Tachyphylaxis After Intravitreal Bevacizumab for Exudative Age-Related Macular Degeneration

Abstract

Purpose To describe tachyphylaxis to intravitreal bevacizumab (IVB) in patients with exudative age-related macular degeneration (AMD). Methods We retrospectively reviewed the records of 59 consecutive patients treated with IVB at the National Eye Institute over a 14 month period, and identified cases demonstrating loss of treatment efficacy as revealed by spectral domain optical coherence tomography. We defined tachyphylaxis as a loss of therapeutic response to IVB 28±7 days after administration in an eye which had previously demonstrated a therapeutic response in the same time interval. Results Five patients (6 eyes) were identified as developing tachyphylaxis following repeated treatment with IVB. High-dose IVB (2.50mg) did not restore therapeutic response in these patients. Bilateral tachyphylaxis to IVB was seen following an episode of unilateral post-injection anterior uveitis. After the first treatment of IVB, the median time taken to develop tachyphylaxis was 100 weeks (range: 31-128 weeks), and the median number of IVB treatments to the development of tachyphylaxis was 8 treatments (range: 5-10). Conclusion Tachyphylaxis can occur following long-term intravitreal use of bevacizumab in patients with AMD. The precise mechanism of tachyphylaxis is unclear, but both local and/or systemic factors may be involved.

Defining response to anti-VEGF therapies in neovascular AMD

“…It has been suggested that reduced response, presumed 'tachyphylaxis' may occur as early as after 2 anti-VEGF injections while others occurred after 10 injections. 45,[55][56][57][58][59] However, some cases of alleged tachyphylaxis may represent poor or suboptimal response to treatment, rather than true tachyphylaxis. This is depicted by the scans of the patient shown in Figure 1 in the report by Gasperini et al 59 It is suggested that many such eyes may respond favourably to a change of in the anti-VEGF agent used.…”

Terapia antiangiogênica associada à fotocoagulação a laser no tratamento de membrana neovascular sub-retiniana: relato de caso

“…O tratamento com injeções intraví-treas de agentes antiangiogênicos trouxe novas perspectivas para o manejo da forma exsudativa da doença. Embora estudos tenham demonstrado o ganho de mais de uma a duas linhas de AV e preservação visual em comparação a valores basais pré-tratamento (9) , seu sucesso exige diversas aplicações; o que aumenta o risco global do tratamento, eleva seu custo e pode levar à perda da sua eficácia a longo prazo (10) . A TFC aplicada no presente caso agiu como importante fator adjuvante no controle da doença.…”

Clinical Application of Drug Delivery Systems for Treating AMD

“…It has been reported that 8.5% (5 of 59 patients) of wet AMD patients who received repeated intravitreal injections of bevacizumab developed tachyphylaxis (Forooghian et al, 2009). The median time to develop tachyphylaxis after the first bevacizumab injection was 100 weeks with a median of 8 injections before tachyphylaxis development.…”