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NSAID use may reduce frequency of anti-VEGF injections in some eyes
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Adjunctive use of topical bromfenac may result in fewer intravitreal injections of ranibizumab over 6 months for patients with small wet age-related macular degeneration lesions, according to a study.
“Our preliminary study suggested that bromfenac might decrease one injection of ranibizumab over 6 months of treatment,” the study authors said. “Although this difference may not be significant for each patient, considering the increasing number of newly diagnosed patients, it seems to be meaningful to reduce the total medical cost.”
The institutional, double-masked, placebo-controlled randomized study analyzed 38 patients with wet AMD with lesions smaller than 2 disc diameters. Sixteen patients received adjunctive topical Xibrom (bromfenac, Ista Pharmaceuticals) and a 0.5-mg Lucentis (ranibizumab, Genentech) injection, and 22 patients received sham and a ranibizumab injection.
Subjects were examined monthly for 6 months with additional ranibizumab injections given as needed.
After 6 months, the mean number of ranibizumab injections was 3.2 in the sham group and 2.2 in the bromfenac group (P = .0274). Changes in visual acuity and central retinal thickness were not statistically significant.
There were no adverse events related to the use of topical bromfenac, but the authors said potential complications associated with prolonged topical use of NSAIDs should be monitored. They called for a larger study comparing the adjunctive effects of other NSAIDs.
Perspective
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Carl D. Regillo, MD, FACS, MD, FACS
It is well recognized that good outcomes for treating neovascular AMD require frequent anti-VEGF treatment and follow-up. The CATT PRN arm showed that seven to eight injections of either ranibizumab or bevacizumab are needed for visual results comparable to monthly injections for new-onset neovascular AMD in the first year. The VIEW studies showed comparable visual outcomes with eight aflibercept injections. A safe and convenient treatment that can reduce the burden of anti-VEGF injections would represent a significant advance. Although the study by Gomi and colleagues is small and limited in follow-up, it suggests that the use of a topical nonsteroidal anti-inflammatory agent may be effective in reducing the number of anti-VEGF injections with ranibizumab without compromising functional or anatomical results. Extrapolating the 6-month primary endpoint results out to 12 months, this regimen may result in an average of two fewer ranibizumab injections (6.4 to 4.4.) This change would be clinically meaningful and, therefore, based on the results of this pilot study, a larger-scale comparative trial should be considered.
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