Permeability and Anti–vascular Endothelial Growth Factor Effects of Bevacizumab, Ranibizumab, and Aflibercept in Polarized Retinal Pigment Epithelial Layer in Vitro

In Brief Purpose: To determine the effects of bevacizumab, ranibizumab, and aflibercept on the permeability and the effects of anti–vascular endothelial growth factor (VEGF) on highly polarized retinal pigment epithelial cells (RPECs) in vitro. Methods: Highly polarized RPECs were cultured in the upper chamber of a Transwell system. Anti-VEGF antibodies were added to the upper chamber, and the concentrations of the drugs in the lower chambers were measured. The permeability rates of the three anti-VEGF drugs through the RPEC layer and the concentration of VEGF in each chamber were determined. Results: The permeability of aflibercept was significantly lower by about 40% than that of bevacizumab through the RPEC layer (P < 0.05). Ranibizumab was significantly more permeable through the RPECs than bevacizumab (180% of bevacizumab, P < 0.05). Although VEGF was almost absent in the upper chamber after exposure to the 3 antibodies, it was decreased more significantly with aflibercept than with bevacizumab in the lower chamber (2.8% vs. 65.8% of control; P < 0.01). Ranibizumab also decreased the VEGF level compared with bevacizumab (31.7% vs. 65.8% of control; P < 0.01). Conclusion: The greater reduction of the amount of VEGF in the lower chamber by aflibercept and ranibizumab than bevacizumab may explain why aflibercept and ranibizumab are more effective than bevacizumab against type 1 choroidal neovascularization. In highly polarized retinal pigment epithelial cells, aflibercept was the least permeable through the retinal pigment epithelial layer of three anti– vascular endothelial growth factor drugs tested. However, aflibercept inhibited vascular endothelial growth factor more potently than ranibizumab or bevacizumab. Although its clinical merit is uncertain, this information would be important to choose the most effective and safe drugs for patients.