Reactivation of CNV after discontinuation of bevacizumab treatment of age-related macular degeneration

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Abstract

INTRODUCTION: Treatment of exudative age-related macular degeneration (ARMD) has shifted to pro re nata and treat-extend-stop strategies. However, a rational discontinuation strategy is lacking. To develop such a strategy, it is important to determine choroidal neovascularization (CNV) recurrence rates after anti-VEGF treatment is discontinued.

METHODS: This prospective, single-centre clinical trial enrolled 191 patients with exudative ARMD. Patients were randomly assigned to receive intravitreal bevacizumab injections every 4, 6, or 8 weeks for one year. CNV activity was determined in the 157 patients who completed the one-year treatment regimen. Patients with inactive CNV were then followed for signs of CNV reactivation.

RESULTS: After one year of treatment, 66 (42%) of the 157 patients still had signs of persistent active CNV. Of the remaining 91 (58%) patients, 61 (67%) needed retreatment for active CNV within the first year after discontinuation of treatment (mean 4.28±0.29 months). CNV was reactivated in 50 (80%) of the 61 patients within 6 months after their final treatment for CNV.

CONCLUSION: Based on quiescent disease, anti-VEGF therapy was discontinued in 58% of patients after they received bevacizumab injections every 4, 6, or 8 weeks for one year; 67% showed reactivated CNV within the year after discontinuation. The high reactivation rate of CNV shown in this study, should help clinicians develop rational discontinuation protocols.

Original languageEnglish
JournalOphthalmologica
DOIs
Publication statusE-pub ahead of print - 19 Jan 2021

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