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Initial intravenous Avastin course sufficient in some AMD patients
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MONTREAL — Patients may not need additional treatments after an initial course of intravenous bevacizumab for the treatment of subfoveal choroidal neovascularization in age-related macular degeneration, according to a speaker here.
Andrew A. Moshfeghi, MD, reported the 6-month efficacy results of 18 patients treated with systemic Avastin (bevacizumab, Genentech), a humanized monoclonal antibody with anti-VEGF binding characteristics. Patients were included in the study if they had subfoveal choroidal neovascularization and a baseline visual acuity of 20/40 to 20/400. All patients were treated with an initial course of two or three infusions of Avastin (5 mg/kg) at 2-week intervals. Follow-up visits were every week for the first 6 weeks, every 2 weeks for the following 6 weeks, and every 4 weeks after that. Initial treatment was stopped after the second or third infusion, Dr. Moshfeghi said.
“Patients were re-treated if there was a loss of five letters observed, and this we would associate with leakage, or if there were an increase in central retinal thickness of at least 100 µm from one visit to the next. It should be noted that only one dose was given at the time of re-treatment,” he said.
At the 6-month follow-up point, 12 of the 18 patients did not require re-treatment. Of the six who were re-treated, four received intravenous Avastin, one was treated with intravitreal Avastin and one was given Macugen (pegaptanib sodium for injection, Pfizer/Eyetech). Patients have now been followed for at least 6 months.
“The patients who were re-treated did have restoration of their initial improvements, and one re-treatment appeared to improve outcomes for 12 to 17 weeks. We also noted the improvement after intravitreal Avastin. The durability of this approach is unknown,” Dr. Moshfeghi said.
Dr. Moshfeghi presented the results here at the American Society of Retina Specialists meeting. Avastin is currently marketed in the United States for the treatment of metastasized colorectal cancer.
Philip J. Rosenfeld, MD, reported the 3-month safety results from the same trial of Avastin earlier this year at the meeting of the Association for Research in Vision and Ophthalmology.