This page shows what was measured, who it was measured in, and what that does not settle.
What Ranibizumab does in the body
Injected into the eye for leaking blood vessels at the back of the eye.
Abnormal vessels grow under the retina because a signalling protein tells them to. Ranibizumab is a fragment of an antibody built to grab that protein and hold it, so it never reaches the receptors on the vessel walls that would tell them to grow and leak. It is injected into the jelly of the eye, spreads through the retina, mops up the signal, and is cleared within weeks — which is why the injection has to be repeated.
What happened in people
Nineteen in 20 treated people kept most of their vision, compared with about six in 10 given dummy injections.
✓ Reviewed first-read answer
Where this came from
A person wrote this and a reviewer approved it against this exact record. It carries no effect size.
A reviewer approved this against this record. The reviewed-claim record carrying the exact population and effect size does not exist yet.
No source is stored against this line.
The limit that matters most
The success definition still allowed a large 14-letter loss, and a far cheaper medicine worked as well.
Where it acts
The vitreous cavity and the retina, reached by a needle through the white of the eye
Kind of result
The kind of result is not recorded
Supervision
Professional supervision is normally required. It is a prescription or clinician-administered medicine where it is approved.
What the registries record it as
The substance registry classes this as protein.
FDA substance registry · ZL1R02VT79 · read 2026-08-29
Where each sentence above came from
No recorded sentence describes the change this makes in a way that stands on its own. The page opens with what it is taken for instead, and the recorded explanation follows below.
Shown as the opening line on this page.
The limit a reviewer approved as the one that matters most here.
The four opening statements run to 112 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
Absolute difference
An absolute difference is how many more people in a hundred were affected.
A picture of it, and where the picture fails
It is like counting heads in two rooms of a hundred.
Where that stops being true. Heads are easy to count. Study results carry a margin of error too.
What people get wrong. It is confused with a percentage change, which can look far larger.
The arithmetic difference in event rates between arms.
Confidence interval
A confidence interval is the range the true answer is likely to sit in.
A picture of it, and where the picture fails
It is like a weather forecast giving a range rather than one number.
Where that stops being true. A forecast range covers tomorrow. This one covers what the study could resolve.
What people get wrong. The middle number is read as the answer. A range crossing zero means no change is still possible.
An interval estimate that would contain the true parameter in a stated proportion of repeated studies.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
Proportion of patients losing fewer than 15 letters from baseline visual acuity at 12 months
94.6% on ranibizumab 0.5 mg against 62.2% on sham, P < 0.001
Repeated elsewhere
Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The endpoint counts a 14-letter loss as maintained vision. Over 24 months, presumed endophthalmitis occurred in 5 patients (1.0%) and serious uveitis in 6 (1.3%), which are per-course rather than per-injection rates in a treatment that continues indefinitely.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Intravitreal injection of 0.5 mg in 0.05 mL; also available as a refillable ocular implant
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Bevacizumab monthly 8.0 letters against ranibizumab monthly 8.5; as-needed 5.9 against 6.8; equivalence met on matched schedules
Repeated elsewhere
Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Serious systemic adverse events, primarily hospitalisations, were higher with bevacizumab, 24.1% against 19.0% (risk ratio 1.29, 95% CI 1.01 to 1.66), with excess events broadly distributed across disease categories not previously flagged. The trial was single-blind rather than double-blind because the two drugs cannot be made to look identical.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Intravitreal injection of 0.5 mg in 0.05 mL; also available as a refillable ocular implant
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Mean difference -1.37 letters (95% CI -3.75 to 1.01, p=0.26) — bevacizumab neither non-inferior nor inferior, because the confidence interval crosses the limit
Repeated elsewhere
Replicated
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. The formal verdict is inconclusive rather than positive: the confidence interval spans the pre-specified 3.5-letter limit. Mortality was lower with continuous than discontinuous treatment, odds ratio 0.47 (95% CI 0.22 to 1.03, p=0.05), a secondary safety finding at the edge of significance.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Intravitreal injection of 0.5 mg in 0.05 mL; also available as a refillable ocular implant
Interval reported. 95% CI -3
Written into the record, not signed off as a reviewed claim.
