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As-needed anti-VEGF regimen shown to be effective for the treatment of wet AMD
A meta-analysis of independent studies comparing ranibizumab and bevacizumab carried out at the University of Lyon showed comparable efficacy and a higher incidence of severe systemic effects with bevacizumab only due to the weight of the CATT study.
“In the other studies, no statistically significant difference was found,” Laurent Kodjikian, MD, said at the meeting of the French Society of Ophthalmology.
Selected studies were the CATT (United States), the IVAN (Great Britain), the GEFAL (France), the MANTA (Austria), the BRAMD (Netherlands) and the LUCAS (Norway), totaling 2,060 patients.
Although a gain of two to three more letters was reported with monthly administration of Lucentis (ranibizumab, Genentech/Novartis) or Avastin (bevacizumab, Genentech/Roche), the as-needed regimen (PRN) showed good results in all studies, with an average of seven injections per year. Inject-and-extend was used for the first time in the LUCAS study, with an average of eight to nine injections per year.
“The worst results over time were found in patients who switched from monthly to PRN, which leads to the conclusion that once a monthly schedule has been started, better not change,” Kodjikian said.
In the meta-analysis, monthly treatment was shown to be associated with a higher rate of geographic atrophy.
Post-hoc analysis of the GEFAL study is under way to evaluate predictive factors for poor response to therapy.
“Preliminary results show that predictive factors are baseline visual acuity less than 37 letters, presence of cystoid macular edema, predominantly classic [choroidal neovascularization] and decision not to treat in spite of re-treatment criteria being present,” Kodjikian said.