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Jose Luna Pinto, Juan Real, Julio Urrets-Zavalia, Claudio Juarez, Santiago Palma, Gladys Granero; Bevacizumab and ranibizumab in exudative age-related macular degeneration: Is the effectiveness conditioned by accessibility?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3798.
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To evaluate different accessibilities to NV-AMD treatment in clinical practice and estimate their impact on therapeutic effects and visual outcome.
A retrospective analysis of the charts of 78 patients (96 eyes) with previously untreated exudative AMD, who were treated with ranibizumab (RNB) or bevacizumab (BVZ) between January 2009 and December 2011, was conducted. The main outcomes measured included time delay and change in mean best-corrected visual acuity (BCVA) between diagnosis and treatment, annual mean number of injections and follow-up examinations and the major clinical outcomes (mean BCVA change and proportion of patient who lost <15 letters and proportion of patients who gained > 15 letters) at 1 year of follow-up
Both studied groups showed a statistically significant reduction in BCVA (p <0.01) over the delay time between diagnostic and treatment. This delay time and the decrease in visual acuity in this period were significantly higher for patients treated with Ranibizumab than those one treated with Bevacizumab (153.8 vs. 36.06 days, p<0.0001), (-13.01 vs. -5.46 letters, p<0,01). After initial loading phase, there was a significant improvement in visual acuity for both groups with a non-significant difference in favor of BVZ (+10.06 vs. +6.27 letters p=0.097). During the maintenance phase, both groups showed a significant decrease of follow-up examinations and a drop in BCVA in this period. Throughout the year of treatment, BVZ-group received significantly more injections than RNB-group (4.71 vs 2.98 p <0.0001) and also had better clinical outcomes (+0.11 vs -8-87 letters p<0.04)
The access to treatment, conditioned by bureaucratic aspects, can be a key factor for success of therapy. In this sense, using off-label BVZ was the option to get best results. However it is not the drug itself which is the most important factors, its accessibility when a dose is required.
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