RNAWiki holds 4 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Ranibizumab
What a person takes: Intravitreal injection of 0.5 mg in 0.05 mL; also available as a refillable ocular implant.
The measurement behind this step
A needle through the pars plana into the vitreous cavity, under topical anaesthetic and antisepsis, repeated on a monthly or individualised schedule. The molecule is an antibody fragment rather than a whole antibody, made small deliberately so it penetrates the retina. The port delivery implant is a surgically placed refillable reservoir that releases drug continuously and is refilled in clinic.
Getting in
A needle through the white of the eye
The drug cannot reach the back of the eye from the bloodstream or from a drop. It is injected directly into the jelly that fills the eyeball, through the white, under local anaesthetic.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Intravitreal injection of 0.5 mg in 0.05 mL through the pars plana. The blood-retinal barrier makes systemic delivery ineffective and the anterior segment blocks topical delivery, so direct vitreous injection is the only practical route. Presumed endophthalmitis occurred in 1.0% of MARINA patients over 24 months of monthly injections.
A whole antibody is bulky. This one has had two thirds of it cut away, leaving only the part that does the gripping, so it can work its way through the layers of the retina.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Ranibizumab is an antigen-binding fragment of approximately 48 kDa, roughly a third the mass of the full-length antibody it was derived from. Removal of the Fc region was intended to improve penetration through the retina to the choroidal neovascular complex, and it also removes Fc-mediated recycling, shortening systemic half-life once drug leaves the eye.
The signal driving the vessels exists in several slightly different forms, and broken-down pieces of it are still active. This fragment binds all of them.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Ranibizumab binds all active isoforms of VEGF-A and their biologically active degradation products. It was affinity-matured from the same parent antibody as bevacizumab and binds VEGF-A substantially more tightly. Binding occupies the surface VEGF-A would otherwise use to engage its receptors.
With the signal captured, the receptors on the abnormal vessels are not switched on. The vessels stop growing, and the leak that was flooding the retina slows and stops.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Neutralised VEGF-A cannot engage VEGFR-1 or VEGFR-2 on vascular endothelial cells, blocking the proliferation, migration and permeability signalling that drives choroidal neovascularisation and the associated exudation. Reduction in central retinal thickness follows, measured in CATT as 196 micrometres with monthly ranibizumab.
Fluid clears and vision improves rather than merely holding
As the leak stops, the retina dries out and often works better than it did. Average vision went up by seven letters in the sham-controlled trial and by eleven against the older treatment.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Mean visual acuity increased 7.2 letters at 12 months in MARINA against a 10.4-letter decrease on sham, and 11.3 letters in ANCHOR against a 9.5-letter decrease on verteporfin. Fifteen letters or more were gained by 33.8% and 40.3% respectively. Improvement rather than stabilisation was novel in this disease.
The drug does not stay. Within weeks it has gone and the signal returns, so the injection has to be repeated, in most cases indefinitely.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Vitreous clearance of the Fab returns VEGF-A to unbound levels within weeks, which is why the pivotal trials used monthly dosing for 24 months. IVAN measured what happens when intervals are stretched: discontinuous treatment cost a small amount of acuity regardless of drug, -1.63 letters (95% CI -4.01 to 0.75), and mortality was lower with continuous treatment (odds ratio 0.47, 95% CI 0.22 to 1.03, p=0.05).
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 6 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
Adults with wet macular degeneration and several related retinal diseases. Treatment is by injection into the eye, repeated indefinitely, often monthly at first.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “The safety and effectiveness of CIMERLI in pediatric patients have not been established.”
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-30
On older people, the label states: “In the clinical studies, approximately 76% (2449 of 3227) of patients randomized to treatment with ranibizumab were ≥ 65 years of age and approximately 51% (1644 of 3227) were ≥ 75 years of age [see Clinical Studies (14) ] .”
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-30
On people who are pregnant, the label states: “Risk Summary There are no adequate and well-controlled studies of ranibizumab products administered in pregnant women.”
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-30
On people who are breastfeeding, the label states: “Risk Summary There are no data available on the presence of ranibizumab products in human milk, the effects of ranibizumab products on the breastfed infant or the effects of ranibizumab products on milk production/excretion.”
