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Matthew Manry, James Allison, Grant Michael Comer; Efficacy of Extended Interval Bevacizumab Therapy in Exudative Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5373.
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Exudative age related macular degeneration (eAMD) is most commonly treated with intravitreal anti vascular endothelial growth factor (anti-VEGF) medications. Clinical trials have demonstrated significant efficacy of intravitreal bevacizumab with every 4 week dosing; however, this frequency presents a large burden to the patient and healthcare system. The purpose of this retrospective, observational study is to describe the outcomes of every 7 week dosing.
We identified 325 patients seen by a single retina provider (GMC) between 2007 and 2014 at the University of Michigan (UM) who received the ICD-9 code for eAMD (362.52) and CPT code for intravitreal injection (67028). Eyes were included if they were treated with intravitreal bevacizumab on an every 7 week schedule for 48 weeks. Patients were excluded if they received any injection 3 months prior to presenting to UM, had treatment within the first 21 weeks with ranibizumab or aflibercept, or had other significant eye conditions thought to affect their vision. Logmar visual acuity and presence of fluid on OCT prior to treatment initiation, at 21 weeks, and at 48 weeks were used to determine treatment success or failure. Individuals were transitioned to ranibizumab or aflibercept if they were determined to have a failure in treatment. 78 eyes were included at the end of review. Paired t-tests were performed for statistical analysis.
17.9% of patients included were determined to have treatment failure. Patients received on average 6.8±0.3 injections. Outcomes for visual acuity and presence of fluid can be seen in Table 1. Visual acuity improved by 7.5 letters (95% CI= -0.09, -0.27 Logmar, p<0.001) at 21 weeks, and 8 letters (95% CI= -0.11, -0.22 Logmar p<0.001) at 48 weeks from baseline. The percentage of all patients with fluid on OCT significantly decreased from 97.4% to 30.4% (p<0.001). The majority of improvement was seen within the first 21 week time period. There were no statistically significant changes observed in the treatment failure group.
Intravitreal bevacizumab injections every 7 weeks can effectively reduce exudation and improve visual acuity in exudative AMD. This study is limited in comparison to recent clinical trials due to crossover to other anti-VEGF medications when failing treatment. This dosing frequency can reduce the annual number of injections received and reduce the potential burden on patients.
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