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K. E. Schmid-Kubista, I. Krebs, S. Ansari Shahrezaei, P. Haas, S. Hagen, S. Binder; Comparison of Combined Therapy of Intravitreal Injection of Avastin and Macugen versus Mono-Therapy. The MAAM Study-a Pilot Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2056.
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A prospective randomized masked pilot study to investigate the efficacy and safety of the combined therapy of Bevacizumab applied first and with Pegaptanib used for retreatment.
Subjects diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration, a predominantly occult lesion composition, and with best corrected visual acuity of 20/40 to 20/200 in the absence of subfoveal atrophy or scarring in the trial eye were included. Subjects were randomized equally to receive 3 intravitreal injections, every 6 weeks, of either 0.3mg Pegaptanib, 1mg of Bevacizumab, or first 1mg Bevacizumab followed by retreatment of 0.3mg Pegaptanib. Best corrected visual acuity, contrast sensitivity, and retinal thickness measurements were performed after 1, 6, 12 weeks, and after 6 months.
Forty-eight subjects were included, of which 13 were randomized to receive only Bevacizumab, 18 received only Pegaptanib, and 17 received first Bevacizumab, followed by Pegaptanib. Bevacizumab lead to significant changes in visual acuity after 6 weeks throughout the entire follow up of 6 months, while retinal thickness only showed significant changes after 6 to 12 weeks. Pegaptanib showed a significant decrease in retinal thickness only after 6 weeks, and a change in visual acuity after 6 months. However, contrast sensitivity increased significantly after 12 weeks and 6 months. The combined treatment with Bevacizumab, followed by Pegaptanib showed a decrease in retinal thickness after 12 weeks.
Bevacizumab, as sole treatment, lead to more significant changes in visual acuity, and retinal thickness, than Pegaptanib or the combined treatment of both monoclonal antibodies. Pegaptanib had a positive influence on contrast sensitivity. We conclude that the combined treatment of Bevacizumab with Pegaptanib is safe, but the single treatment of Bevacizumab is more efficient.
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