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Ranibizumab, bevacizumab have similar effects on visual acuity at 2 years
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Similar use of ranibizumab and bevacizumab resulted in similar visual acuity outcomes over a 2-year period, with regular monthly dosing of each drug offering superior results compared with as-needed treatment, according to the latest results of the Comparison of Age-related Macular Degeneration Treatment Trials.
There were 1,107 patients with neovascular AMD who were followed as part of the multicenter, randomized CATT over 2 years.
Patients initially were assigned to either Lucentis (ranibizumab, Genentech) or Avastin (bevacizumab, Genentech) and to either as-needed or monthly dosing. At 1 year, monthly dosage patients remained with the same drug but were randomly assigned to either monthly or as-needed treatment.
Dosage per intravitreal injection was 0.5 mg ranibizumab in 0.05 mL solution or 1.25 mg bevacizumab in 0.05 mL solution. Monthly dosage was every 4 weeks; as-needed patients were evaluated every 4 weeks and treated when fluid was present on optical coherence tomography or when there was evidence of hemorrhage, decreased visual acuity or dye leakage on fluorescein angiography.
“At both 1 and 2 years, bevacizumab and ranibizumab had similar effects on visual acuity when the dosing regimen was the same,” the study authors wrote. “There was little difference in any visual metric evaluated, including mean gain in visual acuity.”
As-needed dosing of either drug resulted in 2.4 letters less mean gain than monthly dosing (P = .046) at 2 years. Switching from monthly to as-needed dosing after 1 year resulted in a mean decrease of 2.2 letters, producing results similar to as-needed dosing for the 2-year period.
Questions remain regarding the potential for serious adverse events from bevacizumab.
“Results from ongoing randomized clinical trials worldwide may provide additional, independent information about the risk of treatment with bevacizumab relative to ranibizumab,” the study authors wrote.
“The choice of drug and dosing regimen for patients must balance the comparable effects on vision, the possibility of true differences in adverse events, and the 40-fold difference in cost per dose between ranibizumab and bevacizumab,” they said.
See OSN's coverage of the 1-year CATT results.
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Ophthalmology. 2012;doi:10.1016/j.ophtha.2012.03.053.
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