Anti-VEGF and Other Novel Therapies for Neovascular Age-Related Macular Degeneration: An Update

BioDrugs. 2021 Nov;35(6):673-692. doi: 10.1007/s40259-021-00499-2. Epub 2021 Oct 16.


Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness in older adults. The prognosis for the neovascular type of advanced AMD improved with the introduction of biological drugs with antiangiogenic properties, beginning with off-label bevacizumab, which was first used intravitreally in 2006. These drugs target newly formed vessels that grow beneath the center of the retina, causing loss of central vision, and they can help to maintain or improve vision. Repeated intravitreal injections are needed to achieve prolonged inhibition of proangiogenic cytokines, primarily vascular endothelial growth factor (VEGF). Major regulatory agencies have approved several molecules for AMD treatment, including ranibizumab, aflibercept, and brolucizumab. The development of further drugs was mainly targeted at prolonging anti-VEGF inhibition-thus reducing the frequency of injections-and expanding the biological targets of proangiogenic cytokine inhibition. Finally, biosimilars are already being marketed in some countries, allowing the containment of costs of AMD treatment, which are growing steadily in many settings because of the need for long-term treatment. This review summarizes the properties and clinical profiles of anti-VEGF biological drugs that are approved to treat neovascular AMD as well as ongoing research on molecules that may be marketed in the near future.

Publication types

  • Review

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / therapeutic use
  • Bevacizumab / therapeutic use
  • Biosimilar Pharmaceuticals*
  • Humans
  • Intravitreal Injections
  • Ranibizumab / therapeutic use
  • Recombinant Fusion Proteins
  • Vascular Endothelial Growth Factor A
  • Visual Acuity
  • Wet Macular Degeneration* / drug therapy


  • Angiogenesis Inhibitors
  • Biosimilar Pharmaceuticals
  • Recombinant Fusion Proteins
  • Vascular Endothelial Growth Factor A
  • Bevacizumab
  • Ranibizumab