visits scheduled 1 week apart. The safety was excellent: mild eye pain, foreign-body sensation, hyperemia, and blurred vision were reported in 5–15% of patients. In addition, the 7.5- and 15-mg anecortave acetate doses had statistically significant lower mean IOP than vehicle at the 12-week primary efficacy endpoint (P < 0.05). Another way to look at the data is to define treatment success as maintenance of IOP at 21 mmHg. Approximately 55% of patients in the 7.5- and 15-mg arms treated with anecortave acetate had treatment success at week 12. In contrast, in the vehicle control group approximately 50% of patients were treatment failures by week 2 and only 2 patients (6.4%) were treatment successes at 12 weeks.

EFFICACY AND COMPARISON WITH OTHER AGENTS

The only treatment modality for exudative AMD that has been compared head to head with anecortave acetate to date is PDT.31 As discussed above, these two treatments may be comparable in efficacy; however, anecortave acetate has the advantage that treatments need

only be repeated once every 6 months. Also, PDT carries the small but significant risk of acute severe vision loss as well as the possible risk of delayed RPE atrophy,34–37 both of which would be unlikely with anecortave acetate (see below).

In the past few years, intravitreal VEGF inhibitors, such as pegaptanib, ranibizumab, and bevacizumab, have largely replaced other treatment modalities as the first-line monotherapy for subfoveal CNV in the setting of wet AMD.28,38 Ranibizumab and bevacizumab are currently the most commonly used agents in this setting and both have been shown to be very effective in the treatment of exudative AMD (discussed elsewhere). Although none of these agents has been compared directly with anecortave acetate, indirect evidence from comparisons of studies enrolling similar subject populations suggests that ranibizumab (and likely bevacizumab) is superior to anecortave acetate in this setting. Similar to the anecortave acetate phase III wet AMD trial, the Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD (ANCHOR) trial, a 2-year, prospective, randomized, placebo-controlled trial, compared ranibizumab with PDT in subjects with predominantly classic CNV.39 In this trial, the percentage of subjects in the 0.5-mg ranibizumab group losing <3 lines of visual acuity and those gaining 3 lines at 12 months were 96.4%