What is Lucentis?
Lucentis is the brand name for ranibizumab, a drug that comes in the form of a sterile liquid that is injected into the eye to treat wet age-related macular degeneration (wet AMD), macular edema (the build-up of fluids that causes swelling in the edema) following retinal vein occlusion (MEfRVO), diabetic retinopathy (DR), diabetic macular edema (DME), and myopic choroidal neovascularization (mCNV).
Lucentis belongs to a class of drugs called vascular endothelial growth factor (VEGF) antagonists or anti-VEGF drugs. VEGF is a protein that is a major contributor to the growth or protrusion of blood vessels (processes called neovascularization and angiogenesis), so blocking it from working helps prevent the growth of abnormal blood vessels that characterizes wet AMD. This is why Lucentis is also called as an anti-angiogenesis drug. This mechanism of action has been found to slow the progression of macular edema.
Regardless of the condition it is being used to treat, Lucentis is usually administered once per month; the injection is given by your doctor. Lucentis treatment aims to maintain (and even restore) vision.
How does Lucentis work?
Lucentis works by blocking vascular endothelial growth factor (VEGF), a protein that contributes to the growth of blood vessels. Normally, VEGF is a healthy and important molecule, but in conditions relating that are characterized by leaking and swelling of blood vessels in the macula (a part of the eye below the central part of the retina that is responsible for sharp, central eyesight necessary for activities such as reading), its activity makes symptoms worse.
Lucentis prevents VEGF from working by blocking it from “binding” its receptors (called VEGFR1 and VEGFR2). Treatment with Lucentis is often referred to as anti-VEGF therapy. Given the complex anatomy of eyes, injections are required to administer Lucentis (and other anti-VEGF drugs) effectively.
You may also see Lucentis referred to as a monoclonal antibody fragment (Fab). This is a subclass of biotherapeutic agents called monoclonal antibodies (mAbs), which are designed to replicate natural antibodies created by your immune system.
What is Lucentis used for?
Lucentis has been approved by the FDA to treat the following conditions:
Lucentis for Wet AMD
Age-related macular degeneration (AMD) is a common eye condition that usually begins affecting people in their 50s or 60s. It can lead to vision loss and blurriness in the middle part of your vision. “Dry” AMD is more common and can lead to vision loss over several years. “Wet” AMD is the more serious form of the condition and can lead to vision loss in a matter of weeks or months.
It is called wet or exudative AMD because of blood vessels in the eye leaking fluids (such as blood, lipids, and serum) into the macula. Vascular endothelial growth factor (VEGF) contributes to the growth of abnormal and weak blood vessels that are often responsible for leaking fluids.
Because of how Lucentis works (as described in the previous question: How does Lucentis work?), it helps prevent the growth of blood vessels and the subsequent leaking from occurring.
According to the NHS, Lucentis prevents vision from getting worse in 9 out of every 10 patients and improves vision in 3 out of every 10 patients.
Treatment for wet AMD usually consists of one 0.05 mL injection of Lucentis solution (containing 0.5 mg of the active ingredient, ranibizumab) per month.
Lucentis for Macular Edema following Retinal Vein Occlusion (RVO)
Retinal vein occlusion (RVO) is when blood vessels in the retina are blocked, usually because of a blood clot. Either the main retinal vein is blocked (central retinal vein occlusion (CRVO)) or, more commonly, one or more of the smaller branches (branch retinal vein occlusion (BRVO)).
RVO means blood cannot drain from the retina, which can lead to fluids leaking into the macula and causing inflammation and swelling (edema), hence the name macular edema following retinal vein occlusion (MEfRVO). This can lead to loss or blurring of vision, often suddenly (within hours or days).
Additionally, VEGF has been associated with the growth of abnormal blood vessels in MEfRVO. Lucentis helps treat this in the same way it does wet AMD. Two studies have found that Lucentis can improve eyesight in patients with MEfRVO.
Treatment for MEfRVO usually consists of one 0.05 mL injection of Lucentis solution (containing 0.5 mg of the active ingredient, ranibizumab) per month.
