Bevacizumab an effective treat-and-extend regimen for AMD

A treat-and-extend regimen of intravitreal bevacizumab (Avastin, Genentech) produced “significant visual improvements” for eyes with neovascular age-related macular degeneration (AMD), according to an article published in the March issue of the American Journal of Ophthalmology.

Patients also had fewer office visits, ancillary tests, and intravitreal injections compared with a traditional pro re nata (PRN) approach, according to Gary Shienbaum, MD, and colleagues in the Retina Service at Wills Eye Institute of Thomas Jefferson University in Philadelphia, Pa.

“Our goal was to maintain an exudation-free macula while individualizing treatment, and thereby minimizing the total number of injections, office visits, and ancillary tests,” the authors stated. “Overall, patients experienced significant visual acuity improvements on par with the phase 3 ranibizumab studies but with fewer encounters, fewer treatments, and lower costs.”

The researchers identified patients diagnosed with neovascular AMD from 2006 through 2009 for their retrospective, interventional, consecutive case series. They included 74 eyes of 73 patients with treatment-naïve subfoveal choroidal neovascularization secondary to neovascular AMD, managed with a treat-and-extend regimen of intravitreal bevacizumab injections monthly. 

The mean follow-up period was 1.41 years until no signs of macular hemorrhage were observed on slit-lamp biomicroscopic examination and no intraretinal or subretinal fluid was observed on optical coherence tomography (OCT).

Mean Snellen visual acuity improved significantly from 20/230 at baseline to 20/109 at 12 months (P<.001) and 20/106 at 24 months (P<.001). Mean OCT central retinal thickness decreased from 316 to 239 μm at 1 year of follow-up  (P<.001). The mean number of injections during the first year was 7.94 and 5.60 between years 1 and 2.

In addition, the authors directly compared the medical costs of patients treated with intravitreal bevacizumab using a treat-and-extend regimen with those treated with intravitreal ranibizumab (Lucentis, Genentech) using a treat-and-extend regimen.

They found that the mean direct medical cost per patient treated with intravitreal bevacizumab during the first year was almost $3,500 compared with more than $16,000 for those treated with ranibizumab. And the mean direct medical costs per patient treated with intravitreal bevacizumab between years 1 and 2 was more than $1,800 compared with almost $14,000 for those treated with ranibizumab.

Although the authors state that the limitations of their study mean they cannot compare the effectiveness between bevacizumab and ranibizumab as a treatment regimen, they note that the study “demonstrates the favorable visual outcomes achieved using bevacizumab in a treat-and-extend regimen and highlights the need for future prospective, randomized controlled studies evaluating the efficacy of a treat-and-extend regimen versus monthly injections and traditional PRN regimens.”