Systemic anti-VEGF therapy may be a treatment option in certain patients

Br J Ophthalmol. 2009;93(7):914-919.

Systemic infusion of bevacizumab may be offered to some patients with wet age-related macular degeneration who refuse or cannot receive intravitreal injections, according to a study.

The strategy may be especially advantageous for patients with bilateral neovascularization; however, "due to its systemic side effects, expensive costs and comparable results with intravitreal injections, we suggest offering this systemic therapy to selected patients," the study authors wrote.

Patients were enrolled in the randomized, placebo-controlled, double-masked study, nicknamed the BEAT-AMD study, starting in August 2005. After questions about intravitreal anti-VEGF therapy were answered in the literature, which led to a rapid adoption

of the procedure as the preferred treatment modality, enrollment was stopped in January 2008.

At the end of the study, four patients received systemic Avastin (bevacizumab, Genentech) and four received an infusion of sodium chloride. Lesion size was reduced by 0.5 mm in patients in the bevacizumab group, and macular thickness was reduced by 103.6 µm after 24 weeks of follow-up. Overall, visual acuity remained stable in seven eyes and decreased in one.

"The OCT and the [fluoroscein angiography] showed that the macula turns dry and fibrotic under Avastin systemic treatment," the study authors said.