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-30
Where the result stopped carrying
The design rationale did not translate: a publicly funded 1,208-patient trial found no vision advantage over the cheaper parent antibody, and a 610-patient trial in another country reached the same place
The sustained-release implant carries a boxed warning for endophthalmitis and a Warnings list including implant dislocation, septum dislodgement and retinal detachment
Stretching injection intervals costs vision: IVAN measured -1.63 letters for discontinuous against continuous treatment, irrespective of drug
No biosimilar competition existed for the first fifteen years after approval
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Given by a clinician
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Intravitreal injection of 0.5 mg in 0.05 mL; also available as a refillable ocular implant
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
Professional supervision is normally required. It is a prescription or clinician-administered medicine where it is approved.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
The identity record classes it as Monoclonal Antibody (mAb).
No source is stored against this line.
What is in the pack
A needle through the pars plana into the vitreous cavity, under topical anaesthetic and antisepsis, repeated on a monthly or individualised schedule. The molecule is an antibody fragment rather than a whole antibody, made small deliberately so it penetrates the retina. The port delivery implant is a surgically placed refillable reservoir that releases drug continuously and is refilled in clinic.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold and what that means for what is in the pack.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
Presumed endophthalmitis in 1.0% of MARINA patients over 24 months of monthly injections and 1.4% of the ANCHOR 0.5 mg group, serious uveitis in 1.3% and 0.7%. Retinal detachment, intraocular inflammation, raised intraocular pressure and traumatic cataract are recognised risks of the injection procedure. Arterial thromboembolic events are a theoretical class concern from systemic VEGF inhibition; CATT found no difference in death, myocardial infarction or stroke between ranibizumab and bevacizumab (P>0.20) and IVAN found no difference in arterial thrombotic events (odds ratio 1.69, 95% CI 0.80 to 3.57). The ocular implant carries a boxed warning for an up to threefold higher endophthalmitis rate than injection, plus warnings for retinal detachment, implant dislocation, septum dislodgement, vitreous haemorrhage and conjunctival erosion or retraction.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Intravitreal injection of 0.5 mg in 0.05 mL; also available as a refillable ocular implant
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
The molecule is an antibody fragment rather than a whole antibody, made small deliberately so it penetrates the retina. The port delivery implant is a surgically placed refillable reservoir that releases drug continuously and is refilled in clinic.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on which forms are sold and how they compare.
No source is stored against this line.
What is recorded as being sold
18 products list this as an active ingredient in the United States drug directory. 18 of them contain it and nothing else.
FDA National Drug Code directory · 82667-018 · read 2026-08-29
They are sold as injection, solution, solution and solution, concentrate, taken intravitreal.
FDA National Drug Code directory · 82667-018 · read 2026-08-29
The regulator's established pharmacologic class for it is vascular endothelial growth factor inhibitor [epc] and vascular endothelial growth factor inhibitors [moa].
FDA National Drug Code directory · 82667-018 · read 2026-08-29
7 published labels name it as an active ingredient. 7 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-29
Those labels are classed as human prescription drug.
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-29
CIMERLI is intravitreal at 3 DOSAGE FORMS AND STRENGTHS Single-dose glass vial designed to provide 0.05 mL for intravitreal injection., recorded as fda label in effect 2025-05-07 in the United States.
US prescribing information · e0e23118-1490-a554-e053-2995a90ab90c · read 2026-08-30
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
Self-experiment planning is not offered for a prescription or clinician-supervised medicine. The questions below are for a clinician or pharmacist.
Questions worth asking
Which of the trials of Ranibizumab studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That "maintained vision" in the pivotal trials describes preserved sight, when the threshold counts a fourteen-letter loss as success
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the affinity maturation and Fc removal engineered into this molecule produce a clinically superior drug to its parent antibody
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the CATT serious-adverse-event difference is a drug effect; the excess was broadly distributed across unrelated disease categories and IVAN found no difference in arterial thrombotic events
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the port delivery implant reduces treatment burden without cost, when its label opens with a boxed warning for threefold endophthalmitis
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Ranibizumab are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
MARINA: 94.6% kept their vision against 62.2% on sham injections
In plain words
Seven hundred and sixteen patients were randomised to monthly injections of the drug or monthly sham injections, for two years, with nobody knowing which. Nineteen in twenty on the drug kept their vision. Six in ten did on sham. Average vision improved on the drug and fell sharply without it.
