Bevacizumab effective for treatment-na?ve AMD

Liz Meszaros

In patients who have not undergone previous treatment, bevacizumab appears to be a safe and effective treatment for exudative age-related macular degeneration.

Key Points

Philadelphia-In patients who have not undergone previous treatment, bevacizumab (Avastin, Genentech) appears to be a safe and effective treatment for exudative age-related macular degeneration (AMD), said Justin L. Gottlieb, MD, here at the Macula 2011 and Atlantic Coast Retina Club meeting of the Wills Eye Institute.

Dr. Gottlieb, associate professor, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, related that at the University of Wisconsin Retina Service, bevacizumab is used primarily in about 85% of anti-vascular endothelial growth factor (VEGF) treatments for patients with exudative AMD.

"We had a gut feeling that it seemed to be working, but we wanted to find out for sure," he said.

Dr. Gottlieb and colleagues conducted this study to determine whether there was visual acuity (VA) improvement, stabilization, or decrease in eyes with exudative AMD that were treated with bevacizumab monotherapy. Secondarily, they sought to determine if there were reductions in maximum retinal thickness (MRT) or in subretinal fluid (SRF) thickness with bevacizumab monotherapy in these patients.

For this retrospective review, Dr. Gottlieb and colleagues reviewed the billing records of all patients who received bevacizumab at the University Station Clinic and Rockford Clinic. In all, 80 eyes of 77 patients were included. Patients must have had no previous interventional therapy with thermal laser, photodynamic therapy, or ranibizumab (Lucentis, Genentech). Patients were followed up for a minimum of 36 weeks, and cross-hair optical coherence tomography (OCT) scans (Stratus OCT, Carl Zeiss Meditec) were obtained during this time.

At 6 weeks, mean logMAR VA was 0.73 (20/107), for a change of 0.15 from a mean baseline VA of 0.88 (20/160) (95% CI; range: 0.07 to 0.22; p = 0.0001). At week 12, mean VA was 0.71, a change of 0.17 from baseline (95% CI; range: 0.09 to 0.24; p < 0.0001). By week 48, in the 48 remaining patients, mean VA was 0.76 (20/115), a change of 0.12 from baseline (95% CI; range: 0.03 to 0.21; p = 0.01).

MRT was also measured at baseline (mean, 376 µm) and at weeks 6 through 48. At week 6, mean MRT was 251 µm, a change of 126 µm from baseline (95% CI; range: 90 to 161; p < 0.0001). By week 48, mean MRT was 285 µm, a change of 91 µm from baseline (95% CI; range: 58 to 124; p < 0.0001).

SRF measurements were also done from baseline through week 48. At week 6, mean SRF was 14 µm, compared with 25 µm at baseline (95% CI; range: –8 to 29; p = 0.24). By week 48, mean SRF was 19 µm (95% CI; range: –11 to 23; p = 0.50).

Neither changes in VA nor reductions in MRT were dependent on age or gender.

"While the improvement of VA was not statistically significant for baseline VA better than 20/200, the reduction of MRT was statistically significant for baseline VA better than 20/200," Dr. Gottlieb explained. "This implies that bevacizumab is effective in this group.

"In conclusion, bevacizumab monotherapy appears to be an effective treatment of exudative AMD, with improvements in visual acuity and statistically significant reductions in retinal thickening," he continued. "There was also a trend to reduce subretinal fluid with treatment."