Abstract
Purpose::
To report the safety and efficacy of intravitreal Avastin (Genentech, Inc) and Lucentis (Genentech, Inc) as first line monotherapy in the treatment of neovascular AMD.
Methods::
Retrospective, comparative analyses of patients with neovascular AMD treated with either intravitreal 0.5 mg Lucentis, or 1.25mg Avastin. Inclusion criteria consisted of patients >50 years of age with choroidal neovascularization secondary to AMD of all angiographic subtypes, locations, sizes, and Snellen visual acuities (VA) of 20/20 to 20/800. Patients with prior verteporforin photodynamic therapy, laser, or intravitreal or periocular injections were excluded. The primary efficacy endpoint was the proportion of patients who lost less than 3 lines from baseline VA at the last follow-up visit. Secondary VA endpoints included the proportion of patients who had gained 2 or more lines, and the mean change from baseline VA. LogMar converted VAs were used for statistical comparisons.
Results::
Ninety-seven eyes of 89 patients were included in the study. Avastin was given to 44 eyes and Lucentis to 53 eyes. Pre-injection characteristics were similar for both groups. Mean VA - Avastin group = 20/113 (range, 20/25-20/800), Lucentis group = 20/117 (range, 20/20-20/800); Lesion characteristics - Avastin group = 74% occult and 26% classic, Lucentis group = 78% occult and 22% classic; Mean lesion size determined by fluorescein angiography - Avastin group = 2.6 disc areas (DA, range, 0.5-16), Lucentis group = 2.4 DA (range, 1-12). A mean of 1.8 injections (range, 1-3) were given in the Avastin group and 2.0 injections (range, 1-3) in the Lucentis group. Mean follow-up was 113 days (range, 7-315) in the Avastin group, compared to 44 days (range, 6-122) in the Lucentis group. At the last follow-up visit, 97.7% of those given Avastin and 96.2% of those given Lucentis lost fewer than 3 Snellen lines. VA improved by more than 2 lines in 31.8% of the Avastin group compared to 39.6% in the Lucentis group. Mean VA increased by 0.8 lines in the Avastin group and by 0.7 lines in the Lucentis group (P=0.87, student’s t-test). No serious ocular or systemic complications were noted in either group.
Conclusions::
In this single-center non-randomized series, Avastin and Lucentis showed comparable efficacy as first line monotherapy for the treatment of neovascular AMD in terms of VA outcomes in the short term. A large, prospective, randomized clinical trial, with longer follow-up, is necessary to better compare these drugs for the treatment of all subtypes of neovascular AMD.
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials