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Issues with safety of anti-VEGF agents in infants with ROP call for further investigation
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VIENNA — Increasing evidence supports the efficacy of anti-VEGF agents in the treatment of retinopathies, but safety concerns remain with their use in infants, requiring further investigation, according to a specialist speaking at the Advanced Retinal Therapy meeting.
Focusing on retinopathy of prematurity, Mary Elizabeth Hartnett, MD, said that multiple case series and small trials as well as the BEAT-ROP study found efficacy in reducing intravitreal neovascularization and facilitating physiologic retinal vascular development in some cases.
“However, serum VEGF is reduced for 2 months after injections, a time that may be crucial for the development of kidneys, brain and lungs. VEGF is also a survival factor for photoreceptors and Müller cells,” she said.
“On the bright side, there is less myopia after anti-VEGF than laser, but we need more studies,” she said.
Two more clinical trials are ongoing: the Novartis RAINBOW study comparing Lucentis (ranibizumab, Genentech/Novartis) and laser and a study by the Pediatric Eye Disease Investigator Group looking at dosage.
“The ratio between eye and blood volume is greater in infants than adults, so the concentration of the drug that gets into the infants’ circulation is higher and may cause more problems. The [Pediatric Eye Disease Investigator Group] is looking at the lowest dose of bevacizumab (Avastin, Genentech/Roche) that may be used to safely inhibit VEGF,” she said. – by Michela Cimberle
Disclosure: Hartnett reports no relevant financial disclosures.