Intravitreal Bevacizumab vs Verteporfin Photodynamic Therapy for Neovascular Age-Related Macular Degeneration

Bashshur, Ziad F.; Schakal, Alexandre; Hamam, Rola N.; Haibi, Christelle P El; Jaafar, Rola; Noureddin, Baha’ N.

doi:10.1001/archopht.125.10.1357

Cited by 71 publications

(57 citation statements)

References 44 publications

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“…The three RCTs all showed that bevacizumab is more effective than PDT (with or without triamcinolone) [9,27,31]. The RCTs were of a poor-to-reasonable quality and lack of masking was the main methodological problem.…”

Section: Resultsmentioning

confidence: 97%

“…Ultimately, 26 out of these 561 were suitable and used in the analysis. Three randomised controlled trials were published and presented separately [9,27,31]. We also combined in this review the data of the patients of these three RCTs who had received only intravitreal bevacizumab, and the data of patients of 23 before-and-after studies with follow-up of patients who had received bevacizumab for exudative AMD (Tables 2, 3, 4 and 5) [1-4, 7-10, 15-18, 23, 25, 27, 29, 30-35, 37, 40, 41, 48].…”

Section: Resultsmentioning

confidence: 99%

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A systematic review on the effect of bevacizumab in exudative age-related macular degeneration

Schouten

Heij

Webers

et al. 2008

Graefes Arch Clin Exp Ophthalmol

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Aim To provide evidence for the effect of bevacizumab on visual acuity (VA) and central retinal thickness (CRT) in exudative age-related macular degeneration Methods A systematic review of all articles of bevacizumab for exudative AMD was conducted. Articles published up to March 2008 were identified in Medline, Embase, the Cochrane Controlled Trials Register and references from included articles. Search terms were "Bevacizumab or Avastin" and "Macula* or ARMD or AMD or intra(-) vitreal or intra(-)vitreous". Three observers participated in the data retrieval and assignment of the quality scores. Results A total of 561 articles were retrieved. Three randomised controlled trials (RCT) and 23 before-and-after studies of patients (n=1,435) who had received bevacizumab were published. Inclusion criteria varied. Lack of masking was the main methodological shortcoming. These RCTs showed that bevacizumab is more effective than PDT. Bevacizumab was given intravenously or as intravitreal injection. The latter was given once, or repeatedly every 4 weeks, and with or without additional injection when a recurrence occurred, mostly based on visual acuity and/or findings from optical coherence tomography. After intravenous administration, the weighted mean change in VA was +12.8 ETDRS letters (range +11 to +14) and the weighted mean change for CRT was −129 μm (range −100 to −202). For the 23 studies with intravitreal injections, the change in VA was +8.6 letters (range +2 to +26) and the change in CRT was −90 μm (range −46 to −190). The incidence of adverse events was low. The change in VA was 2.7 letters higher for studies with a higher quality vs lower quality. Conclusion Visual acuity improves and central retinal thickness decreases in patients with exudative AMD after bevacizumab. There is no reasonable doubt that this is caused by bevacizumab. It is likely that a randomised controlled trial will show that bevacizumab is equivalent in effect to ranibizumab, which showed a change in ETDRS of +5.9 letters for occult or minimally classic CNV and +9.8 letters for classic CNV after three monthly injections in two large RCTs.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

A systematic review on the effect of bevacizumab in exudative age-related macular degeneration

Schouten

Heij

Webers

et al. 2008

Graefes Arch Clin Exp Ophthalmol

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“…14 The nine studies included in the present review yielded a total of 667 randomized eyes, as shown in Table 1. [15][16][17][18][19][20][21][22][23] Three studies included patients with diagnoses of diabetic macular edema. 17,20,21 One study included patients with diagnoses of clinically significant macular edema who had not responded to earlier subsequent photocoagulation therapy.…”

Section: Description Of Studies With Potential For Inclusionmentioning

confidence: 99%

Bevacizumab for ocular neovascular diseases: a systematic review

et al. 2009

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CONTEXT AND OBJECTIVE: Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES:The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method.DATA SYNTHESIS: A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS:The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity. CONCLUSÕES: A evidência disponível demonstra que bevacizumabe isolado ou combinado com outras terapias é mais eficaz que terapia fotodinâmica, fotocoagulação focal e triancinolona. O uso de bevacizumabe em vez da terapia fotodinâmica poderia reduzir os custos do tratamento em mais de 99% e aumentar significativamente o acesso ao tratamento. Entretanto, o aspecto de segurança do fármaco ainda necessita ser avaliado por estudos em longo prazo com todas as doenças neovasculares em que bevacizumabe tenha o potencial de melhorar acuidade visual.

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“…The various doses of bevacizumab reported in literature are 1 mg, 41 33 2.5 mg 22,[26][27][28] (n ¼ 5 for 1 mg; n ¼ 4 for 1.5 mg; n ¼ 1 for 2 mg and n ¼ 4 for 2.5 mg). The pooled data of these doses indicated a dose-dependent response to the drug, whereas in higher doses they showed a better response ( Figure 3).…”

Section: Effects Of Various Doses Of Bevacizumabmentioning

confidence: 99%

Intravitreal bevacizumab (Avastin) for age-related macular degeneration: a critical analysis of literature

Jyothi

Chowdhury

Elagouz

et al. 2009

Eye

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Purpose The current medical environment demands that quality health care is delivered at an affordable cost through the use of objective, unbiased clinical data. This study was undertaken to review the current literature on bevacizumab for age-related macular degeneration and its value in determining best clinical practice. Methods Randomised controlled trials (RCTs) and observational studies that met the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria were identified from the current literature for further analysis. Data concerning treatment dosing regimens, response to treatment, complications, and factors influencing outcome and safety were extracted and compiled into a database. Results As of January 2009, there were 5 RCTs that compared the outcomes of bevacizumab to other treatment options and 50 studies that met the STROBE criteria with similar visual and anatomical outcomes between RCTs and observational studies. Although the doses and dosing frequencies varied between the studies, the mean gain in vision at 3 months was þ 7.76±5.4 ETDRS letters (range þ 2 to þ 14.4); an effect that was maintained at 6 months in studies with longer follow-up. Predominantly classic lesions were the most responsive of all lesion subtypes. The complication profiles/rates were similar to those reported with other anti-vascular endothelial agents. Conclusions There is sufficient scientific and statistical evidence to advocate the effective use of OCT-guided administration of intravitreal bevacizumab for neovascular AMD. This is reflected in our study outcome measures that are comparable to findings published from recent well-conducted RCTs on intravitreal ranibizumab at the same time point.

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Intravitreal Bevacizumab vs Verteporfin Photodynamic Therapy for Neovascular Age-Related Macular Degeneration

Cited by 71 publications

References 44 publications

A systematic review on the effect of bevacizumab in exudative age-related macular degeneration

A systematic review on the effect of bevacizumab in exudative age-related macular degeneration

Bevacizumab for ocular neovascular diseases: a systematic review

Intravitreal bevacizumab (Avastin) for age-related macular degeneration: a critical analysis of literature

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