tip is aligned with line marking 0.05 mL on syringe Each vial should be used for only one eye. If contralateral eye requires treatment, use new vial and equipment. Refrigerate solution and protect from light; do not freeze.

Patient/Family Teaching

  • Advise patient to notify ophthalmologist immediately if eye becomes red, sensitive to light, painful, or develops a change in vision.

Evaluation/Desired Outcomes

  • Slowing of vision loss.

ranibizumab

A recombinant monoclonal antibody drug that inhibits the action of vascular endothelial growth factor (VEGF) protein and is believed to be useful in the treatment of age-related neovascular macular degeneration.

anti-VEGF drugs 

Drugs which bind to VEGF receptors without causing activation, thus blocking the production of new blood vessels and enhanced vessel permeability by the vascular endothelial growth factor (VEGF). They are used in the treatment of some forms of cancer (administered intravenously), and injected intravitreally in the treatment of choroidal neovascularization, retinal venous occlusion, and macular oedema. Examples: bevacizumab, pegaptanib sodium, ranibizumab. Syn. angiogenesis inhibitors. See age-related macular degeneration; diabetic retinopathy; VEGF.

macular degeneration, age-related (ARMD, AMD)

A common, chronic degenerative condition found in a large percentage of elderly patients (and sometimes middle-aged ones) characterized by loss of central vision. There are two main forms of the condition: non-neovascular (dry, atrophic) AMD, which is the most common, and exudative (wet, neovascular) AMD in which the loss of vision is the most severe. The main features of dry AMD are the presence in the macular region of small, yellowish-white spots (hard drusen) and large, poorly defined, coalescing soft drusen, focal hyperpigmentation of the retinal pigment epithelium (RPE) and at a later stage geographic atrophy of the RPE and depigmentation exposing choroidal vessels. Visual acuity becomes markedly reduced, there is metamorphopsia and the condition usually becomes bilateral over several years. The condition is managed essentially by the use of low vision aids.Exudative AMD has a similar clinical picture initially but is followed by choroidal neovascularization (CNV), which gives rise to subretinal fluid, haemorrhages, exudation, RPE detachment and subretinal fibrosis in the macular region resulting in severe loss of central vision. If detected early (usually with an Amsler chart), treatment with laser photocoagulation will reduce the risk of further visual loss. Photodynamic therapy (PDT) is another method of reducing the risk of visual loss. It allows selective destruction of the choroidal neovascularization with minimal damage to the overlying retinal tissue. It consists of injecting a photosensitizing agent (e.g. verteporfin) that is taken up by the abnormal vessels and when activated by a laser light of a given wavelength (e.g. 689 nm) it damages and shrivels up the vessels. Recent drug therapies, such as the anti-VEGF ranibizumab and bevacizumab, which are injected intravitreally at regular intervals and designed to stop the leakage and the growth of blood vessels, not only reduce loss of vision but improve visual acuity in a significant percentage of cases of wet AMD. Syn. senile macular degeneration. See fluorescein angiography; disciform scar; drusen; macular dystrophy; lipofuscin; age-related maculopathy; oxidative stress; macular pigment; Kollner's rule; photostress test; VEGF.
References in periodicals archive ?
A randomised, double-masked, controlled study of the efficacy and safety of Intravitreal bevacizumab versus ranibizumab in the treatment of macular oedema due to branch retinal vein occlusion: MARVEL Report No 1.
Thirty-six eyes (4.1%) received intravitreal bevacizumab, 222 eyes (25.2%) received intravitreal aflibercept, and 622 eyes (70.7%) received intravitreal ranibizumab as the initial treatment.
For example, in a retrospective observational series of25 patients with active neovascular AMD in one eye and disciform scarring in the fellow eye, treatment of the eye with active disease with ranibizumab resulted in clinical improvement in the fellow eye with disciform scarring, as measured by visual acuity, fluorescein angiography, and/or OCT [5].
Lam, "Ranibizumab for retinal angiomatous proliferation in neovascular age-related macular degeneration," Graefe's Archive for Clinical and Experimental Ophthalmology, vol.
In the case of our patient, the presence of KA on the nasal septum can potentially be explained by the recent use of ranibizumab.
In the IVA group, 36 eyes were previously treated with STTA, 28 eyes had photocoagulation for microaneurysms, 30 eyes had PRP, and 25 eyes had other types of anti-VEGF antibody injections including 24 eyes with ranibizumab and 1 eye with bevacizumab.
The concentrations of VEGF in the vitreous samples of patients with macula swelling caused by diabetic retinopathy or retinal vein occlusion were higher than the concentrations in normal controls.[sup][12],[13] In the retinal vascular system, VEGF plays an important role in the pathogenesis of retinal vascular permeability by affecting the integrity of tight junctions between the endothelial cells.[sup][14] A study has reported that anti-VEGF treatment could reduce retinal edema in retinal diseases.[sup][15] Ranibizumab and conbercept are typical drugs used in anti-VEGF treatments of ophthalmological conditions.
A similar molecule and with same effect which costs approximately 1/60 the cost of Ranibizumab is Bevacizumab (Avastin) and is used in the world over especially in the 3rd World in the treatment of Diabetic Retinopathy.
In the landmark Comparison of AMD Treatments Trials (CATT), researchers from Cleveland Clinic and elsewhere compared treatment with bevacizumab and ranibizumab in nearly 650 people with wet AMD.
With recent advances in stem cell research and therapies, it may be possible to reverse the effects of this degenerative disease as opposed to the current therapies, ranibizumab and bevacizumab, that improve the patient's condition.