What was measured
Proportion losing fewer than 15 letters at 12 months, against matched sham injections
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
MARINA was a multicentre, two-year, double-blind, sham-controlled study in patients with minimally classic or occult choroidal neovascularisation, randomised to 24 monthly intravitreal injections of ranibizumab 0.3 mg or 0.5 mg, or sham injections. At 12 months, 94.5% of the 0.3 mg group and 94.6% of the 0.5 mg group lost fewer than 15 letters against 62.2% of sham (P<0.001 for both). Visual acuity improved by 15 letters or more in 24.8% and 33.8% against 5.0% (P<0.001). Mean visual acuity increased by 6.5 and 7.2 letters against a decrease of 10.4 letters on sham (P<0.001). Benefit was maintained at 24 months. Over 24 months, presumed endophthalmitis occurred in 5 patients (1.0%) and serious uveitis in 6 (1.3%).
Written into the record, not signed off as a reviewed claim
ANCHOR: mean vision improved by 11.3 letters where the old treatment lost 9.5
In plain words
Against photodynamic therapy, the treatment it replaced, ranibizumab did not merely slow decline. Average vision went up by more than eleven letters while the comparison group lost nearly ten.
What was measured
Proportion losing fewer than 15 letters and mean acuity change at 12 months, against verteporfin photodynamic therapy
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
ANCHOR randomised 423 patients with predominantly classic neovascular age-related macular degeneration 1:1:1 to monthly intravitreal ranibizumab 0.3 mg or 0.5 mg plus sham verteporfin, or monthly sham injections plus active verteporfin photodynamic therapy. At 12 months, 94.3% and 96.4% lost fewer than 15 letters against 64.3% on verteporfin (P<0.001 for each). Visual acuity improved by 15 letters or more in 35.7% and 40.3% against 5.6% (P<0.001). Mean visual acuity increased by 8.5 and 11.3 letters against a decrease of 9.5 letters (P<0.001). Among 140 patients on 0.5 mg, presumed endophthalmitis occurred in 2 (1.4%) and serious uveitis in 1 (0.7%).
Written into the record, not signed off as a reviewed claim
CATT: a drug costing a fortieth as much worked just as well
In plain words
The United States National Eye Institute paid for a trial nobody selling either drug wanted. Twelve hundred patients got ranibizumab or bevacizumab, an off-label cancer antibody. On the same schedule, vision outcomes were equivalent. One dose costs about two thousand dollars and the other about fifty.
What was measured
That the affinity maturation and Fc removal engineered into ranibizumab produce a clinically better drug than the parent antibody — a design rationale that a 1,208-patient randomised trial found no visual benefit for
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
CATT was a multicentre, single-blind, non-inferiority trial in which 1,208 patients with neovascular age-related macular degeneration were randomly assigned to ranibizumab or bevacizumab, monthly or as needed with monthly evaluation. The primary outcome was mean change in visual acuity at one year with a non-inferiority limit of 5 letters. Bevacizumab monthly was equivalent to ranibizumab monthly, with 8.0 and 8.5 letters gained. Bevacizumab as needed was equivalent to ranibizumab as needed, with 5.9 and 6.8 letters. Ranibizumab as needed was equivalent to ranibizumab monthly. The bevacizumab as-needed against bevacizumab monthly comparison was inconclusive. Mean decrease in central retinal thickness was greater with monthly ranibizumab (196 micrometres) than the other groups (152 to 168, P=0.03 by analysis of variance). Rates of death, myocardial infarction and stroke were similar (P>0.20). Serious systemic adverse events, primarily hospitalisations, were more frequent with bevacizumab, 24.1% against 19.0% (risk ratio 1.29, 95% CI 1.01 to 1.66), broadly distributed across disease categories not previously flagged. The trial protocol states per-dose costs of approximately US$2,000 and US$50.
Written into the record, not signed off as a reviewed claim
IVAN replicated it in a different country with a different design
In plain words
A British trial reached the same place by a different route: over two years, the two drugs differed by 1.37 letters, which is nothing. It also found that spacing injections out cost a little vision whichever drug was used.
