Managing neovascular AMD: PACORES results

The Pan-American Collaborative Retina Study (PACORES) tested the efficacy of bevacizumab (Avastin, Genentech) in treating choroidal neovascularization (CNV) in patients with age-related macular degeneration using an open-label, uncontrolled study design. J. Fernando Arévalo, MD, FACS, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela, described the trial.

In PACORES, eyes were injected intravitreally with either 1.25 or 2.5 mg of bevacizumab. The drug had been found to be safe and well tolerated during the first 4 months during which a total of 4,300 injections were administered.

A retrospective study of the short-term anatomic response and best-corrected visual acuity (BCVA) in 87 consecutive patients (92 eyes) was later conducted. The mean follow-up was 6.8 months, and the mean patient age was 75.6 years. Fifty-four eyes were treated with the 2.5-mg dose and 38 eyes with the 1.25-mg dose. Compared with the baseline BCVA of 1.25 logMAR, the mean final BCVA was 1.0 logMAR (p

Dr. Arévalo also reported that 33 eyes (35.9%) maintained stable vision, 46 eyes (50%) had an improvement of two or more ETDRS lines of BCVA, and 13 eyes (14.1%) had a decrease of two or more lines of BCVA. Optical coherence tomography showed that the mean central macular thickness decreased from the baseline 345.1 microns to the mean final thickness of 257.8 microns (p

Fifty percent of eyes required a second injection of bevacizumab at a mean of 9.4 weeks after the first injection, 15 eyes required a third injection at a mean of 9.2 weeks, and 10 eyes needed four of more injections.

"Although these results are promising and re-injections may be necessary, follow-up is still too short to make any specific treatment recommendations," Dr. Arévalo stated. "A multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to evaluate the efficacy of this new treatment."

The 12-month data from the trial is expected to be presented at the Pan-American Congress of Ophthalmology in Cancun, Mexico, in June 2007.