Bevacizumab in age-related macular degeneration: a randomized controlled trial on the effect of on-demand therapy every 4 or 8 weeks

Sankha Amarakoon; José P Martinez-Ciriano; L Ingeborgh van den Born; Seerp Baarsma; Tom Missotten

doi:10.1111/aos.13774

Bevacizumab in age-related macular degeneration: a randomized controlled trial on the effect of on-demand therapy every 4 or 8 weeks

Sankha Amarakoon, José P Martinez-Ciriano, L Ingeborgh van den Born, Seerp Baarsma, Tom Missotten

Research output: Contribution to journal › Article › Research › peer-review

Abstract

PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) injections are an effective treatment for neovascular age-related macular degeneration (nARMD). Bevacizumab appears to be a cost-effective off-label anti-VEGF alternative to ranibizumab, but an optimal injection schedule has not yet been determined. In this study, we investigate whether on-demand bevacizumab treatment every 8 weeks is non-inferior to on-demand bevacizumab every 4 weeks in treating nARMD.

METHODS: A total of 120 nARMD patients were randomly assigned to an on-demand regimen of intravitreal bevacizumab (IVB) every 4 (n = 60) or 8 weeks (n = 60). The primary outcome was visual acuity (VA) change after 1 year of treatment.

RESULTS: Visual acuity (VA) improved between baseline and 1 year in both treatment groups. The mean change in the VA score at 1 year was not significantly different between bevacizumab administration on-demand every 4 weeks [5.6 ± 10.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letter] or 8 weeks (4.6 ± 12.0 ETDRS letters). A reduction in the central retinal thickness was observed in both groups. At 1 year, the mean decrease in central foveal thickness ranged from 61 ± 90 μm in the 4-week group to 91 ± 83 μm in the 8-week group (p = 0.07). The mean number of IVB treatments during the study period was 8.7 ± 2.3 in the 4-week group and 5.9 ± 1.0 in the 8-week group.

CONCLUSION: At 1 year, bevacizumab administration on-demand every 8 weeks was non-inferior to administration every 4 weeks. The results strongly suggest that bevacizumab acts longer than 4 weeks in ARMD, reducing the burden of injections for patients.

Original language	English
Pages (from-to)	107-112
Number of pages	6
Journal	Acta Ophthalmologica
Volume	97
Issue number	1
DOIs	https://doi.org/10.1111/aos.13774
Publication status	Published - Feb 2019

Keywords

Aged
Aged, 80 and over
Angiogenesis Inhibitors/administration & dosage
Bevacizumab/administration & dosage
Dose-Response Relationship, Drug
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Intravitreal Injections
Macular Degeneration/diagnosis
Male
Prospective Studies
Time Factors
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Visual Acuity

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@article{645245f91efa4e7db988ede1decf187d,

title = "Bevacizumab in age-related macular degeneration: a randomized controlled trial on the effect of on-demand therapy every 4 or 8 weeks",

abstract = "PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) injections are an effective treatment for neovascular age-related macular degeneration (nARMD). Bevacizumab appears to be a cost-effective off-label anti-VEGF alternative to ranibizumab, but an optimal injection schedule has not yet been determined. In this study, we investigate whether on-demand bevacizumab treatment every 8 weeks is non-inferior to on-demand bevacizumab every 4 weeks in treating nARMD.METHODS: A total of 120 nARMD patients were randomly assigned to an on-demand regimen of intravitreal bevacizumab (IVB) every 4 (n = 60) or 8 weeks (n = 60). The primary outcome was visual acuity (VA) change after 1 year of treatment.RESULTS: Visual acuity (VA) improved between baseline and 1 year in both treatment groups. The mean change in the VA score at 1 year was not significantly different between bevacizumab administration on-demand every 4 weeks [5.6 ± 10.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letter] or 8 weeks (4.6 ± 12.0 ETDRS letters). A reduction in the central retinal thickness was observed in both groups. At 1 year, the mean decrease in central foveal thickness ranged from 61 ± 90 μm in the 4-week group to 91 ± 83 μm in the 8-week group (p = 0.07). The mean number of IVB treatments during the study period was 8.7 ± 2.3 in the 4-week group and 5.9 ± 1.0 in the 8-week group.CONCLUSION: At 1 year, bevacizumab administration on-demand every 8 weeks was non-inferior to administration every 4 weeks. The results strongly suggest that bevacizumab acts longer than 4 weeks in ARMD, reducing the burden of injections for patients.",

keywords = "Aged, Aged, 80 and over, Angiogenesis Inhibitors/administration & dosage, Bevacizumab/administration & dosage, Dose-Response Relationship, Drug, Female, Fluorescein Angiography, Follow-Up Studies, Fundus Oculi, Humans, Intravitreal Injections, Macular Degeneration/diagnosis, Male, Prospective Studies, Time Factors, Tomography, Optical Coherence, Treatment Outcome, Vascular Endothelial Growth Factor A/antagonists & inhibitors, Visual Acuity",

author = "Sankha Amarakoon and Martinez-Ciriano, {Jos{\'e} P} and {van den Born}, {L Ingeborgh} and Seerp Baarsma and Tom Missotten",

note = "{\textcopyright} 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2019",

month = feb,

doi = "10.1111/aos.13774",

language = "English",

volume = "97",

pages = "107--112",

number = "1",

}

TY - JOUR

T1 - Bevacizumab in age-related macular degeneration

T2 - a randomized controlled trial on the effect of on-demand therapy every 4 or 8 weeks

