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C. H. Barnes; Efficacy and Safety of Intravitreal (IVT) Bevacizumab Induction and Pegaptanib Sodium Maintenance in Patients with Neovascular Age-Related Macular Degeneration (NV-AMD). Invest. Ophthalmol. Vis. Sci. 2007;48(13):3371.
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To assess the efficacy and safety of IVT bevacizumab induction and pegaptanib maintenance in patients with NV-AMD.
Records of NV-AMD patients from an office-based retina specialty practice were reviewed. Included in the analysis were those who received ≥1 IVT bevacizumab injection as induction and at least 2 injections of pegaptanib as maintenance regardless of previous therapies; ≥3 months of follow-up was required. Patients had received at least 1, 1.25-mg dose of bevacizumab at the initial visit and maintenance 0.3-mg pegaptanib according to label at 6-week intervals. Pegaptanib was initiated 6 weeks after bevacizumab induction. Additional bevacizumab injections (or ranibizumab after FDA approval) were administered as booster therapy at investigator discretion when retinal thickness increased or when visual acuity (VA) worsened. In patients with bilateral disease, both eyes were treated. VA (Snellen) was measured and optical coherence tomography was performed at baseline and every injection visit.
Eighty-eight patients have been treated (mean follow-up, 8.4 months) with an average of 1.1 injections of bevacizumab (induction) and 3.7 of pegaptanib (maintenance; range, 2-7); 32/88 (36%) received booster therapy with bevacizumab and/or ranibizumab (mean, 1.7 bevacizumab and 0.1 ranibizumab injections/patient). Mean VA improved from 43.8 letters at baseline to 49.2 letters following induction and was 50.3 letters at last measurement. Loss of <3 and <0 lines of VA occurred in 89% and 83% of patients, respectively; gains of ≥3 letters was seen in 33%. Mean retinal thickness decreased from 312 microns at baseline to 251 microns following induction and was 252 microns at last measurement. Similar improvements were seen in the analysis of the subset of 32 patients who received ≥1 bevacizumab postinduction booster. Postinjection side effects were transient; no endophthalmitis, retinal detachment, or any other serious side effects occurred.
Bevacizumab induction followed by pegaptanib maintenance appears to be a promising cost-effective therapy for patients with NV-AMD. Randomized controlled trials are needed to confirm these findings.
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