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M.J. Tolentino, D.M. Misch, A.S. Berger, S.J. Moon; Avastin Enhancement and Macugen Maintenance Therapy for Exudative Age Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5912.
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Pegaptanib Sodium (Macugen) is a VEGF 165 selective inhibitor that has been shown to be efficacious and safe for the treatment of exudative AMD. Bevacizumab (Avastin) is a pan Vascular Endothelial Growth Factor (VEGF) isoform inhibitor that is approved for intravenous use for cancer and is under investigation as an intravitreal drug for the treatment of ocular neovascular disorders. The purpose of this study is to determine if supplemental administration of intravitreal Avastin can enhance the clinical efficacy of intravitreal Macugen and to determine if Macugen can maintain any gain in vision obtained from Avastin injection.
Eight eyes of 8 patients who received one or more prior intravitreal injections of Macugen for exudative age related macular degeneration were given a supplemental injection of Avastin 1–4 weeks after an injection of Macugen. Snellen visual acuity and optical coherence tomography were measured prior to, 1 week after Avastin injection and immediately before subsequent Macugen injections.
1/8 (12.5%) patients developed a worsening of vision, 4/8 (50%) maintained the same vision and 3/8 (37.5%) of patients had an improvement of 1 or more lines of visual acuity. These results were seen 1 week post Avastin injection and results remain stable with subsequent injections of Macugen.
These preliminary results suggest Avastin has the potential to improve vision in patients who have received previous Macugen and that Macugen can be used to maintain these gains. The use of Avastin as a "booster shot" in conjunction with Macugen could potentially minimize the potential toxicity of a pan isoform VEGF inhibitor (Avastin) while taking advantage of the safety profile of a VEGF 165 selective inhibitor ( Macugen)
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