AU - Amarakoon, Sankha

AU - Martinez-Ciriano, José P

AU - van den Born, L Ingeborgh

AU - Baarsma, Seerp

AU - Missotten, Tom

PY - 2019/2

Y1 - 2019/2

N2 - PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) injections are an effective treatment for neovascular age-related macular degeneration (nARMD). Bevacizumab appears to be a cost-effective off-label anti-VEGF alternative to ranibizumab, but an optimal injection schedule has not yet been determined. In this study, we investigate whether on-demand bevacizumab treatment every 8 weeks is non-inferior to on-demand bevacizumab every 4 weeks in treating nARMD.METHODS: A total of 120 nARMD patients were randomly assigned to an on-demand regimen of intravitreal bevacizumab (IVB) every 4 (n = 60) or 8 weeks (n = 60). The primary outcome was visual acuity (VA) change after 1 year of treatment.RESULTS: Visual acuity (VA) improved between baseline and 1 year in both treatment groups. The mean change in the VA score at 1 year was not significantly different between bevacizumab administration on-demand every 4 weeks [5.6 ± 10.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letter] or 8 weeks (4.6 ± 12.0 ETDRS letters). A reduction in the central retinal thickness was observed in both groups. At 1 year, the mean decrease in central foveal thickness ranged from 61 ± 90 μm in the 4-week group to 91 ± 83 μm in the 8-week group (p = 0.07). The mean number of IVB treatments during the study period was 8.7 ± 2.3 in the 4-week group and 5.9 ± 1.0 in the 8-week group.CONCLUSION: At 1 year, bevacizumab administration on-demand every 8 weeks was non-inferior to administration every 4 weeks. The results strongly suggest that bevacizumab acts longer than 4 weeks in ARMD, reducing the burden of injections for patients.

AB - PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) injections are an effective treatment for neovascular age-related macular degeneration (nARMD). Bevacizumab appears to be a cost-effective off-label anti-VEGF alternative to ranibizumab, but an optimal injection schedule has not yet been determined. In this study, we investigate whether on-demand bevacizumab treatment every 8 weeks is non-inferior to on-demand bevacizumab every 4 weeks in treating nARMD.METHODS: A total of 120 nARMD patients were randomly assigned to an on-demand regimen of intravitreal bevacizumab (IVB) every 4 (n = 60) or 8 weeks (n = 60). The primary outcome was visual acuity (VA) change after 1 year of treatment.RESULTS: Visual acuity (VA) improved between baseline and 1 year in both treatment groups. The mean change in the VA score at 1 year was not significantly different between bevacizumab administration on-demand every 4 weeks [5.6 ± 10.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letter] or 8 weeks (4.6 ± 12.0 ETDRS letters). A reduction in the central retinal thickness was observed in both groups. At 1 year, the mean decrease in central foveal thickness ranged from 61 ± 90 μm in the 4-week group to 91 ± 83 μm in the 8-week group (p = 0.07). The mean number of IVB treatments during the study period was 8.7 ± 2.3 in the 4-week group and 5.9 ± 1.0 in the 8-week group.CONCLUSION: At 1 year, bevacizumab administration on-demand every 8 weeks was non-inferior to administration every 4 weeks. The results strongly suggest that bevacizumab acts longer than 4 weeks in ARMD, reducing the burden of injections for patients.

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KW - Fluorescein Angiography

KW - Follow-Up Studies

KW - Fundus Oculi

KW - Humans

KW - Intravitreal Injections

KW - Macular Degeneration/diagnosis

KW - Male

KW - Prospective Studies

KW - Time Factors

KW - Tomography, Optical Coherence

KW - Treatment Outcome

KW - Vascular Endothelial Growth Factor A/antagonists & inhibitors

KW - Visual Acuity

U2 - 10.1111/aos.13774

DO - 10.1111/aos.13774

M3 - Article

C2 - 30369062

SN - 1755-375X

VL - 97

SP - 107

EP - 112

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

IS - 1

ER -

Bevacizumab in age-related macular degeneration: a randomized controlled trial on the effect of on-demand therapy every 4 or 8 weeks

Abstract

Keywords

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