Intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) for the treatment of age-related macular degeneration: a safety review

Schmucker, Christine; Loke, Yoon K.; Ehlken, Christoph; Agostini, Hansjuergen; Hansen, Lutz L.; Antes, Gerd; Lelgemann, Monika

doi:10.1136/bjo.2009.178574

Cited by 71 publications

(69 citation statements)

References 45 publications

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“…25,46 The rates of any cause of deaths, myocardial infarctions, and cerebrovascular events were not significantly increased. 46 Considering the limited details concerning the systemic adverse events associated with intravitreal bevacizumab reported within the articles, the data regarding the systemic safety of intravitreal bevacizumab are less conclusive. In comparison with the ranibizumab clinical trials, intravitreal bevacizumab injections may or may not be associated with an increased risk of nonocular hemorrhage.…”

Section: Methodsmentioning

confidence: 99%

“…25 Although the primary ranibizumab trials individually did not show a significant increase in systemic risks and the overall incidence of systemic adverse events was low, other studies suggest a potential increase in rates of systemic diseases associated with ranibizumab injection, especially in elderly patients. [44][45][46] Intraocular injection of ranibizumab was linked to a significant increase in nonocular hemorrhagic events, including ecchymosis, gastrointestinal hemorrhages, hematoma, vaginal hemorrhages, and subdural hematomas. 25,46 The rates of any cause of deaths, myocardial infarctions, and cerebrovascular events were not significantly increased.…”

Section: Methodsmentioning

confidence: 99%

“…[44][45][46] Intraocular injection of ranibizumab was linked to a significant increase in nonocular hemorrhagic events, including ecchymosis, gastrointestinal hemorrhages, hematoma, vaginal hemorrhages, and subdural hematomas. 25,46 The rates of any cause of deaths, myocardial infarctions, and cerebrovascular events were not significantly increased. 46 Considering the limited details concerning the systemic adverse events associated with intravitreal bevacizumab reported within the articles, the data regarding the systemic safety of intravitreal bevacizumab are less conclusive.…”

Section: Methodsmentioning

confidence: 99%

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

Falavarjani

Nguyen

2013

Eye

737

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%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Falavarjani

Nguyen

2013

Eye

737

505

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“…The basis of systemic safety concern roots from the known risk of serious adverse events associated with intravenous anti-VEGF therapy used in cancer patients, evidence of systemic absorption after intraocular anti-VEGF injections (28), and possible safety signals from large epidemiological studies of age-related macular degeneration (29)(30)(31). Potential adverse effects of systemic VEGF blockade that are particularly worrisome for diabetic patients include hypertension, proteinuria, impaired wound healing, and critical vascular responses to ischemia (32).…”

Section: Safetymentioning

confidence: 99%

Ocular Anti-VEGF Therapy for Diabetic Retinopathy: Overview of Clinical Efficacy and Evolving Applications

2014

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Ocular anti-vascular endothelial growth factor (VEGF) therapy represents one of the most significant advances in modern medicine. The introduction and widespread use of ocular anti-VEGF therapy for age-related macular degeneration heralded a new era in the treatment of vascular and exudative diseases of the retina. Its expanding indications now include diabetic macular edema and proliferative diabetic retinopathy, two vision-threatening forms of diabetic retinopathy. It is widely anticipated that ocular anti-VEGF therapy could spark a dramatic shift in the treatment paradigm for diabetic retinopathy. However, despite its clear efficacy shown in clinical trials, the dynamic landscape of evolving medical, ethical, and economic issues related to this new treatment suggests significant challenges ahead. In this article, we provide a discussion of this topic as part of this two-part Bench to Clinic narrative. Here, our Clinic contribution provides an overview of the current evidence from clinical trials on anti-VEGF therapy for diabetic retinopathy, and highlights the hopes and fears of this new treatment from clinical and public health standpoints. In the Bench narrative that precedes this contribution, Simó et al. provide an overview of the role of VEGF in the pathogenesis of diabetic retinopathy.