Lucentis for Diabetic Retinopathy (DR) With or Without Diabetic Macular Edema (DME)
Diabetic retinopathy (DR) is a (type 1 or type 2) diabetes complication in which high blood sugar levels cause damage to blood vessels in the retina. When diabetic retinopathy worsens, it can also affect the edema and lead to swelling, which is called diabetic macular edema (DME).
As with MEfRVO, VEGF has been associated with the growth of abnormal blood vessels in cases of DR and DMR. Several studies have found that Lucentis can improve vision in patients with DR either with or without DME.
Treatment for DR and DME usually consists of one 0.05 mL injection of Lucentis solution (containing 0.3 mg of the active ingredient, ranibizumab) per month.
Lucentis for Myopic Choroidal Neovascularization (mCNV)
In 2017, Lucentis became the first anti-VEGF drug to be approved by the FDA to treat myopic choroidal neovascularization (mCNV), which is one of the most serious complications of a common eye condition called pathological myopia (PM). Neovascularization is the formation of new blood vessels (similar to angiogenesis, as mentioned in question one).
Treatment for mCNV usually consists of one 0.05 mL injection of Lucentis solution (containing 0.5 mg of the active ingredient, ranibizumab) per month for up to three months, with retreatment when necessary.
Please be aware that the conditions Lucentis has been approved to treat, and specific treatment guidelines, may vary in different countries.
How is Lucentis administered?
After disinfectant and local anesthesia are used on the eye, the injection is administered by a qualified healthcare professional. The most common dose of a Lucentis injection is 0.05 mL, which contains 0.5 mg of active ingredient (ranibizumab), which is usually given once per month.
Lucentis is also available in a 0.05 mL solution that contains 0.3 mg of ranibizumab, which is primarily used to treat diabetic macular edema (DME).
Do eye injections hurt?
Although the thought of eye injections is scary for many people, anesthetic eye drops help ensure they are usually painless.
If you do experience pain, you should speak to your doctor about your options (including different anesthetics).
Does Lucentis interact with other medications?
Only a small amount of Lucentis is injected into your eye, meaning very little enters your bloodstream. While this suggests the possibility of drug interactions is low, no drug interaction studies have been performed.
A known interaction is with verteporfin, a drug used as part of photodynamic therapy. You should tell your doctor if you are receiving, or have recently received, any such treatment.
In general, it is highly recommended that you tell your doctor about any medications you take, have taken recently, or plan to take.
Who should not take Lucentis?
Lucentis is not be used if:
- If you are allergic to ranibizumab or any other ingredients of Lucentis
- You have an infection in or around your eye(s)
You should tell your doctor if:
- You have had a stroke or have had temporary signs of a stroke (weakness or paralysis of the limbs or face, difficulty speaking, or understanding)
- You have glaucoma
- If you are pregnant, think you may be pregnant, or are planning to have a baby. It is not known if Lucentis can harm a developing baby, so an alternative treatment may be preferable
- If you are breastfeeding. It is not known whether Lucentis is excreted in human milk, so an alternative treatment may be recommended for a nursing mother
For how long do I need to receive Lucentis injections for macular degeneration?
There is no standard length of time Lucentis therapy lasts in the treatment of wet AMD. Your doctor will likely perform regular evaluations to assess how the treatment is performing. In some cases, your doctor may decide to stop treatment or extend the length of time between injections.
This is usually the case for macular edema following retinal vein occlusion, diabetic retinopathy, and diabetic macular edema as well.
A round of treatment for myopic choroidal neovascularization usually lasts three months, with retreatment possible when necessary.
What are the side effects of Lucentis?
Eye injections, including those with Lucentis, carry inherent risks. Warnings include:
- Endophthalmitis (inflammation usually caused by infection) and retinal detachments
- Increases in intraocular pressure (the pressure of fluids within the eye)
- Thromboembolic events (nonfatal stroke, nonfatal heart attacks, or vascular death)
- Fatal events in patients with diabetic macular edema and diabetic retinopathy at baseline
The risk of serious or fatal adverse events is considered low, particularly for patients who do not have diabetic macular edema or diabetic retinopathy. Nonetheless, your doctor should check your eye pressure and eye health before and after the injection. Additionally, you should contact your doctor immediately if your eye becomes red, sensitive to light, or painful, or if you have a change in vision.
