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J. S. kent, Y. Iordanous, A. Mao, S. Shukla, T. Sheidow; Comparison of Outcomes When Switching Treatment From Intravitreal Bevacizumab to Ranibizumab in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):82.
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To compare visual acuity outcomes and retinal thickness in patients initially treated with bevacizumab (Avastin) and switched to ranibizumab (Lucentis) for neovascular age-related macular degeneration (AMD).
A retrospective review of consecutive patients with neovascular AMD initially being treated with bevacizumab and subsequently switched to ranibizumab when it became available through the provincial government drug plan. All patients underwent optical coherence tomography (OCT) before beginning bevacizumab, before switching to ranibizumab and at the end of treatment. Outcomes include comparison of visual acuity and retinal thickness.
152 eyes from 138 patients were included. The mean duration of treatment on bevacizumab was 329 days (mean number of injections = 3.84) and 515 days on ranibizumab (mean number of injections = 5.38). The mean baseline vision in logMAR (standard deviation, Snellen equivalent) was 0.73 (SD = 0.39, 20/107). The mean visual acuity after treatment with bevacizumab was 0.63 (SD = 0.34, 20/85) and after ranibizumab was 0.61 (SD = 0.43, 20/81) (p= 0.47). The mean retinal thickness (µm) after the final treatment of bevacizumab was 325 (SD = 117) and 267 (SD = 67) (p= 0.0002) after the final ranibizumab treatment. Comparison of the final visual acuity following bevacizumab (0.63, SD = 0.34, 20/85) to the best visual acuity while on ranibizumab (0.45, SD = 0.30, 20/57) showed a statistically significant difference (p < 0.0001). Subgroup analysis of eyes with <3 bevacizumab injections (n=53) showed a mean visual acuity of 0.70 (SD = 0.37, 20/101) for bevacizumab and 0.77 (SD = 0.55, 20/117) for ranibizumab (p=0.25) while a statistically significant difference was seen in those eyes with >=3 bevacizumab injections (n=99) with a mean acuity of 0.59 (SD = 0.32, 20/77) for bevacizumab and 0.52 (SD = 0.33, 20/66) for ranibizumab (p=0.009).
In patients with neovascular AMD initially treated with bevacizumab then switched to ranibizumab there was no statistically significant improvement in visual acuity. However, when comparing the last visual acuity on bevacizumab to the best-recorded visual acuity on ranibizumab there was a significant difference. Evaluation of the larger subgroup of patients receiving 3 or more bevacizumab injections showed a statistically significantly improvement in visual acuity after ranibizumab. Retinal thickness assessment by OCT also showed a statistically significant decrease after ranibizumab versus bevacizumab in all subgroups of the study.
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