By Cameron Johnston
FT. LAUDERDALE, Fla. -- April 28, 2008 -- There appear to be few meaningful differences other than price between the vascular endothelial growth factor inhibitors ranibizumab and bevacizumab -- at least in the short term.
Researchers presented the results of a retrospective review of patient charts in a poster presentation here at the Association for Research in Vision and Ophthalmology (ARVO) 2008 Annual Meeting.
The researchers observed no clinically relevant or statistically significant differences between the drugs when used to treat choroidal neovascularisation secondary to age-related macular degeneration (AMD).
Investigator Frances Cosgrove, MD, Resident, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, presented the review on April 27.
The review analysed outcomes for 50 eyes from 42 patients who were treated with intravitreal bevacizumab (1.25 mg) and 25 eyes from 24 patients who received 0.5-mg intravitreal injections of ranibizumab. Repeat injections were administered when the patient had a prespecified loss of visual acuity or when there was leakage seen on optical coherence tomography or with fluorescein angiography.
No significant differences were evident in baseline characteristics between patients in either group. Mean ages were 78.4 years in the bevacizumab group and 76.4 years in the ranibizumab group, which were high when compared with patients involved in other AMD studies, Dr. Cosgrove noted.
Over 10.8 months of follow-up, patients received a mean of 3.14 injections of bevacizumab, while patients treated with ranibizumab received 3.28 injections over a mean of 6.9 months of follow-up.
Improvements in visual acuity were seen in both groups but were not significantly different compared with baseline or between the 2 groups. Visual acuity improved from a baseline mean of 20/279 to 20/220 post-treatment for patients treated with bevacizumab, and from 20/269 at baseline to 20/259 post-treatment for patients treated with ranibizumab.
Dr. Cosgrove speculated that at least part of the reason for the less-than-spectacular improvements in visual acuity could be explained by the fact that patients had already been treated with other therapies, including photodynamic therapy, and therefore, they had already experienced some improvements in visual acuity.
Improvements in foveal thickness were also observed, but again, the between-group differences, and pretreatment and post-treatment differences were not statistically significant. Mean foveal thickness for patients treated with bevacizumab decreased from 420 to 351 microns at follow-up, while for patients treated with ranibizumab, mean reductions were from 398 to 320 microns.
No ocular complications such as endophthalmitis, retinal detachment, vitreous haemorrhage, or traumatic cataract formation were seen in either group.
The fact that significantly fewer injections were required for patients in the bevacizumab group suggests that this may be a longer-acting drug, Dr. Cosgrove said.
"Bevacizumab appears to be as safe as ranibizumab for the treatment of neovascularisation and age-related macular degeneration, but a larger, prospective study may still be needed to confirm the findings that I am reporting here," she said.
[Presentation title: Comparison of Intravitreal Bevacizumab (Avastin) Vs. Ranibizumab (Lucentis) for Neovascular Age-Related Macular Degeneration (AMD). Poster D637]
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