Ranibizumab Treatment of Patients With Neovascular AMD Previously Treated With Intravitreal Bevacizumab

Abstract

Purpose:: Ranibizumab (Lucentis^TM), recently approved by the FDA for the treatment of neovascular age-related macular degeneration (AMD), is a humanized antigen-binding antibody fragment that targets all active forms of vascular endothelial growth factor-A. This retrospective study examines the efficacy of intravitreal ranibizumab in patients who had previously received off-label intravitreal bevacizumab (Avastin) for neovascular AMD.

Methods:: Patients with neovascular AMD who had received intravitreal bevacizumab were treated with 0.5 mg intravitreal ranibizumab at the discretion of the treating physician. Changes in Snellen visual acuity (VA) and central retinal thickness (CRT), as measured by optical coherence tomography, were evaluated. Ranibizumab response was stratified by patient response to bevacizumab, with "responders" classified as having improvement in VA or CRT measurements with bevacizumab, and "nonresponders" classified as having no improvement or worsening in VA or CRT measurements.

Results:: Of 33 study eyes, 28 eyes (26 patients) with at least 1 month follow-up (mean, 2.8 mo) after at least 1 ranibizumab injection (mean, 1.6 injections) were evaluated. Among 13 responders, bevacizumab treatment resulted in VA improvement from a median 20/200 (mean logMAR, 0.98) to a median 20/80 (mean logMAR, 0.73) and mean CRT reduction of 69.8 µm. Subsequent ranibizumab treatment continued to improve VA and CRT measurements (VA from a median 20/80 [mean logMAR, 0.73] to a median 20/60 [mean logMAR, 0.72]; mean CRT reduction of 50.9 µm). In contrast, among 15 bevacizumab nonresponders (VA from a median 20/200 [mean logMAR, 0.95] to a median 20/300 [mean logMAR, 1.11]; mean CRT increase of 16.2 µm), ranibizumab treatment resulted in a mean 50.6-µm reduction in CRT, but had little effect on VA (VA from a median 20/300 [mean logMAR, 1.12] to a median 20/200 [mean logMAR, 1.14]). No significant adverse events were observed with the switch to ranibizumab.

Conclusions:: Ranibizumab may provide clinical benefit in patients with neovascular AMD previously treated with off-label intravitreal bevacizumab.

Keywords: age-related macular degeneration • choroid: neovascularization • growth factors/growth factor receptors