Bevacizumab versus Ranibizumab on As-Needed Treatment Regimen for Neovascular Age-Related Macular Degeneration in Turkish Patients

Purpose. To compare the efficacy of intravitreal bevacizumab versus ranibizumab in the treatment of neovascular age-related macular degeneration (nAMD). Methods. Retrospective, comparative study. The newly diagnosed nAMD patients who were treated with intravitreal bevacizumab or ranibizumab on an as-needed treatment regimen were included in the study. Main outcome measures were the change in best corrected visual acuity (BCVA), and central retinal thickness (CRT). Secondary outcome measures were the number of injections, and complications. Results. A total of 154 patients were included in the study. Bevacizumab group consisted of 79 patients, and ranibizumab group consisted of 74 patients. Mean follow-up time was 18.9 months, and 18.3 months in the bevacizumab and ranibizumab groups, respectively. There was not a significant difference between the two groups regarding the change in BCVA and CRT at all time points (P>0.05 for all). The mean number of injections at month 12 was 4.8 and 4.7 in bevacizumab and ranibizumab groups, respectively (P>0.05). No serious complications were detected in any of the groups. Conclusion. Both of the bevacizumab and ranibizumab found to be effective in the treatment of nAMD in regards of functional and anatomical outcomes with similar number of treatments and similar side effects.

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Intravitreal bevacizumab treatment for neovascular age-related macular degeneration and thromboembolic events

European Journal of Ophthalmology ◽

10.1177/1120672118823128 ◽

2019 ◽

Vol 30 (1) ◽

pp. 66-71

Author(s):

Orly Weinstein ◽

Muhammad Abu Tailakh ◽

Tova Lifshitz ◽

Victor Novack ◽

Jaime Levy

Keyword(s):

Acute Coronary Syndrome ◽

Macular Degeneration ◽

Intravitreal Bevacizumab ◽

Age Related Macular Degeneration ◽

Thromboembolic Events ◽

Coronary Syndrome ◽

Intravitreal Bevacizumab Injection ◽

Age Related ◽

Significant Difference ◽

Bevacizumab Injection

Background: Systemic complications of intravitreal anti-vascular endothelial growth factor agents are relatively uncommon but highly significant. Objectives: Primary objective: To assess the risk for thromboembolic events following intravitreal bevacizumab injection in neovascular age-related macular degeneration patients by a large population-based study. Secondary objective: To analyze the association between injection frequency and the risk for thromboembolic events, the time interval between the injection and the thromboembolic events, and the influence of chronic diseases on complications rate. Design: A retrospective cohort study. Methods: Consecutive neovascular age-related macular degeneration patients receiving intravitreal bevacizumab at Soroka University Medical Center from December 2005 to December 2013 were included. Thromboembolic events analyzed included acute coronary syndrome, acute myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism. The thromboembolic event rate was compared 2 years prior and 2 years after the initial intravitreal bevacizumab injection. Results: A total of 2102 patients were included. Acute coronary syndrome and stroke rate were higher 2 years after intravitreal bevacizumab (p = 0.03 and p = 0.01, respectively). No statistical significant difference was found for the rest of thromboembolic events. Patients older than 80 years and patients receiving less than six intravitreal bevacizumab injections were more likely to experience stroke. Patients with known cardiovascular risk factors before starting injections did not develop significant more thromboembolic events. Conclusion: In our study population, patients treated with intravitreal bevacizumab were significantly more likely to experience stroke during 2 years after first injection.

