Choroid is the part of eye that lies in between the retina (vision sensory area) and the sclera (the outer layer of the eye), this area consist of blood vessels that supply nutrients to the retinal part of our eye. Choroidal NeoVascularization (CNV) is a disease, which is characterized by the formation of new blood vessels that arise either due to the presence of Vascular Endothelial Growth Factors (VGEF) or due to Age-related Macular Degeneration (AMD). This results in fluid accumulation below the retinal pigment epithelium, which can lead to vision loss or extreme myopic vision among individuals.
CNV is also seen in individuals with diabetic retinopathy. In rare cases, it can occur among individuals with defects in Bruch’s membrane, the innermost layer of the choroid. It has also been observed by the American Academy of Ophthalmology and other reports that patients with CNV in one eye have a very high probability to contract CNV in the other eye within a short frame of time. According to the British Journal of Ophthalmology published in 2007, age?related macular degeneration (AMD) is one of the leading causes of irreversible sight loss among adults registered as legally blind.
Among these, two-thirds of people with AMD have the wet form, which can progress quickly causing irreversible sight loss within days or weeks. In 2007, approximately 250,000 people were suffering from neovascular AMD in the U.K, with an incidence rate of 25,000 and 30,000 new cases annually.
The only successful treatment option that is available commercially in the market for CNVs include intravitreal (direct to the eye) injections of anti-VEGF drugs to control the neovascularization and reduce the fluid accumulated. The most common anti-VGEF compounds are Ranibizumab (Trade name: Lucentis), Bevacizumab (Trade name: Avastin) and the novel drug Pegaptanib (Trade name: Macugen). These drugs belong to a class called anti-angiogenic drugs, their primary objective being the inhibition of the growth of new blood vessels.
Anti angiogenic drugs are more commonly used for cancer treatment, where cancerous cells promote angiogenesis resulting in the proliferation of cells in large numbers, thus forming tumors. Bevacizumab is a successfully used cost effective drug for the treatment of cancer as well as AMD related CNVs with a very high half life (more than twice) in comparison with Ranibizumab. However chances of adverse effects with Bevacizumab are comparatively higher, hence Ranibizumab (Lucentis) is now currently the most effectively and safely used treatment for CNV. Pegaptanib on the other hand is in Phase IV of the clinical trials wherein only 1000 patients so far have been treated with significant success rate.
With increasing aging population throughout the world the probability of occurrence of wet-AMD is high, especially in China and Japan where the aging population is predicted to tip over the young adult population. The patents for both Bevacizumab and Ranibizumab are till 2018 hence after patent expiry it is predicted that their sales shall significantly increase, especially with the entrance of Asian drug manufacturers.
Currently the companies that manufacture Ranibizumab are Novartis (licensed) in global market and Genetech (patented) in the U.S. Bevacizumab too was developed by Roche Pharma in association with Genentech and is currently marketed by Roche internationally. Pegaptanib is manufactured by Eyetch Inc. and marketed by Pfizer Inc.
Pegaptanib has been approved and is available only in North America, Europe, Brazil and Australia. Ranibizumab is available under the name Lucentis with high market share in Europe and North America and growing in Asia-Pacific region. Bevacizumab is sold as Avastin globally with highest growth rate observed in Asia and highest voluminous growth seen in the North Americas and European markets.
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