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A.A. Moshfeghi, P.J. Rosenfeld, C.A. Puliafito, S. Michels, A.E. Fung, K.D. Rosenberg, A.S. Venkatraman; Durability of Systemic Bevacizumab (Avastin®) Therapy for Neovascular Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1381.
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Purpose: To evaluate the durability of the treatment effects observed following systemic bevacizumab (Avastin®, Genentech Inc.) therapy in patients with age–related macular degeneration (AMD) and subfoveal choroidal neovascularization (CNV). Methods: AMD patients with subfoveal CNV and visual acuity from 20/40 to 20/400 were enrolled in a prospective, open–label, single–center, uncontrolled clinical study. They were treated initially with 2 or 3 infusions of bevacizumab (5mg/kg) at 2 week intervals. Patients were examined every week for the first 6 weeks, every 2 weeks for the next 6 weeks, and every 4 weeks thereafter. At baseline and at each follow–up visit, patients underwent imaging using the Stratus OCTTM. At baseline and every 4 weeks, patients were imaged using fluorescein angiography (FA). Once the treatment was stopped after the second or third dose, additional therapy was offered if there was vision loss of at least 5 letters associated with increased leakage from CNV as assessed by FA or OCT at 2 sequential visits. An additional indication for retreatment included an increase in central retinal thickness of more than 100 microns at 2 sequential visits. Results: Of the 15 patients enrolled in the study, 9 patients have been followed for at least 3 months, and 4 patients have been followed for at least 6 months. No patient required retreatment by 3 months, and only 1 of the 4 patients followed for as long as 6 months received retreatment. This patient experienced an increase in central retinal thickness of more than 100 microns, and her visual acuity dropped from 20/20 to 20/32. Two weeks after a single retreatment with bevacizumab, her normal macular contour was restored and vision improved to 20/26. Conclusions: After 2 or 3 infusions with bevacizumab, no retreatment was needed through 3 months of follow–up, and the treatment benefit could be sustained for as long as 6 months. These results suggest that systemic bevacizumab therapy may have better durability than similar drugs given intravitreally. Additional follow–up is ongoing to determine the durability of bevacizumab therapy in all our patients.
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