Anti-VEGF antibody for the treatment of predominantly

classic choroidal neovascularisation in AMD (ANCHOR)

by Dr. Hasan Usmani





         Phase III, randomised, multi-centre double-masked active treatment-controlled trial

         Comparing two different doses of Ranibizumab to verteporfin photodynamic therapy (PDT) in treating subfoveal neovascular macular degeneration.

         423 patients in the United States, Europe and Australia

         Randomised 1:1:1 to either PDT plus sham injection or to placebo PDT plus Ranibizumab (0.3 mg or 0.5 mg) monthly for 24 months.

         Fluorescein angiography every three months to determine the need for additional PDT or placebo PDT



Inclusion criteria


         patients with predominantly classic CNV

         VA 6/12 6/96



Primary endpoint


         Proportion of subjects losing less than 15 ETDRS letters at one year.



Secondary endpoint


         Change in VA from baseline





         Maintaining vision: patients losing fewer than 15 letters at 12 months

o        94% in Ranibizumab 0.3 mg vs. 96% in Ranibizumab 0.5 mg vs. 64% in PDT group (p < 0.0001)

         Improving vision: patients gaining 15 letters or more

o        36% (Ranibizumab 0.3 mg) vs. 40% (Ranibizumab 0.5 mg) vs.  6% (PDT) (p < 0.0001)

         Other findings:

o        Average number of letters gained or lost

         9 letters gained (Ranibizumab 0.3 mg) vs. 11 letters gained (Ranibizumab 0.5 mg) vs.  10 letters lost PDT (p< 0.0001)

o        Severe visual loss

         0% Ranibizumab vs.13% PDT

o        Change in leakage on FFA

         Decreased by average 2 disc areas (DA) in Ranibizumab vs.  increased by average 1/3 DA in PDT (p < 0.0001)


Adverse events



         0% in 0.3mg Ranibizumab vs. 1.4% in 0.5mg Ranibizumab



           10.2% in 0.3mg Ranibizumab vs.15% in 0.5mg Ranibizumab vs. 2.8% in PDT


           Non-ocular vascular events

           2.2.% in 0.3mg Ranibizumab vs. 4.3% in 0.5 mg Ranibizumab vs. 2.1% in PDT



Further reading


         Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S; ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432-1444.



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