Comparison of outcomes after switching treatment from intravitreal bevacizumab to ranibizumab in neovascular age-related macular degeneration

Kent, Jerrod S.; Iordanous, Yiannis; Mao, Alex; Powell, Anne-Marie; Kent, Shefalee S.; Sheidow, Tom G.

doi:10.1016/j.jcjo.2012.01.003

Cited by 26 publications

(24 citation statements)

References 13 publications

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“…Similar benefits also have been reported after switching from bevacizumab to ranibizumab in AMD with refractory choroidal neovascular membranes. 31,32 However, the increased VEGF levels in patients with DME relative to AMD 33,34 provides further support to the reasoning that increased VEGF inhibition may be of benefit in DME cases refractory to bevacizumab treatment.…”

Section: Discussionmentioning

confidence: 92%

Residual edema evaluation with ranibizumab 0.5 mg and 2.0 mg formulations for diabetic macular edema (REEF study)

Dhoot

Pieramici

Nasir

et al. 2015

Eye

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Purpose To compare the efficacy of ranibizumab 0.5-mg and 2.0-mg intravitreal injections for persistent diabetic macular edema (DME) previously treated with bevacizumab. Methods In all, 43 patients with residual center-involved DME following intravitreal bevacizumab were included in this 12-month prospective, nonrandomized, multicenter study. Enrolled patients received three monthly ranibizumab 0.5-mg injections. At month 3, patients with residual macular edema switched to three monthly injections of ranibizumab 2.0-mg. Assessments included monthly visual acuity and spectraldomain optical coherence tomography. Results Mean visual acuity improved by þ 6.4 letters at month 3 and þ 8.8 letters at month 6. Mean central subfield thickness (CST) decreased by -113 mm at month 3 and -165 mm at month 6. Before enrollment, 29/43 (67.4%) patients showed o10% CST reduction following monthly bevacizumab treatment. After three monthly ranibizumab 0.5-mg injections, 22/29 (75.9%) patients showed 410% reduction in CST, whereas 6 showed o10% reduction. Of these six, three (50%) showed 410% reduction in CST after switching to three monthly ranibizumab 2.0-mg doses. No serious adverse events were observed to month 6. Conclusion Ranibizumab 0.5-mg or 2.0-mg may improve visual and anatomic outcomes in patients with DME who demonstrated minimal or no response to bevacizumab therapy. Moreover, increased dosage of ranibizumab (2.0-mg) may provide additional benefit over ranibizumab 0.5-mg in some patients. However, 2.0-mg ranibizumab is not currently commercially licensed or available.

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Section: Discussionmentioning

confidence: 92%

Residual edema evaluation with ranibizumab 0.5 mg and 2.0 mg formulations for diabetic macular edema (REEF study)

Dhoot

Pieramici

Nasir

et al. 2015

Eye

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“…74,75 In a separate study, patients switching from bevacizumab (Zthree-injection subgroup) to ranibizumab demonstrated a statistically significant improvement in both VA and retinal thickness. 76 These small studies suggest ranibizumab may provide greater benefits on VA than bevacizumab, but larger studies are required to reveal significant efficacy differences in the overall wet AMD population.…”

Section: Implication Of Pharmacological Differences On Clinical Outcomesmentioning

confidence: 99%

Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab

Meyer

Holz

2011

Eye

113

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Three anti-vascular endothelial growth factor (VEGF) therapies are currently used for the treatment of patients with wet age-related macular degeneration (AMD): pegaptanib, ranibizumab, and bevacizumab. Ranibizumab is an antibody fragment approved for the treatment of wet AMD. Bevacizumab is a fulllength antibody registered for use in oncology but unlicensed for wet AMD. However, it is used off-label worldwide not only for wet AMD but also for various other ocular diseases associated with macular edema and abnormal vessel growth. We consider aspects of ranibizumab and bevacizumab in relation to their molecular characteristics, in vitro and in vivo properties, and preclinical safety data. Before 2009, most studies described the shortterm toxicity of bevacizumab in multiple cell types of the eye. Since 2009, an increasing number of studies have compared the properties of ranibizumab and bevacizumab and investigated their impact on retinal cell functioning. Compared with bevacizumab, ranibizumab neutralizes VEGF better at low concentrations, maintains efficacy for longer, and has a higher retinal penetration and potency. Studies in animals demonstrate ranibizumab to be better localized to the injected eye, whereas bevacizumab appears to have a greater effect in the fellow eye. In humans, a localized and systemic effect has been reported for both molecules. In conclusion, overlapping yet distinct pharmacological properties of ranibizumab and bevacizumab indicate that safety or efficacy data from one cannot be extrapolated to the other.

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“…With the growth of the number of patients requiring treatment for wet AMD, there has been great discussion regarding the efficacy and safety of ranibizumab versus bevacizumab [20,21]. The recent results of multicentric randomized controlled trials, like CATT and IVAN [18,19], demonstrated the noninferiority of bevacizumab when comparing both medications and their effect on the VA of patients after 2 years of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…This transition from ranibizumab to bevacizumab provided a unique opportunity to compare each drug in the same patient. This allowed the patients to be used as their own controls, avoiding selection bias [20]. …”

Section: Discussionmentioning

confidence: 99%

Switch from Intravitreal Ranibizumab to Bevacizumab for the Treatment of Neovascular Age-Related Macular Degeneration: Clinical Comparison

et al. 2014

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Objective: To compare outcomes after switching from intravitreal ranibizumab to bevacizumab in neovascular age-related macular degeneration (AMD). Methods: A retrospective review of 110 eyes treated in a 1+PRN (pro re nata) clinical setting with ranibizumab that were switched to bevacizumab. Patients analyzed had at least 3 ranibizumab injections followed by at least 3 bevacizumab injections. Changes in best-corrected visual acuity (BCVA), retinal thickness and frequency of injections were compared. Results: The mean duration of ranibizumab treatment was 18.1 months, followed by 12.2 months of bevacizumab. Mean injection rates per month were similar (0.54 and 0.56 respectively, p = 0.230). There were no significant differences between BCVA at baseline and at the time of the switch (52.4 and 54.8 letters, p = 0.059). After the switch, there was a statistically significant decrease in BCVA to 51.7 letters (p < 0.001). Conclusion: Switching patients to bevacizumab may have a minor negative effect on the initial gain obtained with ranibizumab; however the degenerative history of wet AMD could explain this small variation in visual acuity.

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Comparison of outcomes after switching treatment from intravitreal bevacizumab to ranibizumab in neovascular age-related macular degeneration

Cited by 26 publications

References 13 publications

Residual edema evaluation with ranibizumab 0.5 mg and 2.0 mg formulations for diabetic macular edema (REEF study)

Residual edema evaluation with ranibizumab 0.5 mg and 2.0 mg formulations for diabetic macular edema (REEF study)

Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab

Switch from Intravitreal Ranibizumab to Bevacizumab for the Treatment of Neovascular Age-Related Macular Degeneration: Clinical Comparison

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