Periodic injections of bevacizumab more effective than 1 injection in AMD

Periodic injections of bevacizumab (Avastin, Genentech) for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) every 6 weeks resulted in better control of CNV and improved or stabilized best-corrected visual acuity, said Veronica Kon-Jaar, MD, from the Retina Service, Asociation Para Evitar La Ceguera, Hospital "Dr. Luis Sanchez Bulnes," Mexico City, Mexico.

"Choroidal neovascularization secondary to AMD is the leading cause of vision loss in patients older than 60 years of age," Dr. Kon-Jaar said. "Vascular endothelial growth factor (VEGF) increases vascular permeability and bevacizumab binds to all VEGF isoforms and blocks their actions."

While other anti-VEGF agents have controlled disease activity, the number of injections needed to control the production of VEGF has not been established.

Dr. Kon-Jaar and colleagues evaluated the efficacy of bevacizumab in maintaining or improving visual acuity and retinal thickness with re-treatment based on two management protocols. They conducted a prospective, longitudinal, and experimental study in which 14 patients aged 60 to 90 years were included. All patients had CNV that was secondary to AMD and they received an intravitreal injection of 2.5 mg (0.1 ml) of bevacizumab.

The best-corrected visual acuity was measured and fluorescein angiography and optical coherence tomography were performed at baseline and at 6 weeks and 3 months after treatment.

Group 1, which was treated with one injection according to clinical signs of activity, included five eyes of five patients (two men, three women; mean age, 77.2 ± 4.54 years). Two patients were excluded because of missing follow-up. In group 2, which included five eyes of five patients (three men, two women; mean age, 78.6 ± 8.88 years), the patients were treated every 6 weeks three times. Two patients were excluded because of missing follow-up.

"Although one injection controlled CNV, three injections showed a greater improvement and stabilization of visual acuity (p = 0.085 compared with p = 0.59). The mean retinal thickness decreased significantly (p ± 0.05) in both groups during the study," Dr. Kon-Jaar reported. No complications developed during the study. The 2.5-mg dose of bevacizumab appears to be well tolerated.

Periodic injections of bevacizumab every 6 weeks according to an established algorithm results in better control of CNV and improved or stabilized best-corrected visual acuity.