From the Guidelines
Ranibizumab (Lucentis) is contraindicated in patients with active ocular or periocular infections, and known hypersensitivity to ranibizumab or any of its excipients, as well as in pregnant or lactating women due to the lack of studies on its risks in these populations. When considering anti-Vascular Endothelial Growth Factor (VEGF) therapy using Ranibizumab, it is essential to weigh the potential benefits against the risks, particularly in patients with certain medical histories.
Key Considerations
- Theoretical risks for systemic arterial thromboembolic events and increased intraocular pressure associated with anti-VEGF treatments, including ranibizumab, although clinical trials have yielded inconclusive results 1.
- Potential for endophthalmitis, noninfectious inflammation, retinal tear, or detachment following intravitreal pharmacotherapy 1.
- Lack of data on the safety of ranibizumab in pregnant or lactating women, making it a contraindication in these groups 1.
Patient Evaluation and Monitoring
Before initiating ranibizumab therapy, a thorough ocular examination is necessary to rule out active infections or inflammation. Patients should be closely monitored after injection for signs of inflammation, increased intraocular pressure, or endophthalmitis.
Treatment Approach
The choice of treatment regimen, such as fixed monthly, pro re nata (PRN), or treat-and-extend, should be individualized based on the patient's response and disease activity, considering the efficacy and safety profiles of ranibizumab in various studies, including the Lucentis Compared to Avastin Study (LUCAS) 1.
From the FDA Drug Label
• Ocular or periocular infections (4.1) • Hypersensitivity (4.2) The contraindications for anti-Vascular Endothelial Growth Factor (VEGF) therapy using Ranibizumab (Lucentis) are:
- Ocular or periocular infections
- Hypersensitivity 2
From the Research
Contraindications for Anti-Vascular Endothelial Growth Factor (VEGF) Therapy using Ranibizumab (Lucentis)
- The provided studies do not directly list contraindications for anti-VEGF therapy using Ranibizumab (Lucentis) 3, 4, 5, 6, 7.
- However, the studies mention potential risks and adverse events associated with anti-VEGF therapy, including:
- Ocular inflammation and increased intraocular pressure (IOP) 4
- Endophthalmitis (less than 1% of anti-VEGF-treated participants) 4
- Gastrointestinal perforations (associated with antiangiogenic tyrosine kinase inhibitors and bevacizumab) 5
- Systemic adverse events, such as major adverse cardiac events, heart failure, thromboembolic events, and major bleeding 6
- Hypertension (associated with bevacizumab) 7
- These risks and adverse events may be considered when determining contraindications for anti-VEGF therapy using Ranibizumab (Lucentis), but the studies do not provide explicit contraindications.