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Differences in 1-year anatomical outcomes for CATT categorized as subtle
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 Glenn J. Jaffe |
BOSTON — Differences in decreased retinal fluid shown for ranibizumab and bevacizumab in the Comparison of Age-Related Macular Degeneration Treatments Trials may be relatively minimal, a speaker here said.
According to Glenn J. Jaffe, MD, who spoke at the American Society of Retina Specialists meeting, differences in reduced retinal fluid demonstrated by the prospective, multicenter, randomized CATT were subtle. The study evaluated 1,208 patients, assessing treatment of age-related macular degeneration using monthly and as-needed dosing of Lucentis (ranibizumab, Genentech) and Avastin (bevacizumab, Genentech).
"Both of these drugs produce an immediate decrease in fluid. Neither of the drugs eliminated fluid in the majority of eyes, but when we are talking about residual fluid, we are talking about small amounts, on average. It was the exception that patients had lots of residual fluid," Dr. Jaffe, an OSN Retina/Vitreous Board Member, said.
More eyes that underwent ranibizumab monthly dosing were completely dry, but more of these eyes also experienced thinner-than-normal central retinal thickness, comparatively speaking, he said. Eyes that underwent as-needed treatment had more leakage.
"We saw discrepancies, but I think it is really important to recognize that those discrepancies were small," Dr. Jaffe said, encouraging colleagues to stay tuned for the 2-year results.
- Disclosure: Dr. Jaffe has no relevant financial disclosures.
While Dr. Jaffe’s comments at the American Society of Retina Specialists meeting were cautious, they failed to emphasize several important points that he has appropriately stated at other times. First of all, the optical coherence tomography findings were based on old technology — low-resolution time-domain OCT. Two-year results will be based on much higher resolution spectral-domain OCT that is likely to show more subretinal fluid. Secondly, in terms of percentages, the differences between ranibizumab and bevacizumab were large. Moreover, some patients treated with bevacizumab had substantial amounts of subretinal fluid. As I have stated in previous commentary, subretinal fluid has not been shown to be beneficial. This debate raises the question of whether we, as surgeons, are dedicated to offering patients the best available therapy or simply providing them with treatment that is “good enough.”
– Steve Charles, MD, FACS, FICS
Clinical
professor of ophthalmology, University of Tennessee
Disclosure: While Dr.
Charles has never been a consultant for Genentech or Regeneron, he participated
briefly in a Genentech DME study and a Regeneron AMD trial.