Safety questions remain for bevacizumab in treatment of ROP

FORT LAUDERDALE, Fla. — Anti-VEGF therapy is known to be helpful in the treatment of retinopathy of prematurity, but the use of bevacizumab may pose some safety risks for pediatric patients.

“There are fellow eye effects and distant effects that have been proven. There is biologic plausibility for systemic effects in the development of lungs and neural development,” Robert L. Avery, MD, said at the inaugural Retina World Congress.

Robert L. Avery

Anti-VEGF is effective in treating ROP, especially posterior disease, but the injections get into the bloodstream and reduce VEGF levels, more so with Avastin (bevacizumab, Genentech) than Lucentis (ranibizumab, Genentech). This may be due to pharmacokinetics because bevacizumab “lingers in the bloodstream for 3 weeks, whereas Lucentis clears in about 2 hours,” Avery said.

Additionally, in a 2016 study in Ophthalmic Research, patients experienced reduced cerebral blood flow after an injection of bevacizumab for ROP, Avery said.

“However, the studies to date are inconclusive. The only real way of proving if there is a safety effect is going to be with a clinical trial, a prospective study evaluating Avastin, Lucentis and laser in ROP,” he said. – by Robert Linnehan

Reference:

Avery RL. Are there safety concerns with bevacizumab for ROP? Presented at: Retina World Congress; Feb. 23-26, 2017; Fort Lauderdale, Fla.

Disclosure: Avery reports he is a consultant for Alcon, Alimera, Allergan, Bausch + Lomb, Genentech, Iridex, Novartis, Ocular Therapeutix, Regeneron, Replenish and Regenxbio; is an investigator with Allergan and Genentech; is a stockholder with Novartis, Ocular Therapeutix, Regeneron and Replenish; is a speaker with Iridex; and has intellectual property rights and receives royalties from Replenish.