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W. F. Schrader, L. Walter, K. Kleibert, A. Bernhard, R. Guthoff; Preservation of Functional Benefit of Loading Dose and Long-Term Visual Outcome After 4-Weekly Injection of Ranibizumab versus 8-Weekly Injection of Bevacizumab for Wet Amd. Invest. Ophthalmol. Vis. Sci. 2010;51(13):927.
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MARINA and ANCHOR have shown that main visual acuity (VA) benefit is achieved by the 3 initial 4-weekly intravitreal ranibizumab injections (IVI, loading dose). The range of time without loss of VA benefit to the following injection is still unclear, but is, according to PIER, less than 3 month. The aim of this study is to compare, whether an initial 4-weekly loading dose of ranibizumab preserves longer VA benefit than an initial 8-weekly loading dose of IVI of bevacizumab, and to compare long-term final VA of both agents.
Retrospective analysis of 272 patients with choroidal neovascularisation in AMD, who were initially treated with either 3 IVIs of bevacizumab (1,5 mg) 8 weekly or ranibizumab (0,5 mg) 4-weekly and following IVIs with the same agent were performed as needed. Main outcome parameters between both groups were final VA after 1 year and the range of time from first to fourth injection.
103 eyes (103 patients, mean age 75,9 yrs, 73 females, 30 males) have been treated with bevacizumab, and 169 patients (mean age 76,6 yrs, 112 females, 57 males) with ranibizumab.79/103 bevacizumab-treated eyes (77%) maintained VA by the initial 3 IVIs within 12 months, and 24 eyes (23%) by 4 or more IVIs (mean 3.7). The fourth IVI was given 37.7±11.9 weeks after first IVI. VA benefit of 0.67 logMAR (baseline VA 0.85 logMAR) could be kept for 6.5 months. VA at 1 year was 0.83 logMAR and final mean VA (mean follow-up 12.9±1.8 months) 0.80 logMAR.94/169 ranibizumab-treated eyes (56%) kept stable VA by 3 IVIs, and 75 eyes (44%) required 4 or more IVIs (mean 4.4). Fourth IVI was given 30.0±15.5 weeks after first IVI. VA benefit of 0.56 logMAR (baseline 0.76 logMAR) could be maintained over 5.3 months. VA after 1 year was 0.87 logMAR and final mean VA (mean follow-up 16.3 ± 3.7 months) was 0.88 logMAR.
Bevacizumab treatment based on 8-weekly injections was not inferior to a ranibizumab treatment based on 4-weekly injections according to the development of VA over one year and the time, the VA benefit could be kept. However, our treatment schemes of bevacizumab and ranibizumab were inferior to a monthly injection scheme as reported in Marina or Anchor Studies.
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