Bevacizumab and ranibizumab tachyphylaxis in the treatment of choroidal neovascularisation

Abstract

Patients with CNV who develop tachyphylaxis to ranibizumab or bevacizumab may respond to another anti-VEGF drug. The majority of cases (81%) in this series demonstrated at least some response after switching therapies.

Defining response to anti-VEGF therapies in neovascular AMD

“…This is depicted by the scans of the patient shown in Figure 1 in the report by Gasperini et al 59 It is suggested that many such eyes may respond favourably to a change of in the anti-VEGF agent used. 59 Others have referred to a lack of response to anti-VEGF drugs at the time of reactivation of CNV that was previously responsive to that drug as 'tachyphylaxis'. Tachyphylaxis was thought to occur in 2% when treatment was given for recurrent CNV.…”

“…It has been suggested that reduced response, presumed 'tachyphylaxis' may occur as early as after 2 anti-VEGF injections while others occurred after 10 injections. 45,[55][56][57][58][59] However, some cases of alleged tachyphylaxis may represent poor or suboptimal response to treatment, rather than true tachyphylaxis. This is depicted by the scans of the patient shown in Figure 1 in the report by Gasperini et al 59 It is suggested that many such eyes may respond favourably to a change of in the anti-VEGF agent used.…”

“…45,[55][56][57][58][59] However, some cases of alleged tachyphylaxis may represent poor or suboptimal response to treatment, rather than true tachyphylaxis. This is depicted by the scans of the patient shown in Figure 1 in the report by Gasperini et al 59 It is suggested that many such eyes may respond favourably to a change of in the anti-VEGF agent used. 59 Others have referred to a lack of response to anti-VEGF drugs at the time of reactivation of CNV that was previously responsive to that drug as 'tachyphylaxis'.…”

Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD

“…Tachyphylaxis has been discussed to be important in the development of a resistance to intravitreal injections. 16,17 However, the mechanisms are not clear. In some cases, high doses of ranibizumab (2.0 mg opposed to the regularly used 0.5 mg) could yield a response in patients with persisting SRF or IRF under monthly injections of ranibizumab.…”

“…Gasperini et al 16 reported on 26 nonresponders, defined as no improvement in sub-or intraretinal fluid, or pigment epithelium detachment. Eight of ten patients responded (ie, total or partial resolution of fluid in OCT) after switching to ranibizumab.…”