What was measured
Best corrected visual acuity at two years, ranibizumab against bevacizumab in a 2×2 factorial design
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
IVAN was a multicentre 2×2 factorial non-inferiority randomised trial at 23 UK hospitals. Six hundred and twenty-eight patients were randomised and 610 received study drugs — 314 ranibizumab, 296 bevacizumab — in continuous monthly or discontinuous as-needed regimens. The primary outcome was best corrected visual acuity at two years with a non-inferiority limit of 3.5 letters. Bevacizumab was neither non-inferior nor inferior to ranibizumab, mean difference -1.37 letters (95% CI -3.75 to 1.01, p=0.26). Discontinuous treatment was neither non-inferior nor inferior to continuous, -1.63 letters (-4.01 to 0.75, p=0.18). Arterial thrombotic events or heart failure admissions did not differ by drug, 20 of 314 (6%) against 12 of 296 (4%), odds ratio 1.69 (95% CI 0.80 to 3.57, p=0.16). Mortality was lower with continuous than discontinuous treatment, odds ratio 0.47 (95% CI 0.22 to 1.03, p=0.05), and did not differ by drug. The authors conclude that the choice of anti-VEGF strategy is less straightforward than previously thought.
Written into the record, not signed off as a reviewed claim
The sustained-release implant carries a boxed warning for eye infection
In plain words
A refillable implant was developed to replace monthly injections. Its label opens with a boxed warning that it causes up to three times as much infection inside the eye as the injections it was meant to replace.
What was measured
Endophthalmitis rate with the implant relative to monthly intravitreal injection, as stated in the boxed warning
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
The ranibizumab port delivery implant carries a boxed warning stating that the implant has been associated with an up to three-fold higher rate of endophthalmitis than monthly intravitreal injections of ranibizumab, that many of these events were associated with conjunctival retraction or erosion, and that appropriate conjunctival management with early surgical repair may reduce the risk. The Warnings and Precautions section additionally lists rhegmatogenous retinal detachment, implant dislocation, septum dislodgement, vitreous haemorrhage, conjunctival erosion, conjunctival retraction and conjunctival blebs, and notes that in some cases these events present asymptomatically. Antithrombotic medication is to be temporarily discontinued before implant insertion to reduce vitreous haemorrhage risk, and vitrectomy may be needed. The device solves the burden of monthly injections by substituting a surgical implant with its own failure modes.
Source
SUSVIMO (ranibizumab injection) for ocular implant, US prescribing information, Boxed Warning and Warnings and Precautions (BLA 761197)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
Fifteen letters is a threshold, not a description of sight
In plain words
The headline number from the pivotal trials — nineteen in twenty patients maintained vision — counts anyone who lost fewer than fifteen letters on a chart. Fourteen letters is a large loss and counts as success.
What was measured
That "94.6% maintained vision" describes preserved sight, when the threshold counts a fourteen-letter loss as a success and no functional endpoint was primary
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The primary endpoint of both MARINA and ANCHOR was the proportion of patients losing fewer than 15 letters of best corrected visual acuity from baseline at 12 months. Fifteen letters on an ETDRS chart is three lines, and a patient who loses fourteen letters is counted as having maintained vision. This is why the secondary endpoint — the proportion gaining 15 letters or more, which was 33.8% in MARINA and 40.3% in ANCHOR — carries more information about how well people actually saw. Chart letters are also not reading, driving, or recognising faces. No registration trial in this programme used a patient-reported functional outcome as its primary endpoint, and the threshold chosen defines success generously by design, because it was set when the realistic aim was to slow loss rather than to produce gain.
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What is not here
7 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What was measured, goal by goal — found nothing in the sources checked.
How close this is to real life — found nothing in the sources checked.
Felt, measured, or meaningful — found nothing in the sources checked.
How long anything takes — found nothing in the sources checked.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
Everything above is built from what is below. This layer keeps the technical vocabulary, record identifiers and every stored row, so a reader who wants to check the page can.