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“…[5][6][7][8] Since the introduction of the anti-VEGF antibodies bevacizumab (Avastin ® ) and ranibizumab (Lucentis) for the treatment of ARMD, ophthalmologists have used these anti-VEGF for the treatment of other neovascular ocular diseases, such as proliferative diabetic retinopathy, diabetic macular edema (DME), and cystoid macular edema (CME). [8][9][10][11] Even though the rates of serious ocular adverse events are low, in the range of 1-2 %, 8,9 the increased use of these drugs has meant an number of cases with significant serious side effects. Intravitreal injection with an anti-angiogenic drug is accomplished by anesthetizing the patient locally with an injection of lidocaine or a topical anesthetic, followed by the injection of the anti-VEGF, usually infero-temporally, 3.5 to 4 mm posterior to the limbus through the pars plana.…”

mentioning

confidence: 99%

A Novel Avastin Injection Technique—“Sunalp Protocol”

Sunalp¹,

Buchbinder²,

Shehu³

2015

US Ophthalmic Review

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Purpose: The introduction of vascular endothelial growth factor (VEGF) inhibitors began a new era in the treatment of exudative age-related macular degeneration (ARMD). These drugs are effective at suppressing choroidal neovascularization (CNV) resulting in improvement or stabilization of visual acuity; however, the chronic nature of the disease require these drugs be administered periodically (usually monthly) for the life of the patient. Since intravitreal injections are administered through the sclera, there is the possibility of adverse events, such as vitreous hemorrhage, endophthalmitis, retinal tears, or retinal detachment. To avoid some of the adverse events associated with intravitreal delivery via the scleral route we have developed a technique to deliver bevacizumab (Avastin ® ) into the vitreous cavity in pseudophakic eyes via a corneal route. Methods: A 27-gauge, 5 mm angled cannula attached to a 1.0 ml syringe is fitted into an 11 o'clock limbal incision and advanced through the anterior and posterior chamber. The cannula is maneuvered through the zonules into the vitreous and 0.1 ml of Avastin is delivered behind the lens into the vitreous cavity. The procedure was performed in 50 eyes (Addendum 1: 499 injections 2014-2015), of five exudative ARMD patients, 21 diabetic macular edema (DME) patients, two cystoid macular edema (CME) patients, and one central retinal vein occlusion (CRVO) patient. Visual acuity (VA), edema, optical coherence tomography (OCT), and endothelial cell counts were performed 1 day following Avastin administration. VA was also determined in 16 eyes at 1 month after Avastin administration. Results: At 1 day post-Avastin administration, vision acuity and edema index improved or remained stable in all eyes, with the exception of one eye from an exudative ARMD patient whose vision deteriorated. At 1 month the average visual acuity in 16 eyes was also significantly improved. The improvement in edema was evident through retinal OCTs. No change in endothelial cell counts was observed. Conclusions: Administration of Avastin via an anterior chamber route in pseudophakic (Addendum 2: Phakic eyes were also treated with no cataract formation) patients is effective for the treatment of exudative ARMD, DME, CME and CRVO, minimizing the possible adverse events related to the administration by the traditional scleral route.In addition, anterior segment administration allows the ophthalmologist to directly observe the delivery of the drug with microscope precision.Pars plana injections are usually performed without magnification and no direct visualization. KeywordsAge-related macular degeneration, anterior segment, bevacizumab, choroidal neovascularization, diabetic macular edema, pseudophakic, Compliance with Ethics Guidelines: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patients involved in this study. Sunalp protocol

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Intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) for the treatment of age-related macular degeneration: a safety review

Cited by 71 publications

References 45 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

Ocular Anti-VEGF Therapy for Diabetic Retinopathy: Overview of Clinical Efficacy and Evolving Applications

A Novel Avastin Injection Technique—“Sunalp Protocol”

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