Higher-dose anti-VEGF may cause more adverse events in CNV due to AMD

Retina. 2009;29(3):319-324.

A higher dose of an off-label anti-VEGF agent was similarly effective as a lower dose in treating choroidal neovascularization associated with age-related macular degeneration, but showed a higher incidence of adverse events.

The prospective, randomized clinical trial included 86 patients. Baseline best corrected visual acuity ranged from 20/40 to 20/2000. Thirty-nine patients received 2.5 mg intravitreal injections of Avastin (bevacizumab, Genentech); 47 patients received 1.25 mg injections.

BCVA measurement and clinical ocular examination were performed 1 week after injection, 1 month and then once a month for 5 months. Assessments with fluorescein angiography and optical coherence tomography were undertaken 1 month and 3 months after each injection.

At 3 months, study data showed a mean change in BCVA of –0.06 logMAR in the 1.25 mg group and –0.07 logMAR in the 2.5 mg group. At 5 months, the mean change in BCVA was –0.06 logMAR in the 1.25 mg group and –0.09 logMAR in the 2.5 mg group. Visual acuity differences between the groups were not statistically significant at any follow-up intervals.

The mean change in foveal thickness was –49 µm in the 1.25 mg group and –65 µm in the 2.5 mg group. Three incidents of vitreous reaction and one massive subretinal hemorrhage occurred in the 2.5 mg group, the authors said.