Avastin Doesn't Blind People, People Blind People

González, Serafín Vegas; Rosenfeld, Philip J.; Stewart, Michael W.; Brown, Jane Κ.; Murphy, Steven P.

doi:10.1016/j.ajo.2011.11.023

Cited by 88 publications

(81 citation statements)

References 23 publications

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“…18 Noncompliance with recognized standards and poor aseptic technique from the compounding pharmacies were accounted responsible for these outbreaks, and strict adherence to the US Pharmacopeia Chapter 797 requirements was strongly recommended. 19 Active external infection, including significant blepharitis, should be treated before injection. In addition, eyelid abnormalities such as ectropion are reported as risk factors for endophthalmitis and should be considered.…”

Section: Methodsmentioning

confidence: 99%

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

Falavarjani

Nguyen

2013

Eye

736

505

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Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases, including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with systemic adverse events and devastating ocular complications. In this review, we provide an overview of safety data for intravitreal injection of common anti-VEGF agents.

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Section: Methodsmentioning

confidence: 99%

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

Falavarjani

Nguyen

2013

Eye

736

505

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“…Recent well-publicized infectious outbreaks from compounded ophthalmic and non-ophthalmic medications, including bevacizumab, methylprednisolone and betamethasone, have resulted in significant morbidity and mortality to patients [5,6,12]. As a result, compounding pharmacies have come under intense scrutiny, and in September 2011 VA Hospitals discontinued the use of compounded bevacizumab.…”

mentioning

confidence: 99%

“…A meta-analysis of endophthalmitis cases after anti-VEGF injections between 2005 and 2009 reported a rate of 0.049% [4]. Recent endophthalmitis outbreaks due to contaminated compounded bevacizumab have heightened physicians' fears of this devastating complication [5,6]. Should bilateral injections be administered?…”

mentioning

confidence: 99%

“…As a result, compounding pharmacies have come under intense scrutiny, and in September 2011 VA Hospitals discontinued the use of compounded bevacizumab. If a compounding pharmacy is used, providers need to ensure that the pharmacy adheres to the US Pharmacopeia, chapter 797 sterile preparation guidelines and performs sterility testing (which is actually not required by the USP 797 but is the last line of defense against contamination) [5]. It is also prudent to use vials from different medication lots for each eye, in order to mitigate the risk of giving potentially contaminated vials or aliquots in both eyes.…”

mentioning

confidence: 99%

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Safety of bilateral intravitreal injections delivered in a teaching institution

Chao

Gregori

Khandji

et al. 2014

Expert Opinion on Drug Delivery

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“…Its lower cost of treatment, approximately $40 per dose compared with approximately $2000 per dose for ranibizumab, largely explains its more frequent widespread use over the latter. 2 Paradoxically, despite the increasing number of indications and patients under anti-VEGF treatment, the price of ranibizumab has barely declined. Moreover, although the content of a single-dose vial of ranibizumab is two to three times larger than that needed for single use, due to the dead space in the tuberculin syringe, a significant portion of the drug is unused and wasted.…”

mentioning

confidence: 99%

More on a patient-centric approach in the anti-VEGF therapy

Grzybowski

Ascaso

2012

Eye

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Sir, More on a patient-centric approach in the anti-VEGF therapy We read the article by Brand 1 with interest; however, we believe that the role of bevacizumab was underestimated in the patient-centric approach of retinal vascular diseases treatment. In fact, although bevacizumab has not been authorised by any Health Authority worldwide, its off-label use for a variety of chorioretinal disorders has gained global acceptance, and now it is the most commonly used anti-VEGF drug all over the world. Its lower cost of treatment, approximately $40 per dose compared with approximately $2000 per dose for ranibizumab, largely explains its more frequent widespread use over the latter. 2 Paradoxically, despite the increasing number of indications and patients under anti-VEGF treatment, the price of ranibizumab has barely declined. Moreover, although the content of a single-dose vial of ranibizumab is two to three times larger than that needed for single use, due to the dead space in the tuberculin syringe, a significant portion of the drug is unused and wasted.Similarly, the 2-year CATT study 3 results have recently reported the non-inferiority of bevacizumab as compared with ranibizumab, providing the first-level 1 evidence for the use of bevacizumab in most people with neovascular AMD who will never have the opportunity to receive ranibizumab because of cost. This is particularly the case for developing countries, in which the high unit cost of ranibizumab over bevacizumab has limited its use after licensing. 4 The real dilemma in these countries is not between ranibizumab and bevacizumab, but between bevacizumab and no treatment. There, people cannot afford the treatment and, in this perspective, bevacizumab seems to be a miracle drug. Therefore, it seems that regulators in certain countries should be forced to reconsider their policies that make it illegal to use drugs off-label, particularly when so many of their citizens cannot afford ranibizumab. 5 With primary-care trusts under financial pressure, an increasing number are considering, allowing ophthalmologists to use the cheaper bevacizumab for certain ocular conditions. This low-cost alternative to ranibizumab would have a rapid impact of reducing incident global blindness, and is certainly an important alternative in the patient-centric approach of retinal vascular diseases treatment. Conflict of interestThe authors declare no conflict of interest. Bevacizumab for neovascular age related macular degeneration (ABC Trial): multicentre randomised double masked study.

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Avastin Doesn't Blind People, People Blind People

Cited by 88 publications

References 23 publications

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

Safety of bilateral intravitreal injections delivered in a teaching institution

More on a patient-centric approach in the anti-VEGF therapy

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