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Jonathan Siktberg, Stephen J Kim, Shriji Patel; Efficacy of Avastin Step-Therapy for Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4197.
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Given the high costs of FDA-approved anti-VEGF agents for exudative age-related macular degeneration (nAMD), step-therapy requiring initial treatment with bevacizumab is being proposed nationally. Controversy exists regarding the efficacy and cost-effectiveness of such a protocol. Beginning in January 2012, Vanderbilt Eye Institute (VEI) initiated a treatment algorithm for nAMD beginning with bevacizumab. We performed a retrospective cohort study of patients treated under this protocol to investigate the efficacy of bevacizumab step-therapy.
We analyzed the clinical course of patients meeting the inclusion criteria of undergoing initial treatment within the nAMD step-therapy protocol at VEI with at least 3 consecutive monthly injections of Avastin (bevacizumab, Genentech) from January 2012 to August 2018. Patients were excluded if they had past intraocular surgery other than routine cataract surgery. Of the 257 patients in the original VEI database, 124 patients were eliminated due to inclusion and exclusion criteria. The study population is 133. Age range is 59-106. The primary outcome was defined as the success rate of Avastin therapy. Treatment success was defined as achieving a stable injection regimen without recurrence of neovascular disease, loss of 3 or more Snellen chart lines, or requirement of switching to an FDA-approved anti-VEGF agent.
Of 133 patients, 106 (80%) achieved treatment stability on Avastin. 70 patients (53%) were stable on injections every 8 weeks or longer, and 36 patients (27%) required injections more frequently than every 8 weeks. Of the 27 patients who failed Avastin, 14 did not switch to another drug, and 13 were switched to aflibercept (Eylea, Regeneron).
Treatment of neovascular AMD with a regimen consisting of bevacizumab as first-line therapy is efficacious in the majority of patients.
This is a 2020 ARVO Annual Meeting abstract.
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