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Claudine Bellerive, Benoît Cinq-Mars, Gilles Lalonde, Mario Malenfant, Éric Tourville, Yvon Tardif, Marcelle Giasson, Marc Hébert; Bevacizumab and Ranibizumab for Neovascular Age-Related Macular Degeneration: a Treatement Approach Based on Individual Patient Needs. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1665.
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Multicenter clinical trials have shown that monthly intravitreal injections of ranibizumab during the first year is an effective treatment for CNV in AMD. At present, the optimal frequency for VEGF inhibitor injections has not been established. In attempt to reduce the number of treatment required, there is a trend among retina specialists to use a treatment regimen based on patient needs. Patients receive an initial treatment of three monthly intravitreal injections of ranibizumab or bevacizumab and retreatment is individually considered for each patient on the basis of OCT, angiography and clinical examination. The aim of the study was to compare the VA outcomes of ranibizumab and bevacizumab with this therapeutic regimen at 1 year.
654 files of patients with either predominantly, minimally classic or occult CNV were reviewed. Data were collected at the Centre Oculaire de Québec between June 2006 and December 2009. All eyes with prior treatment or additional treatment for AMD were excluded. Clinical data included VA at baseline and 12 months (Snellen chart), and number of injections received over 12 months. For analysis, Snellen VA was converted into logMar.
A total of 192 eyes were included; 50 eyes treated with ranibizumab and 142 eyes with bevacizumab. Mean age at baseline was 76.9 ± 8 years and 76.4 ± 8 years in the ranibizumab and bevacizumab group respectively. Mean logMar equivalent of VA improved from 0.69 to 0.55 at 12 months in the ranibizumab group and 0.70 to 0.67 logMar in the bevacizumab group. At 1 year, 92% of eyes treated with ranibizumab had lost fewer than 0.3 logMar, as compared with 83% in the bevacizumab group. These observations are similar to those observed in the MARINA (94.6%), ANCHOR (96.4%) and PIER (90.2%) studies. The ranibizumab group received a mean of 4.92 injections over 12 months, compared to 4.75 injections in the bevacizumab group. After the first three injections, 20% of patients in the ranibizumab group and 26% in the bevacizumab group never needed another injection.
VA outcomes of eyes treated with ranibizumab and bevacizumab correlate closely with the results from multicenter clinical trials but with fewer injections. These findings suggest that an approach based on clinical onset and CNV progression at angiography may provide benefit by reducing the risks of adverse events associated with intravitreal injections.
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