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A. Korotkin, I. Kozak, V.L. Morrison, L. Magana, W.R. Freeman; An Emerging Problem: Recurrence of CNV in AMD is Common After Cessation of 24 Month Treatment With Ranibizumab (Lucentis®) . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2961.
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Ranibizumab (Lucentis®) is a Fab fragment of a humanized monoclonal antibody to VEGF currently under investigation for the treatment of choroidal neovascularization (CNV) in AMD. Recent 12 month results from a ranibizumab trial using monthly intravitreal injections for 24 months demonstrated an average 17 letter difference between drug treated and control groups, with 25 to 34% of patients in the treated group gaining 15 letters or more. Two–year data have not been announced. In addition, the long–term outcome of patients after they discontinue treatment with Ranibizumab is not known.
We treated 7 patients with Ranibizumab for two years. At the conclusion of treatment we observed the patients’ ETDRS visual acuity, fluorescein angiograms (FA), OCT, and fundus exams for stability after discontinuation of ranibizumab.
There were three documented reactivations of CNV (documented by decreased visual acuity, fundus photographs, or OCT) after an average of 6.2 months after the last ranibizumab injection. Ranibizumab was then restarted and a clinical response was seen.
Ranibizumab treatment results in regression of CNV manifest by resorption of sub–retinal fluid and decreased leakage on FA. Despite 24 months of monthly treatments CNV activity recurred in a significant proportion of patients after cessation of treatment. We conclude that CNV is a chronic process and while clinical response is seen during the period that VEGF is sequestered the underlying stimulus and disease process may persist resulting in recurrence of CNV after cessation of treatment in a significant proportion of patients.
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