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Switching from Intravitreal Ranibizumab to Bevacizumab for Age-Related Macular Degeneration

ISRN Ophthalmology ◽

10.5402/2011/916789 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kisaburo Yamada ◽

Kenichi Kimoto ◽

Hirofumi Kono ◽

Toshiaki Kubota

Keyword(s):

Macular Degeneration ◽

Intravitreal Bevacizumab ◽

Age Related Macular Degeneration ◽

Rank Test ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Signed Rank ◽

Significant Difference ◽

Signed Rank Test ◽

Ranibizumab Treatment

Purpose. To report our experiences in patients with age-related macular degeneration (AMD) treated initially with intravitreal ranibizumab and then switched to bevacizumab. Methods. We retrospectively reviewed the records of 7 patients (7 eyes) who were treated with monthly injections of intravitreal ranibizumab and then switched to injections of bevacizumab (every 6 weeks) for six months. The best-corrected visual acuity measurements (BCVA) and optical coherence tomography (OCT) were performed at the baseline examination and then at each visit. The Wilcoxon signed-rank test was used for the statistical analysis. Results. Following three monthly ranibizumab treatments, there was no significant difference in the BCVA, while the foveal retinal thickness (FRT) significantly decreased (). Switching from ranibizumab to bevacizumab resulted in maintenance (57.2%) of the BCVA and a further decrease in the FRT () after 6 months. Conclusions. Switching to intravitreal bevacizumab may be effective in patients who wish to discontinue intravitreal ranibizumab treatment due to the high cost.

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Seven-Year Visual and Anatomical Outcomes of Intravitreal Vascular Endothelial Growth Factor Inhibition for Neovascular Age-Related Macular Degeneration

Journal of Ophthalmology ◽

10.1155/2020/8345850 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Martin Stattin ◽

Julia Forster ◽

Daniel Ahmed ◽

Anna-Maria Haas ◽

Alexandra Graf ◽

...

Keyword(s):

Growth Factor ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Secondary Outcome ◽

First Year ◽

Anti Vegf ◽

Age Related ◽

Endothelial Growth Factor ◽

Anatomical Outcomes ◽

Number Of Injections

Purpose. To evaluate 7-year visual and anatomical outcomes of intravitreal injections (IVI) with antivascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD) based on a personalized pro re nata (PRN) regimen. Methods. Anonymized data of 124 consecutive eyes in 121 patients with treatment-naïve nAMD were initially collected in 2010. Of those, 45 received anti-VEGF IVI at least every 6months until 2017 in one single center in Austria and hence were retrospectively analyzed. All eyes had been initiated on a loading dose of 3 monthly IVI with different anti-VEGF agents followed by a PRN regimen in the first year. At year 2, monitoring as well as therapeutic intervention could be prolonged every 2weeks up to intervals of 3months without capping treatment. Primary outcome measure was the change of visual acuity (VA) assessed by Early Treatment Diabetic Retinopathy Study charts at 4 meters (ETDRS) in letters—counting every correctly read letter—and converted to Snellen. Secondary outcome measures were number of injections and change of central retinal thickness (CMT) from baseline. Results. Mean baseline VA was 20/63 + 1 (0.63 ± 0.26 ETDRS) and declined to 20/100 + 2 (0.45 ± 0.33) with an overall loss of 9 letters ETDRS after 7years (p = 0.001). An average of 3.5 ± 1.9 IVI was given per year and eye. Mean CMT at baseline was 322 ± 95 μm, decreased by 52 μm to 270 ± 70 μm within the first year, and remained below baseline at year 7 (271 ± 106 μm; p<0.001). Conclusions. Our data confirm an absolute vision loss in eyes compromised by nAMD after 7 years of continuous VEGF inhibition. The visual decline was significantly related to baseline VA as well as the number of injections. We suggest following patients thoroughly independent of the initial VA and a greater incentive for the physician to treat.

