Back to Search Start Over

Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration

Authors :
Daniel F. Martin
Maryann Redford
Gui-Shuang Ying
Maureen G. Maguire
Cynthia A. Toth
Frederick L. Ferris
Juan E. Grunwald
Stuart L. Fine
Glenn J. Jaffe
Source :
Ophthalmology. 127:S135-S145
Publication Year :
2020
Publisher :
Elsevier BV, 2020.

Abstract

Objective To describe effects of ranibizumab and bevacizumab when administered monthly or as needed for 2 years and to describe the impact of switching to as-needed treatment after 1 year of monthly treatment. Design Multicenter, randomized clinical trial. Participants Patients (n = 1107) who were followed up during year 2 among 1185 patients with neovascular age-related macular degeneration who were enrolled in the clinical trial. Interventions At enrollment, patients were assigned to 4 treatment groups defined by drug (ranibizumab or bevacizumab) and dosing regimen (monthly or as needed). At 1 year, patients initially assigned to monthly treatment were reassigned randomly to monthly or as-needed treatment, without changing the drug assignment. Main Outcome Measures Mean change in visual acuity. Results Among patients following the same regimen for 2 years, mean gain in visual acuity was similar for both drugs (bevacizumab-ranibizumab difference, −1.4 letters; 95% confidence interval [CI], −3.7 to 0.8; P = 0.21). Mean gain was greater for monthly than for as-needed treatment (difference, −2.4 letters; 95% CI, −4.8 to −0.1; P = 0.046). The proportion without fluid ranged from 13.9% in the bevacizumab-as-needed group to 45.5% in the ranibizumab monthly group (drug, P = 0.0003; regimen, P P = 0.03) and a lower proportion without fluid (−19%; P P > 0.60). The proportion of patients with 1 or more systemic serious adverse events was higher with bevacizumab than ranibizumab (39.9% vs. 31.7%; adjusted risk ratio, 1.30; 95% CI, 1.07−1.57; P = 0.009). Most of the excess events have not been associated previously with systemic therapy targeting vascular endothelial growth factor (VEGF). Conclusions Ranibizumab and bevacizumab had similar effects on visual acuity over a 2-year period. Treatment as needed resulted in less gain in visual acuity, whether instituted at enrollment or after 1 year of monthly treatment. There were no differences between drugs in rates of death or arteriothrombotic events. The interpretation of the persistence of higher rates of serious adverse events with bevacizumab is uncertain because of the lack of specificity to conditions associated with inhibition of VEGF. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

Details

ISSN :
01616420
Volume :
127
Database :
OpenAIRE
Journal :
Ophthalmology
Accession number :
edsair.doi.dedup.....b8575b9d5223d2b47d6ca1d4654dabc0
Full Text :
https://doi.org/10.1016/j.ophtha.2020.01.029