Bevacizumab in age-related macular degeneration: why an off-label treatment is the preferred therapy?

The current use of bevacizumab for age-related macular degeneration is mainly motivated by economic considerations, based on equivalent clinical functional efficacy in comparison with ranibizumab, as demonstrated in head-to-head trials; however, this should be balanced against the poorer anatomical outcomes and suspected higher rate of systemic serious adverse events compared with ranibizumab at 1 year. It is still not clear whether this higher rate of systemic serious adverse events is because of genuine differences in systemic toxicity or confounding factors in the various trials that might have affected the data. Until this point is clarified, clinicians and patients should continue to weigh up the benefits and harms of the two treatments carefully, in cases where this choice is available to them.