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One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310318 ◽

2017 ◽

Vol 102 (1) ◽

pp. 91-96 ◽

Cited By ~ 8

Author(s):

Imoro Zeba Braimah ◽

Komal Agarwal ◽

Ahmad Mansour ◽

Jay Chhablani

Keyword(s):

Adverse Events ◽

Macular Degeneration ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Secondary Outcome ◽

Free Interval ◽

Age Related ◽

Significant Difference ◽

The Mean

AimTo evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.MethodsThis retrospective study included 16 eyes (14 patients) with nAMD who were on prior treatment with bevacizumab and ranibizumab and were treated with as-needed IVZ (1.25 mg/0.05 mL) for 12 months. The primary outcome measure was the mean change in best corrected visual acuity (BCVA) and secondary outcome measures included mean change in central macular thickness (CMT), retinal pigment epithelial detachment (RPED) heights, longest treatment free interval, presence of subretinal fluid (SRF) and intraretinal fluid (IRF) and adverse events.ResultsThere was no change in the mean logarithm of minimum angle of resolution (logMAR) BCVA at baseline and following treatment with IVZ therapy (p=0.978). The mean number of IVZ injections during 12 months was 5.9±3.3, and the mean number of antivascular endothelial growth factors (VEGFs) injections prior to switching to IVZ was 8.4±4.7. The mean treatment free interval was longer during IVZ therapy (114.4±67.1 days) compared with 76.3±54.6 days before IVZ therapy (p=0.03). Five (31.25%) eyes had visual gains of at least 0.1 logMAR, 3 (18.75%) eyes had stable BCVA (within 0.1 logMAR) and 8 (50%) eyes had BCVA decline of at least 0.1 logMAR. There was no significant difference in the mean CMT, RPED heights and presence of IRF and SRF at 12 months compared with baseline. No adverse events were noted.ConclusionIVZ increased the treatment free interval in non-responders but no significant change in visual and anatomic outcomes.

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Treat and extend versus fixed regimen in neovascular age related macular degeneration: A systematic review and meta-analysis

European Journal of Ophthalmology ◽

10.1177/1120672120964699 ◽

2020 ◽

pp. 112067212096469

Author(s):

Matteo Fallico ◽

Andrew J Lotery ◽

Antonio Longo ◽

Teresio Avitabile ◽

Vincenza Bonfiglio ◽

...

Keyword(s):

Macular Degeneration ◽

Randomized Clinical Trials ◽

Random Effect ◽

Pooled Analysis ◽

Age Related Macular Degeneration ◽

Treat And Extend ◽

Age Related ◽

Significant Difference ◽

The Mean ◽

Number Of Injections

Purpose: To compare efficacy of treat and extend (T&E) versus fixed regimen treatment protocols in neovascular age-related macular degeneration (nAMD). Methods: Randomized clinical trials (RCTs) comparing T&E versus fixed regimen protocols for nAMD were systematically searched. Primary outcome was to compare the mean best corrected visual acuity (BCVA) change in T&E regimen versus fixed regimen. Secondary outcomes were change in the mean optical coherence tomography (OCT) central retinal thickness (CRT) and mean number of injections. Standardized mean difference (SMD) along with 95% confidence intervals (CIs) were calculated. Random-effect models were used for meta-analyses. Results: Four RCTs were included, with a total of 649 and 621 eyes in the T&E and fixed regimen cohort at 12 months, and 267 and 249 eyes at 24 months. Pooled analysis of mean BCVA change included all four RCTs at 12 months and two RCTs at 24 months, showing no difference between the two groups (12-month: SMD = 0.08, 95% CI: −0.20 to 0.35, p = 0.55; 24-month: SMD = 0.04, 95% CI: −0.13 to 0.21, p = 0.64). Pooled analysis of OCT CRT change at 12 months included three studies, showing no difference between the two groups (SMD = 0.03, 95% CI: −0.46 to 0.51, p = 0.91). Pooled analysis of mean injection number included all four RCTs at 12 months and two RCTs at 24 months, showing significant difference between the two groups (12-month: SMD = −1.11, 95% CI: −1.67 to −0.56, p < 0.001; 24-month: SMD = −1.34, 95% CI: −1.54 to −1.15, p < 0.001). Conclusion: A T&E regimen proved as effective as a fixed dosage regimen throughout a 24-month follow-up and with a lower number of injections.

