Comparison of Combined Bevacizumab plus Dexamethasone Vs. Ranibizumab Monotherapy as First-Line Therapy in Patients with Treatment Naive Neovascular Age-Related Macular Degeneration in Real-Life Clinical Practice: A Retrospective Case-Series Analysis

Abstract

Purpose: To identify the differences between combination bevacizumab plus dexamethasone and ranibizumab in treatment naïve neovascular age-related macular degeneration in terms of functional/morphological outcomes and number of injections when evaluated in real-life clinical practice. Methods:We compared two groups of patients either receiving intravitreal bevacizumab (1.25 mg) plus dexamethasone sodium phosphate (0.2 mg) or intravitreal ranibizumab (0.5 mg) over a 12 month period. The former, Group A, received treatment at baseline and followed a pro re nata (PRN) regimen. The latter, Group B, received treatment at baseline followed by two additional monthly injections as per the universally accepted protocol whilst continuing treatment on PRN regimen thereafter. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp fundus examination and central macular thickness (CMT) via optical coherence tomography (OCT) were recorded at the initial visit (Baseline, BSL) and at each subsequent follow-up visit.Results: CMT at BSL was 362.8 ± 45.4 μm in Group A and 358.3 ± 47.2 μm in Group B. At the end of the data analysis, CMT was improved substantially in both groups (246.1 ± 42.4 μm in Group A, 254.9 ± 21.2 μm in Group B), while BCVA improved as well (From 0.87 ± 0.15 logMAR to 0.48 ± 0.15 in Group A, from 0.81 ± 0.20 logMAR to 0.52 ± 0.10 in Group B). Group A received 248 injections, whereas Group B received 313. Conclusion:Combination treatment with DSP and bevacizumab provided the same efficacy and allowed a statistically significant reduction in the frequency of injections compared with ranibizumab monotherapy.

Biological drug therapy for ocular angiogenesis: Anti‐VEGF agents and novel strategies based on nanotechnology

“…Moreover, these therapies appeared as an alternative to laser surgery and chronic corticosteroid use, which can induce raise of the intraocular pressure and cataracts 60,61 . Currently, corticosteroids are widely used as co‐treatment to antiangiogenic therapy for ocular angiogenesis disorders 27,62 …”

“…60,61 Currently, corticosteroids are widely used as co-treatment to antiangiogenic therapy for ocular angiogenesis disorders. 27,62 In the design and the development of a BD product, different factors should be taken into account due to their large size, high structural complexity, and limited stability. 35 BD are susceptible to physical and chemical degradation, which directly impact their structure and function and, consequently, their efficacy.…”