Bevacizumab step therapy for wet AMD may be effective for majority of patients
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Patients treated with a step therapy protocol of bevacizumab injections for neovascular age-related macular degeneration experienced similar outcomes as those treated with FDA-approved therapies.
“Based on our findings, bevacizumab step therapy is an effective treatment protocol for exudative age-related macular degeneration, with a long-term treatment success rate of 70.8% of patients, which is comparable to reported success rates of the FDA-approved ranibizumab therapy,” Jonathan Siktberg, a medical student at Vanderbilt University School of Medicine, said at the virtual Association for Research in Vision and Ophthalmology meeting.
Siktberg and colleagues performed a retrospective cohort study on the efficacy of an Avastin (bevacizumab, Genentech) step therapy protocol in 626 patients with wet AMD treated from January 2012 to August 2018 at Vanderbilt Eye Institute. Patients underwent at least three consecutive monthly injections of bevacizumab.
Therapy success was defined as no recurrence of neovascular disease, no loss of three or more Snellen eye chart lines and not having to switch to an FDA-approved anti-VEGF agent. Outcomes were recorded at 3 months, 1 year and the final treatment visit.
At the final treatment visit, 70.8% of patients experienced treatment success, 41.7% of patients were stable on injections every 8 weeks or longer, and 7.7% failed bevacizumab and were switched to Eylea (aflibercept, Regeneron). Siktberg said 21.6% of patients failed bevacizumab but were not switched to aflibercept.
“This group surprised us, but as we read through the charts, we realized these were likely patients that did not have recurrent neovascular disease but developed atrophy that contributed to the decline of their vision,” he said.
At 3 months, overall treatment success was 92%. No patients at 3 months were switched to aflibercept, and 18.4% were stable on injections every 8 weeks or longer.
At 12 months, the overall treatment success rate was 83.7%, with 5.4% of patients requiring a switch to aflibercept.
At 3 months and 12 months, the study populations gained Snellen lines from their baseline vision, with mean gains of 1.06 and 1.15 lines, respectively. However, at the final treatment visit, patients experienced a mean 0.25 Snellen line loss from baseline.
“Although patients who failed bevacizumab lost more than three lines of vision, most did not have active neovascular disease, therefore they did not require a switch to an FDA-approved agent. This actually indicates that the cost savings of step therapy are likely greater than previously thought because not everyone who fails Avastin treatment needs to switch to an FDA-approved agent,” Siktberg said.
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Siktberg J, et al. Efficacy of Avastin step-therapy for age-related macular degeneration. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).
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