One‐year real‐world outcomes of bevacizumab for the treatment of macular oedema secondary to retinal vein occlusion

Abstract

Background Bevacizumab is the only agent that many people can afford, yet there are only limited data on whether it improves macular oedema (MO) secondary to retinal vein occlusion (RVO) in real‐world clinical practice. Here we studied 12‐month real‐world treatment outcomes of bevacizumab for RVO‐related MO. Methods This was a multicentre, observational study analysing 12‐month data from the Fight Retinal Blindness! (FRB) database. We studied treatment‐naïve eyes with MO secondary to RVO commencing bevacizumab therapy between June 2009 and June 2019. Visual acuity (VA) and central subfield thickness (CST) were measured at baseline, 6 and 12 months. The primary outcome was a change in VA from baseline to 12 months. Results Two hundred and twenty treatment naive eyes were analyzed. The baseline VA for BRVO was better than CRVO (55.8 vs. 42.6 LogMAR letters) and this gap widened over the 12‐month period, with a 12‐month VA change of +14.0 (95% CI 11.1, 16.8) letters for BRVO and + 11.9 (95% CI 6.4, 17.4) for CRVO. The mean CST at baseline was 511 μm for BRVO and 627 μm for CRVO, falling at 12 months by −155 μm (−190, −121) in BRVO and −198 μm (−252, −145) in CRVO. The median number of injections for BRVO and CRVO completers was 7 (5, 9). Conclusions Bevacizumab can be an effective treatment of RVO‐MO in a real‐world setting with outcomes approaching those reported by the seminal clinical trials. The functional and anatomical outcomes of intravitreal therapy were better for BRVO than CRVO.

Initial response and 12-month outcomes after commencing dexamethasone or vascular endothelial growth factor inhibitors for retinal vein occlusion in the FRB registry

“…This study has inherent weaknesses associated with the use of observational data from a real-world database 16 – 20 , 27 . In contrast to randomized controlled trials (RCT), treatment and retreatment decisions including timing are based on the physician´s observation and in accordance with the patient, resulting in a heterogeneity of treatment.…”

Update on Retinal Vein Occlusion

“…Intravitreal bevacizumab was found to be superior to macular grid laser in a small study 126. A real-world study of 135 eyes reported visual improvement of 14 letters at 2 years with a median of 7 injections 127…”

“…126 A real-world study of 135 eyes reported visual improvement of 14 letters at 2 years with a median of 7 injections. 127 The BRAVO study compared 128 2 different doses (0.5 mg and 0.3 mg) of ranibizumab injections. At 6 months, ranibizumab-treated eyes gained about 16-18 letters compared with 7.3 letters of the sham group.…”

Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion

“…And fewer injections compared with monthly. Even when Bevacizumab is not approved for the treatment of macular edema in RVO, several studies show that in the real-world setting, Bevacizumab can be effective at improving vision in patients with ME secondary to RVO (51). There are no available clinical trials (head-to head trials) to clearly state the best treatment for RVO patients.…”