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Two year outcome of 6 weekly bevacizumab versus 4 weekly ranibizumab as required treatment for neovascular age-related macular degeneration

Session Details

Session Title: AMD I

Session Date/Time: Thursday 17/09/2015 | 08:30-10:30

Paper Time: 09:58

Venue: Athena

First Author: : V.Ho UNITED KINGDOM

Co Author(s): :    P. Chiam   N. Hickley   V. Kotamarthi        

Abstract Details

PURPOSE:To compare the visual acuity and central macular thickness (CMT) changes in patients with neovascular age-related macular degeneration treated with either a 6-weekly bevacizumab or 4-weekly ranibizumab on an as required (PRN) basis over a 24-month period.

Setting:

Eye Care Centre, Leighton Hospital, Crewe, United Kingdom.

Methods:

Retrospective case note review of 102 consecutive patients treated with 6-weekly bevacizumab and 101 consecutive patients treated with 4-weekly ranibizumab between August 2008 and October 2010. Patients made an informed choice on the first visit choosing between bevacizumab 1.25mg or ranibizumab 0.5mg. Patients were treatment naïve. They all received 3-loading dose of intravitreal injections followed by as-required-basis treatment. Patients in the bevacizumab group were followed-up on a 6-weekly interval and those in ranibizumab group a 4-weekly interval. Retreatment criteria were based on the reduction of more than 5 letters in the best corrected visual acuity (BCVA), the presence of retinal fluid on OCT scans or new retinal haemorrhage.

Results:

At 1-year, the mean letter gained was 7.6 with bevacizumab and 10.7 with ranibizumab, a difference of 3.1 letters (p= 0.10, 95% CI -6.8 to 0.6). At 2-year, the mean letter gained was 7.0 with bevacizumab and 9.2 with ranibizumab (p=0.31, 95% CI -6.4 to 2.0). Ninety percent of bevacizumab patients and 98% ranibizumab patients had not lost 15 letters or more (p=0.054) at 1-year. These values were 88% bevacizumab and 94% ranibizumab (p=0.13) at 2-year. Both treatment groups had reduction of CMT compared to baseline in 1- and 2-year. At 1-year, there was a mean reduction of 139 µm in bevacizumzb and 150 µm in ranibizumab (p=0.85). At 2-year, these were 146 µm and 160 µm respectively (p=0.72). The mean number of injections in 1-year was 6.6 for bevacizumab, 5.9 for ranibizumab (p=< 0.001); at 2-year, these were 11.9 and 10.3 respectively (p=0.023).

Conclusions:

Bevacizumab 6-weekly PRN was not demonstrably non-inferior to ranibizumab 4-weekly PRN. In the bevacizumab group, there were fewer visual acuity letters gained and one more injection was required per year compared to the ranibizumab group.

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