Comparative Study of Intravitreal Bevacizumab (Avastin) versus Ranibizumab (Lucentis) in the Treatment of Neovascular Age-Related Macular Degeneration

Abstract

Aims: To compare the safety and efficacy of 2 anti-vascular-endothelial-growth-factor agents – bevacizumab (Avastin) versus ranibizumab (Lucentis) – in the treatment of patients with neovascular age-related macular degeneration (AMD). Methods: Retrospective analysis of patients who received intravitreal injections of bevacizumab or ranibizumab for neovascular AMD. Primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) assessed by Spectral Domain scanning laser ophthalmoscope-optical coherence tomography (SD-OCT). A secondary outcome measure was the report of any adverse events in the 2 groups. Results: The number of injections in the bevacizumab group was 184 (average of 4.7 per eye) compared to 187 in the ranibizumab group (average of 5.5 per eye). The mean logMAR equivalent of BCVA at 1 month after the injection improved by 0.18 in the bevacizumab group (p = 0.009) and by 0.13 in the ranibizumab group (p = 0.004). The average SD-OCT CFT decreased from 325 ± 72 to 300 ± 69 μm in the bevacizumab group (p = 0.016) and from 307 ± 57 to 289 ± 56 μm in the ranibizumab group (p = 0.017). In the bevacizumab group, there was 1 event of lower extremity pain (0.54%) and 1 event of increased arterial blood pressure (0.54%). In the ranibizumab group, there were 2 events of transiently increased intraocular pressure (1.1%) and 1 event (0.53%) of intraocular inflammation following injection. Conclusions: Bevacizumab and ranibizumab treatments resulted in similar gains in visual acuity and reduction in macular thickness, documented each month following injection. Intravitreal bevacizumab appears to be as safe and effective as intravitreal ranibizumab in the treatment of exudative AMD.

Predictors of response after intravitreal bevacizumab injection for neovascular age-related macular degeneration

“…Although there are no wellknown trials with bevacizumab, recent studies have shown that the clinical outcomes of intravitreal bevacizumab injections are similar to those of well-conducted trials of intravitreal ranibizumab injections in neovascular AMD. [10][11][12] In this regard, we have been treating patients with intravitreal bevacizumab injections based on the OCT-guided variabledosing regimen protocol suggested by the PrONTO study. However, clinical results in our patients have been quite different to those reported in either the MARINA or the ANCHOR trials.…”

High-Molecular-Weight Aggregates in Repackaged Bevacizumab

“…2 Although the use of intravitreal bevacizumab (IVB) for ocular disease did not go through the Food and Drug Administration approval process, published reports suggest that it is safe and apparently effective at treating wet age-related macular degeneration. 3,4 Despite the apparent safety profile of both IVB and ranibizumab, there have been recent reports of elevated intraocular pressure (IOP) after single or multiple injections of either agent. [5][6][7][8] The number of reported cases of IOP spikes has, overwhelmingly, involved IVB prepared in plastic syringes by one or more repackaging formularies with fewer cases involving ranibizumab obtained directly from the manufacturer.…”

Intravitreal Bevacizumab Treatment for Exudative Age-Related Macular Degeneration With Good Visual Acuity

“…Mean initial IOP was 14.2 ± 2.4 mmHg (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and mean final IOP was 14.3 ± 2.45 mmHg (10-22) (P = 0.94, one-way ANOVA). Four eyes (2 with juxtafoveal CNV and 2 with subfoveal CNV), acquired either glaucoma or ocular hypertension, with an IOP between 22 mmHg and 28 mmHg at diagnosis (mean …”