One‐year outcome of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization

Abstract

ABSTRACT.Purpose: To evaluate and compare the 12-month outcomes of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization (CNV). Methods: We retrospectively reviewed the medical records of 46 consecutive, treatment-naive eyes which received intravitreal ranibizumab for subfoveal and juxtafoveal CNV secondary to pathologic myopia with a follow-up of 12 months. Two groups were created according to different initial dosing regimens: group 1 included 25 eyes treated by a single intravitreal injection; group 2 included 21 eyes treated by three consecutive monthly injections. Additional injections were performed if needed. Patients' demographic data, best-corrected visual acuity (BCVA), recurrence of CNV and total number of treatments were recorded and evaluated. Results: There was no significant difference between two groups among baseline demographic data. At 12 months, the mean logMAR BCVA improved from 0.58 to 0.23 in group 1 and from 0.55 to 0.22 in group 2 (both p < 0.001; Wilcoxon signedrank test). The mean logMAR BCVA at 12 months did not differ significantly. The average number of injections was 2.32 (SD 1.22) in group 1 and 3.57 (SD 1.12) in group 2 (p = 0.001; two-tailed t-test). During the follow-up, 17 of 25 eyes in group 1 and 5 of 21 eyes in group 2 received additional injections (p = 0.004). Conclusions: Similar visual improvement was achieved in both groups. Although the eyes with a loading dose of 3 monthly injections required a higher number of total injections over 1 year, there was a much lower rate of retreatment needed.

Long-Term Outcomes of Two Different Initial Dosing Regimens of Intravitreal Ranibizumab Used to Treat Myopic Choroidal Neovascularization

“…However, Yang et al [26] were able to associate CNV recurrence with baseline CNV lesion size in eyes with mCNV treated with bevacizumab given as 1+ PRN. With regard to age, as in the present study, Kung et al [13] found no relationship between the need for retreatment and patient age.…”

“…In their study [14] , the initial regimen (1+ vs. 3+) was not found to affect the need for retreatment or the number of retreatments required (2 ± 2.3 vs. 1.7 ± 2.1). In contrast, in the study by Kung et al [13] , patients treated initially with 1 or 3 monthly ranibizumab injections required 1.32 ± 1.22 or 0.57 ± 1.12 additional injections, respectively, over 1 year of follow-up. This meant that their 1+ PRN group required more additional treatments in the first year, which is similar to our observations (1.27 ± 0.96 and 0.46 ± 0.82).…”

“…Both treatment groups experienced significant visual improvement, suggesting a single initial injection does not compromise visual prognosis, and the effect of multiple anti-VEGF loading doses on visual acuity appears to be minimal [13] . In a similar study comparing the visual outcome of ranibizumab injections given also as 1+ PRN or 3+ PRN, Kung et al [13] also reported no differences in visual acuity between the two groups, but the duration of follow-up was only 1 year. In two studies by the group of Ruiz-Moreno, again no correlation was detected between visual acuity and the starting dosing regimen of bevacizumab 1+ PRN versus 3+ PRN [14] or 2+ PRN versus 1+ PRN [20] .…”

“…This rate, although lower, is in agreement with the rate reported by Ruiz-Moreno et al [14] for 6 years of follow-up, where 38% of the eyes (37/97) needed no retreatment after the initial regimen. In the study by Kung et al [13] , over 1 year of follow-up, the 3+ PRN (ranibizumab) group showed many more patients not needing retreatment (76.2%) than the single-initial-injection group, in which 32% did not require retreatment. Hence, these authors concluded that despite similar visual improvement in the two treatment groups, far fewer patients required retreatment when the loading dose was 3 monthly injections.…”

“…In a study by Ruiz-Moreno et al [18] , initial dosing regimens of 3 monthly injections and a single injection of bevacizumab (Avastin; Genentech, South San Francisco, CA, USA) were compared in patients with mCNV over 1 year. Kung et al [13] also compared these two starting regimens, but with ranibizumab (Lucentis; Novartis Pharma AG, Basel, Switzerland), and follow-up was also limited to 1 year.…”