Single low-dose bevacizumab injection promising for treating type 1 ROP

Issue: May 10, 2016

VANCOUVER, British Columbia — A single low-dose injection of bevacizumab as primary intervention yielded a “good success rate” in treating type 1 retinopathy of prematurity, according to a study presented here.

Perspective from R.V. Paul Chan, MD

However, “a second bevacizumab injection has not been successful in our experience,” Terry S. Kang, MD, told colleagues at the American Association for Pediatric Ophthalmology and Strabismus meeting.

Terry S. Kang

The retrospective analysis conducted at Texas Children’s Hospital, Houston, included 49 eyes that underwent injection with 0.25 mg Avastin (bevacizumab, Genentech) 2.5 mm inferior to the inferior limbus.

Patients were followed up until discharged, either with apparent full retinal vascularization or demonstrated regression without areas that were concerning for future reactivation.

Forty-three eyes (87.8%) had no recurrence requiring re-treatment after one injection. Four eyes (8.2%) required subsequent retinal laser; of these, three had undergone a second injection with bevacizumab. Two eyes (4.1%) required subsequent pars plana vitrectomy; of these, one had undergone a second injection with bevacizumab.

“The kids who ended up failing primary low-dose bevacizumab injection with just one treatment tended to be sicker children. They tended to have lower birth weights, lower gestational age and tended to have more comorbidities, causing them to have significantly worse clinical course,” Kang said.

Average age at first bevacizumab injection was postmenstrual age 35.2 weeks; average time to failure was 6.8 weeks after injection.

“The purpose of us presenting this was to show that, even with a lower dose of 0.25 mg of bevacizumab, we had good results as far as 88% success with a single injection and a low rate of unfavorable structural outcomes — 4% of eyes ultimately requiring surgery,” Kang said.

Systemic side effects remain a concern with bevacizumab injection, Kang said, and further studies are needed to establish the lowest effective dose that will treat ROP and minimize side effects. – by Patricia Nale, ELS

Reference : Kang TS. Treatment of type 1 retinopathy of prematurity with 0.25 mg intravitreal bevacizumab. Paper 12 presented at: American Association for Pediatric Ophthalmology and Strabismus 42nd annual meeting; April 6-10, 2016; Vancouver, British Columbia.

Disclosure: Kang reports no relevant financial disclosures.

Perspective

R.V. Paul Chan, MD

This paper discusses using a smaller dose of Avastin (bevacizumab, Genentech) for type 1 ROP and the authors present their use of 0.25 mg vs. the more generally used dose of 0.625 mg, which is half the dose used in adults for retinal disease. The concept has merit and is being studied by other researchers as well with positive results. The relevance of using the lower dose is that there may be fewer potential adverse events, and the results look promising. Regardless, we are still left with many of the same questions that we have had for almost a decade: What are the indications for using an intravitreal anti-VEGF agent vs. laser? Is anti-VEGF therapy safe? What are the potential long-term adverse effects? How do we best follow children who have been treated with anti-VEGF therapy? Do we need additional imaging, such as a fluorescein angiogram, on every child after treatment with anti-VEGF in order to assess the retinal vasculature?

Using a smaller dosage may be good, but I think the proof will be in creating larger prospective studies designed to address the actual absolute appropriate maximum effective dose we should use. Many of us will be looking forward to seeing the results of the RAINBOW Study: Ranibizumab compared with laser therapy for the treatment of INfants BOrn prematurely With ROP.

Reference:

Harder BC, et al. Acta Ophthalmol. 2014;doi:10.1111/aos.12266.

R.V. Paul Chan, MD

OSN Pediatrics/Strabismus Board Member

Disclosures: Chan reports no relevant financial disclosures.