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Alternating anti-VEGF agents may reduce AMD treatment risk, cost

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PHILADELPHIA — Biweekly alternating intravitreal ranibizumab and bevacizumab injections improved vision in patients with wet AMD, according to a study presented here.

Alternating injections every 2 weeks may help clinicians prevent risks and complications associated with monthly injections of a single agent, Andre J. Witkin, MD, said at the Wills Eye Institute Alumni Conference.

Biweekly alternating injections also may cost less than injections of ranibizumab alone, by virtue of bevacizumab's lower cost, Dr. Witkin said.

"With a single agent there is a theoretical risk of tachyphylaxis, and there have been some reports that have shown patients possibly developing tachyphylaxis in both ranibizumab and bevacizumab," Dr. Witkin said. "Another alternative is to alternate both ranibizumab and bevacizumab every 2 weeks. This moderates the cost and may decrease the risk of tachyphylaxis from a single medication."

The retrospective study included 19 eyes of 19 patients with a mean age of 75 years and persistent fluid activity despite having undergone at least six monthly anti-VEGF injections, mostly of ranibizumab. All patients received four alternating injections over 8 weeks.

Study results showed that mean Snellen visual acuity improved from 20/88 before treatment to 20/62. No patients lost vision. One-third of patients had no change in vision. Two-thirds of patients had some improvement in vision. About one-fourth of patients had a significant improvement in vision.

Mean change in foveal thickness was statistically insignificant. Mean reduction in foveal plus subfoveal thickness was significant (P < .02). No adverse events were reported.

Limitations of the study included its retrospective design, small patient sample and short follow-up duration.

Further study to gauge long-term outcomes is warranted, Dr. Witkin said.

• Disclosure: Dr. Witkin has no relevant financial disclosures.