Over the past two decades, the management of retinal vascular diseases, such as neovascular age-related macular degeneration (nAMD)—the leading cause of blindness globally among those over 50—has been transformed by introducing anti-VEGF therapies. The profound, vision-saving efficacy of these therapies has led to their broad adoption, driving global sales of branded anti-VEGF therapies to over $15 billion in 2024. While this reflects use across multiple retinal vascular diseases beyond nAMD, nAMD accounts for a majority of sales and is often the entry point for new therapies in development for these indications.
Authored by William Blair’s Lachlan Hanbury-Brown, biotechnology analyst, this report reviews the epidemiology, pathophysiology, and commercial landscape for nAMD and reviews products in clinical development for the indication.
While the market has grown from nothing to over $15 billion in the past two decades, our analysts see a robust growth trajectory for several years ahead. First, introducing new therapies requiring less frequent injections should lower the burden of treatment, thereby improving adherence and long-term outcomes. Up to an estimated 40% of patients discontinue therapy within the first year because of the burden of intravitreal injections. Simply reducing this continuation rate could meaningfully increase the number of treated patients. Second, the prevalence of nAMD increases exponentially with age, so aging populations across much of the Western world are expected to lead to an increased prevalence of nAMD. Beyond nAMD, these new therapies may also drive growth in other retinal vascular diseases, such as diabetic retinopathy (DR), where the treatment burden of current anti-VEGF therapies has limited their adoption despite demonstrating efficacy.
Given the large and growing commercial opportunity, relatively concentrated prescriber base, and significant remaining unmet needs, there’s a robust pipeline of assets in development for nAMD. The commercial dynamics in the anti-VEGF market demonstrate that new products with even modest increases in durability on the order of days to weeks rapidly gain market share, which translates into fewer injections per year. Technologies being developed include new biologics, bioerodible or biodegradable implants that slowly release tyrosine kinase inhibitors (TKIs), and gene therapies that seek to make a “biofactory” of anti-VEGF proteins in the back of the eye to alleviate the need for regular injections of anti-VEGF proteins.
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