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N. J. Sund, M. M. Lai, A. Capone, Jr., T. S. Hassan; Efficacy of Intravitreal Bevacizumab (AvastinTM) vs. Ranibizumab (LucentisTM) as First Line Monotherapy for the Treatment of Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1813.
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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.
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.
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.
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.
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