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Effect of intravitreal bevacizumab (Avastin®) in neovascular age-related macular degeneration using a treatment regimen based on optical coherence tomography: 6- and 12-month results

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2008.01485.x ◽

2009 ◽

Vol 88 (5) ◽

pp. 594-600 ◽

Cited By ~ 21

Author(s):

Christina Leydolt ◽

Stephan Michels ◽

Franz Prager ◽

Gerhard Garhoefer ◽

Michael Georgopoulos ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Treatment Regimen ◽

Intravitreal Bevacizumab ◽

Age Related Macular Degeneration ◽

Optical Coherence ◽

Age Related

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The Role of Epiretinal Membrane on Treatment of Neovascular Age-Related Macular Degeneration with Intravitreal Bevacizumab

The Scientific World JOURNAL ◽

10.1155/2013/958724 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Zeynep Alkin ◽

Abdullah Ozkaya ◽

Ozen Ayranci Osmanbasoglu ◽

Alper Agca ◽

Yalcin Karakucuk ◽

...

Keyword(s):

Macular Degeneration ◽

Intravitreal Bevacizumab ◽

Retrospective Chart Review ◽

Age Related Macular Degeneration ◽

Epiretinal Membranes ◽

Time Points ◽

Age Related ◽

Anatomical Outcomes ◽

Number Of Injections

Purpose. To determine the effect of epiretinal membranes (ERM) on the treatment response and the number of intravitreal bevacizumab injections (IVB) in patients with neovascular age-related macular degeneration (nAMD).Methods. A retrospective chart review was performed on 63 eyes of 63 patients. The patients were divided into AMD group (n=35) and AMD/ERM group (n=28). Best corrected visual acuity (BCVA) and central retinal thickness (CRT), as well as the number of injections, were evaluated.Results. There was a significant improvement in BCVA at 3 months for the AMD and AMD/ERM groups (P=0.02,P=0.03, resp.). At 6, 12, and 18 months, BCVA did not change significantly in either of the groups compared to baseline (P>0.05for all). At 3, 6, 12, and 24 months, the AMD group had an improvement in BCVA (logMAR) of 0.09, 0.06, 0.06, and 0.03 versus 0.08, 0.07, 0.05, and 0.03 for the AMD/ERM group (P=0.29,P=0.88,P=0.74,P=0.85, resp.). A significant decrease in CRT occurred in both groups for all time points (P<0.001for all). The change in CRT was not statistically different between the two groups at all time points (P>0.05for all). The mean number of injections over 24 months was 8.8 in the AMD group and 9.2 in the AMD/ERM group (P=0.76).Conclusion. During 24 months, visual and anatomical outcomes of IVB in nAMD patients were comparable with those in nAMD patients with ERM with similar injection numbers.

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Telephone-Delivered Dietary Intervention in Patients with Age-Related Macular Degeneration: 3-Month Post-Intervention Findings of a Randomised Controlled Trial

Nutrients ◽

10.3390/nu12103083 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3083

Author(s):

Diana Tang ◽

Paul Mitchell ◽

Gerald Liew ◽

George Burlutsky ◽

Victoria M. Flood ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Macular Degeneration ◽

Controlled Trial ◽

Age Related Macular Degeneration ◽

Leafy Vegetables ◽

Secondary Outcome ◽

Post Intervention ◽

Age Related ◽

Significant Difference ◽

Randomised Controlled

There is an evidence–practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 ± 8 years; control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar’s test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings ± SE) of total vegetables (primary outcome) and other key food groups; however, there was a significantly higher intake of nuts (secondary outcome) (3.96 ± 0.51 vs. 2.71 ± 0.32; p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 ± 0.17 vs. 1.71 ± 0.22; p = 0.003) and legumes (0.69 ± 0.10 vs. 1.12 ± 0.16; p = 0.02) and intake of sweets and processed/prepared foods (8.31 ± 0.76 vs. 6.54 ± 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.

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