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Safety, efficacy balance needed for ROP treated with bevacizumab
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WAILEA, Hawaii — A balance between safety and efficacy is needed when deciding whether to treat retinopathy of prematurity with bevacizumab or diode laser photocoagulation in premature newborns, a speaker here said.
Bevacizumab is a powerful suppressive agent given during a time when a lot of organ systems are developing, peaking in the systemic circulation around 2 weeks and lasting to about 8 weeks in systemic circulation, Darius M. Moshfeghi, MD, said at Retina 2018. Furthermore, neurodevelopmental abnormalities have been noted in small sick babies receiving bevacizumab in some studies.
“If you look at all the original papers that came out on the use of bevacizumab for retinopathy of prematurity, they all positioned it as a ‘one-and-done, fire-and-forget’ type of treatment,” Moshfeghi said.
However, there is “a lot of untreated retina” remaining in those patients, and those patients need to be followed up long term, Moshfeghi said.
Moshfeghi and colleagues conducted a retrospective case-control study looking at safety of intravitreous bevacizumab 0.625 mg vs. diode laser photocoagulation in premature newborns with type 1 ROP.
The researchers found bevacizumab slowed progression until definitive treatment 4 to 5 months later, it was associated with fewer diagnoses at discharge than diode laser, it was associated with significantly fewer readmissions than diode laser, and there was no difference in neurodevelopment outcomes.
Moshfeghi recommended honest discussion with the family about risk and benefits of treatments and further investigations into neurodevelopmental concerns.
“You really have to have a very honest discussion with the family before using it,” Moshfeghi said. – by Patricia Nale, ELS
Reference:
Moshfeghi DM. Retinopathy of prematurity: Role, safety and follow-up using bevacizumab. Presented at: Retina 2018; Jan. 14-19, 2018; Wailea, Hawaii.
Disclosure: Moshfeghi reports financial relationships with 1-800 Contacts, Alcon, Allergan, dSentz, Iconic Therapeutics, InSitu Therapeutics, Krypton Vision, OCT Advanced Technologies, Promisight, Versl and Visunex Medical Systems.