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Repeated bevacizumab injections similarly effective to initial treatment, study finds

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Patients repeatedly treated with bevacizumab for choroidal neovascularization experienced improvements in vision similar to patients who received their first treatment with the drug, a retrospective study found.

Mitchell J. Goff, MD, and colleagues at Alta Bates Summit Medical Center in Berkeley, Calif., investigated whether there was a difference in treatment effect between initial and repeated intravitreal injections of Avastin (bevacizumab, Genentech). The study included 54 eyes of 51 patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration who had a visual acuity of at least 20/320.

Of the 51 patients, 70% had previously been treated for CNV. Surgeons performed 178 injections overall, with an average of 3.3 injections per eye. In 20% of cases, surgeons also performed Visudyne (verteporfin, Novartis/QLT) photodynamic therapy at the time of the initial intravitreal bevacizumab injection.

Follow-up averaged 138 days, and 91% of patients were followed for at least 90 days post-injection, according to the study.

The researchers found that central macular thickness, measured using optical coherence tomography (OCT), significantly decreased after treatment. Central macular thickness averaged 362 µm at baseline and decreased to 278 µm at 1 week follow-up and to 235 µm at 1 month.

Mean central macular thickness increased slightly to 238 µm at 3 months follow-up but remained significantly lower compared with baseline and averaged 244 µm at final follow-up, according to the study.

Mean visual acuity significantly improved from 20/125 at baseline to 20/100 at final follow-up. No differences in either OCT findings or visual acuity were noted between repeatedly treated patients and patients treated for the first time, the authors noted.

In addition, "There was no difference in OCT or visual acuity outcomes between patients who received combination therapy and those who received monotherapy with intravitreal bevacizumab," they said.

"This series suggests that previously treated and treatment-naive patients have similar outcomes," the authors said.

The study is published in the April/May issue of Retina.