Additionally, MayoClinic and Drugs.com say you should contact your doctor or nurse immediately if you experience any of these more common side effects:
- Blindness
- Bloody eye
- Blurred vision or loss of vision
- Decreased vision or other changes in vision
- Disturbed color perception
- Dizziness
- Double vision
- Dry eye
- Eye pain
- Fainting
- A feeling of having something in the eye
- Halos around lights
- Headache
- Night blindness
- Over bright appearance of lights
- Pain or tenderness around the eyes and cheekbones
- Red, sore eyes
- Redness of the white part of the eyes or inside of the eyelids
- Redness, swelling, or itching of the eyelid
- Seeing flashes or sparks of light
- Seeing floating spots before the eyes, or a veil or curtain appearing across a part of your vision
- Sensitivity of the eye to light
- Tearing of the eyes
- Tunnel vision
- Watering of the eyes
You should contact your doctor or nurse immediately if you experience any of these less common side effects:
- Body aches or pain
- Chest pain
- Chills
- Cough
- Difficulty with breathing
- Dry mouth
- Fast, slow, or irregular heartbeat
- General feeling of discomfort or illness
- Head congestion
- Hoarseness, loss of voice, or other voice changes
- Loss of consciousness
- Muscle aches and pains
- Nasal congestion
- Pain in the chest, groin, or legs, especially the calves
- Painful blisters on the trunk of the body
- Pale skin
- Runny nose
- Severe, sudden headache
- Shivering
- Slow wound healing
- Slurred speech
- Sneezing
- Sore throat
- Sudden loss of coordination
- Sudden, severe weakness or numbness in the arm or leg
- Sudden, unexplained shortness of breath
- Sweating
- Tightness in the chest
- Trouble sleeping
- Unexplained weight loss
- Unusual tiredness or weakness
Some more common side effects that do not usually need medical treatment and often go away as your body adjusts to the treatment include:
- Back pain
- Difficulty having a bowel movement
- Difficulty with moving
- Muscle stiffness
- Swelling or redness of the joints
Signs of a serious allergic reaction should be treated as a medical emergency. They include:
- Skin rash – for example itchy, red, or swollen skin
- Wheezing
- Tightness in the chest or throat
- Trouble breathing or talking
- Swollen mouth, face, lips, tongue, or throat
This is not a complete list of the possible side effects of Lucentis. For more information, you should speak to your doctor or read the Lucentis patient information label.
Can I drive while taking Lucentis?
It is normally recommended that you do not drive on the day of your injection, as side effects can impair your ability. If you experience any vision problems, do not drive until your vision is back to normal.
In most cases, you are still able to drive while taking Lucentis if your eyesight meets the minimum requirements where you live. In some places, including the UK, you may need to report your condition to the relevant agency (such as the DVLA) or face a fine or other punishment.
What are possible alternatives to Lucentis?
Anti-VEGF treatment is a relatively recent development and is considered superior and more effective than older options, such as photodynamic therapy, in the treatment of wet AMD and macular edema.
Lucentis is one of four anti-VEGF drugs on the market, alongside EYLEA (aflibercept), Beovu (brolucizumab), and Avastin (bevacizumab). Like Lucentis, EYLEA and Beovu are approved by the FDA for treating wet AMD and other eye conditions, while Avastin is approved to treat several cancers.
While Avastin is not approved to treat wet AMD or other eye conditions, it is considered safe and effective and is often used because it is cheaper. However, this may depend on where you live and your insurance coverage.
While other types of treatment, including high-dose intravitreal triamcinolone acetonide (ITVA) and atypical protein kinase C (aPKC) inhibitors, have been touted as possible alternatives, anti-VEGF treatment is usually still considered the first-line treatment for wet AMD.
Alternative treatment may be used for macular edema, including steroids, eye drops, and laser treatment, but these are often when the underlying cause is different from those discussed in this article.
You should speak to your doctor about your specific condition and the treatment options available.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.