The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A humanised antibody fragment engineered to bind every active form of VEGF-A and small enough to penetrate the retina, which kept 94.6% of 716 patients within 15 letters of their starting vision against 62.2% on sham injections in MARINA — and which two publicly funded randomised trials, CATT in 1,208 patients and IVAN in 610, then showed to be no better than an off-label cancer antibody costing about a fortieth as much per dose.
Recorded evidence blocks (9)
Q1
On the Ranibizumab label: indicated for what?
"NUFYMCO is indicated for the treatment of patients with: NUFYMCO, a vascular endothelial growth factor (VEGF) inhibitor, is indicated for the treatment of patients with: Neovascular (Wet) Age-Related Macular Degeneration (AMD) ( 1.1 ) Macular Edema Following Retinal Vein Occlusion (RVO) ( 1.2 ) Diabetic Macular Edema…": indications and usage on Ranibizumab's label. DailyMed label · 05ed75bc-ae21-480b-9be4-cbc51689dd8a · 2026-06-04
Q2
470 registered trials of Ranibizumab — at which phases?
Registered studies posting no result
302 of 470
470 registered studies of Ranibizumab: 163 phase2, 125 phase3, 90 phase4, 86 phase1, 35 na, 33 na or unstated, 1 early phase1. CLINICALTRIALS_SNAPSHOT · 2026-09-01
9 days; Based on the disappearance of ranibizumab from serum, the estimated average vitreous elimination half-life was approximately 9 days.
recorded 2026-06-04 · last checked 2026-09-04
Q6
Which 166 trials of Ranibizumab posted no result?
Posted no result
166 of 166 completed trials
Registrations
NCT00344227, NCT00373659, NCT00288561, NCT00089765, NCT00457067 and NCT00457145, and 160 more
Completion dates
oldest 2007-04; newest 2024-08-08
Show the evidence
Trial
NCT00344227
2007-04
NCT00373659
2007-06
NCT00288561
2007-07
NCT00089765
2007-08-15
NCT00457067
2007-10-24
NCT00457145
2007-10-24
14 further recorded trials
NCT00570726
2007-11
NCT00395707
2008-04
NCT00429962
2008-06
NCT00567697
2008-10
NCT00470678
2008-11
NCT00378196
2008-12
NCT00804934
2009-01
NCT00387582
2009-02
NCT00500344
2009-03
NCT00395551
2009-06
NCT00504400
2009-09
NCT00680498
2009-10
NCT00390208
2009-12
NCT00590694
2009-12
Q7
At the median, Ranibizumab's trials enrolled 56 people — anything larger?
Median enrolment
56
Largest enrolment
369600
Registered trials counted
469
Q8
What do 5492 spontaneous reports say about Ranibizumab — and not say?
These are reports people sent to a regulator. They do not show the medicine caused the reaction. Nobody counted how many people took the medicine and reported nothing. The same event can be reported more than once, and many reports are incomplete. News coverage, lawsuits and new warnings change how often people report. A count is not a rate and not a risk.
Ranibizumab appears in spontaneous reports to regulators. Across the 10 most-reported reaction terms, 5492 reaction mentions were counted: visual acuity reduced 1355; cerebrovascular accident 675; retinal haemorrhage 574; endophthalmitis 553. FAERS via Open Targets · CHEMBL1201825 · 2026-06-24
Show the evidence
visual acuity reduced
1355
cerebrovascular accident
675
retinal haemorrhage
574
endophthalmitis
553
visual impairment
513
macular oedema
423
4 more recorded rows
vision blurred
384
vitreous haemorrhage
339
eye pain
339
blindness
337
recorded 2026-06-24 · last checked 2026-09-04
Q9
Which 10 reactions does Ranibizumab's label not list?
ChEMBL 37 — CC BY-SA 3.0 Unported · ChEMBL ATC CC BY-SA · ClinicalTrials.gov — US Government work · Open Targets 26.06 — CC0 · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
✗ required summary fields resolved: 4 required field(s) not terminal: Why people use it, Best-supported result, Biggest unanswered question, Human evidence
✓ public claims reviewed: 0 reviewed claim(s); drafts are never rendered
✓ source coverage passed: 6 source rows
✓ no critical contamination: no quarantine open
✓ canonical metadata passed: slug and display name present
✓ no raw internal fields: enforced by the copy-contract test over the rendered page
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