Document resource
Background and Importance Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss in older adults. Anti-VEGF intravitreal agents have revolutionised management by improving and maintaining visual acuity through inhibition of pathological angiogenesis. Several options are currently available in Spain—ranibizumab, aflibercept (2 mg and 8 mg), brolucizumab, and faricimab—each differing in dosing interval, mechanism, and cost. Comparative evaluation of their efficacy, safety, and economic impact is essential for optimising therapeutic decisions in hospital pharmacy settings.Aim and Objectives To compare the efficacy, safety, and cost-effectiveness of anti-VEGF agents used in nAMD based on pivotal clinical trials and local cost data, supporting evidence-based treatment selection.Material and Methods A structured literature review of phase III randomised clinical trials was performed (MARINA, ANCHOR, VIEW 1–2, HAWK, HARRIER, TENAYA, LUCERNE, and PULSAR). Efficacy was assessed by change in best-corrected visual acuity (BCVA, ETDRS letters). Safety outcomes included ocular and systemic adverse events, serious ocular adverse events, and endophthalmitis rates. Economic evaluation was based on Spanish ex-factory prices (PVL+VAT) considering labelled dosing regimens, with and without vial sharing.Results All anti-VEGF agents demonstrated comparable efficacy to aflibercept 2 mg every 8 weeks, with significant improvement in BCVA versus placebo or verteporfin. No significant differences were found in ocular or systemic adverse events, although brolucizumab 6 mg q12w showed a higher risk of serious ocular events. Aflibercept 8 mg and brolucizumab were associated with lower systemic adverse event rates. Without vial sharing, aflibercept 8 mg prefilled syringe was the most cost-efficient option; with vial sharing, faricimab vials offered the lowest annual treatment cost. All anti-VEGF agents demonstrated comparable efficacy to aflibercept 2 mg every 8 weeks, with significant improvement in BCVA versus placebo or verteporfin. No significant differences were found in ocular or systemic adverse events, although brolucizumab 6 mg q12w showed a higher risk of serious ocular events.Conclusion and Relevance Anti-VEGF therapies present similar efficacy and safety profiles, with differences mainly in dosing intervals and cost efficiency. Economic optimisation depends on hospital logistics and vial use policies.Conflict of Interest No conflict of interest